The Lowest Cost for the Highest Return

It happens every day in a busy medical practice - the things that need doing often get done by whomever can do it at the time. But that can be a costly mistake.

It happens every day in a busy medical practice - the things that need doing often get done by whomever can do it at the time. But that can be a costly mistake, as you might inadvertently have your most highly compensated staff members attending to some of the lowest level tasks.

For example, my company recently assessed a client's vaccine management program. After financial losses had been identified, the practice had taken several measures to ensure that every vaccine was tracked and billed appropriately. With profit margins being very thin on such inventory, only one missed vaccine may be enough to wipe out a single day's profits. The group's nursing supervisor had been tasked with putting together the tracking program, and the process included performing inventory counts at the end of each day - which were then compared to charge entry reports to ensure that everything was billed correctly.

The problem? The nursing supervisor was the one spending an hour each day performing the counts. Considering that the practice also employed medical assistants who were paid far less than the supervisor, we recognized immediately that the most expensive resource was being used to perform a lower-level task - one that lesser-paid employees could be trained to do instead.

However, the benefit realized was not simply freeing up the nursing supervisor's time for more high-level functions. There is a domino effect created when resources are redeployed to different tasks. By focusing her time at the end of the day on returning patient phone calls, it not only improved work flow and patient service, but also freed up physician time by releasing them from phone duty. This allowed the physicians to see more patients at the end of the day and get out of the office in a timely manner. So not only were savings gained by having the medical assistant take over the inventory counts, but new revenue was created by releasing physicians from returning phone calls and putting them back in the exam room instead.

Where else can you realize savings in your practice? Start with your office manager: How does she spend her time?

At one office, we discovered that charges were not being posted to the practice management system in a timely fashion because the office manager was the only one allowed to post them. Most days she was so busy that she could only input a fraction of the volume of charges being generated. So these superbills were stacking up and cash flow was suffering. Every two weeks she would come in on the weekend and attempt to get caught up. For this she was paid extra. Because coding mistakes had been made in the past when charges were entered, the practice felt that the office manager should be responsible for ensuring that these charges were posted error-free. With three staff members on the billing team, there was no shortage of helping hands to get the work done; we just needed to remove that task from the office manager's to-do list.

But how could we also satisfy the group's desire to have quality control at the front end of the process? We simply took the hour a day that the office manager was spending inputting charges, and instead had her spend that time spot-checking posted charges for accuracy. Within a matter of weeks, charges were cleaned up, cash flow greatly improved, and posting inaccuracies became few and far between, giving even more time back to the office manager.

In your own practice, take a look at tasks that are being performed by your most expensive resources. Have each staff member list the daily tasks they work on. Can any of those tasks be carried out by other lesser-paid employees or maybe outsourced altogether? One example would be to use an automated system to send out appointment reminders rather than having your receptionists spend an hour on the phone each day making those calls. Or perhaps your physicians are handling administrative tasks that a nurse, medical secretary, or bookkeeper could be trained to do instead? By creating a list of tasks being performed throughout your practice, you can assign the best resource - the most effective, for the least cost - to carry out each job. You may be surprised at just how much you save and how much more productive your practice can be with just a few simple tweaks.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at or by visiting