How Improving a Practice’s ‘People Flow’ Can Improve Cash Flow

In the old days of medical practice, being concerned about actual processes of the office was of no importance. Many physicians didn’t mind being paid with chickens or produce. Many offices had two rooms and one assistant or nurse, and doctors often went to peoples’ homes. 

From that point, doctors grew their office space organically. They would add on exam rooms, enlarge their waiting rooms, and add staff. Then the age of health insurance controlling reimbursement levels happened. Now doctors had to add more exam rooms, more staff to meet billing needs, and obviously more patients in order to keep their heads above water.

Once the insurance companies and CMS got comfortable, it seems; they came up with pre-certifications, pre-authorizations, sending bills to the insurance carrier and/or Medicare instead of sending bills to the patients, electronic submission of all claims, credentialing with all carriers, etc., etc., ad nauseum. Now, with technology requirements by the government, helpful technology for patient care, and technology for just running a practice efficiently, life has dramatically changed for the medical office. No longer can a practice grow organically. The growth must be planned and planned very carefully.

Many practices have been doing things the same way for decades and aren’t able to get full “buy-in” from the physicians, much less the staff, to change their processes. Some offices need to take the changes incrementally versus a full-scale change as human beings don’t seem to handle total changes well. So, little changes that move you towards a goal are much more palatable. The following is the first suggestion for the incremental approach.

Many offices need to look at the actual flow of people. It helps to actually take out a floor plan and mark in all the movements of the patients as well as the staff. Many patients would appreciate fewer steps to make when visiting the doctor. For example, the patient first must see the front desk to check in and verify their insurance information and other information. Then the patient sits in the waiting room. When a room becomes available (and the chart is found) a nurse comes out, calls the patient, and they go to the exam room. There could be a stop for the patient being weighed, height checked, etc. The patient is examined by the physician, then an EKG or some other procedure is ordered, and the patient may need to go to another room for that. The process goes on. When the patient is through being seen by the medical provider, he/she passes the front desk again to set up any future appointments or referrals and possibly stops in to see the financial counselor.

With all these steps you need to also look at all the support staff steps in addition to the physician’s steps. Where are people backtracking, looking for things that can’t be found easily and answering phones, talking to patients in front of other patients? Where are patients able to see what is on the computer screen with the possibility of HIPAA and privacy law violations occurring? Is the front desk staff trained on handling copay collections, current information collection, past due balance collection and HIPAA?

Many practices have saved a lot of money once they have streamlined “people flow.” They don’t need as much office space, so they can either reduce their rent or they can repurpose some rooms to do things that can bring more revenue into the practice. We have seen where they have not needed as many people as they thought they needed due to the disorganization they had and/or they could repurpose their staff members to take care of processes that had been left to chance that actually add to the bottom line.

Most importantly, if the “people flow” is smooth, the patients and the staff are less stressed. The patients have a much better experience, the staff is not frazzled, and the office presents a more patient centric appearance. This one attribute of a practice helps to ensure returning patients and as a result continuing cash flow.

Therefore, some immediate steps that should be taken are:
1. Make the map of traffic flow;
2. Have the business people and rooms located away from regular traffic (for privacy as well as efficiency);
3. Ensure that the fewest possible steps are taken during one visit;
4. Have portable equipment to take to patients rather than. taking the patients to the equipment when possible; and
5. Make sure that all staff members are trained in customer service, collections and HIPAA.

After that basic change is made and everyone is used to it, then you can concentrate on the next changes that need to be made in order to save, as well as make, more money for the practice.

Sue A. Irwin, MCS-P, is the president of NCEB – Practice Management Solutions which has been helping medical practices ‘sail through’ transitions since 1992. She has been in the health insurance reimbursement and practice management world since the “golden days” of 100 percent insurance reimbursement.

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