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Don't Mistake Activity for Productivity at Your Practice


Some practice administrators and physicians are under the belief they can get by with fewer back-office staffers. This may not be the case.

My partners and I have worked with practices that were very proud to have minimized back-office staff - noting that they've discovered they can "get by easily" with fewer [medical assistants]. But how, exactly, are they getting by? And are they really getting by?

Consider this hypothetical example - based on experiences we've had with real clients.

A practice employs an MA floater, who works alongside a team of MAs who each directly support one of five physicians. The floater covers absences, ensures all rooms are cleaned and identically stocked, pitches in to relieve bottlenecks during rushes, and monitors patient flow from front to back, to be sure no one's missed or left waiting too long.

The practice's diligent administrator is highly motivated to improve practice efficiency. It's not just her natural inclination: she's been promised a bonus for cutting waste. She looks at the floater's tasks and decides they can be absorbed by others. She also notices that everyone has at least a few minutes each hour when they don't appear busy.

 "Everyone has slack time during the day, and that's wasteful," she reasons. "If we eliminate the floater, that's $35,000 or so right to the bottom line. The front desk can watch for patients who've been waiting too long. We'll make sure the other MAs know how to stock and clean their rooms properly. We just need to get everyone working more productively."

So say the practice eliminates the job and things seem to have sorted themselves out fine, at least at first. Or have they?

The receptionists had plenty of work to do before they were asked to "just keep an eye out" for patients who'd been waiting too long - and they know their primary tasks are more important. The daily metrics they're measured on tell them what matters most: copay collection, emails captured, insurance cards scanned. So sure, they'll keep an eye out - when they have nothing more pressing to do.

Even when they notice a patient waiting too long, the receptionists may not be able to address the problem. They can't see what's causing a delay in back from their desks in the front. They can ask the physician's MA for help - but if the doctor is backed up, the MA likely is too (especially now that the MAs no longer have the floater's help).

So what used to be a primary responsibility for the floating MA becomes an if-you-have-time responsibility for the front desk. Patients waiting too long are less likely to be spotted, and even if someone notices, they won't be able to help. Extra delays and less attention don't impact every patient, but the number having this unpleasant experience increases.

Back-office work flow takes a hit, too. With their MAs busier, the doctors now occasionally have to step out of the exam room for missing supplies. Sometimes they get behind because no room is ready or because no one was available to escort their patient. They may eventually even get into the habit of fetching their patients themselves sometimes, to avoid falling further behind. And then when everyone's slightly increased workload puts the entire clinic behind, perhaps they even find themselves hoping for a no-show or two to catch up.

These little problems are easy to overlook in the short run. In fact, they may even look like success: If everyone is busier, doesn't that mean they're better utilized?

But, gradually, less attentive service means some patients will be disappointed. And that leads to fewer referrals, more complaints, even attrition - and that means higher marketing costs.

Less support in the back office also lowers the ceiling on physician productivity. Productivity losses that are too small to notice day-to-day eventually become measurable, just more slowly than the immediate "savings" from cutting staff. Just one fewer visit per day for the entire clinic could almost negate the $35,000 saved by cutting an MA - and the reduction in throughput could easily end up being much greater than that.

The practice likely incurs more overtime costs, too. Even just a little more overtime here, a little more there can quickly offset much of the savings from the lost headcount.

And what if the MA floater had not been let go? Instead of focusing on cutting costs, the administrator could have tried to increase weekly visits to improve profitability. This would have required more analysis and creativity, but could potentially have yielded much more than $35,000 in new annual revenue.

A little slack prevents bigger problems

Mistaking activity for productivity can do great damage to patient flow, patient service, and profitability.

This idea can be very counterintuitive when you look out of your office door and see staff with idle time. If you're a motivated, energetic person, it can be hard not to see any staff downtime as a cost. But zero slack is an unrealistic goal. What's more, striving for it can actually be more costly to your practice than a little bit of downtime.

When everyone is running at full speed 100 percent of the time, some tasks are probably not getting done - or are not being done well. And there is no room to stretch, so when an unexpected need or sudden surge of demand occurs, it can lead to more errors and unnecessary stress.

Even practices that excel at analyzing their scheduling and peak load times will find there are still events that cause unpredictable waves - a particularly bad flu season, a drug recall that prompts nervous calls, emergencies that pull a doctor away from the clinic, etc. A network or software outage can cause a sudden temporary increase in everyone's workload. And, of course, there are smaller, daily variations, like visits that just take longer than expected, or an employee illness or emergency.

Having enough staff to accommodate these situations, without sacrificing patient service or other trade-offs, helps insure your practice against patient attrition. With enough staff to stretch, you'll handle surges without increased errors, incomplete tasks, or turning patients away. And surges are revenue opportunities, too. Being able to handle them in stride brings more money through the door.

Excerpted with permission from Laurie Morgan's new book,  "People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business." It has been edited for formatting and style.

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