Runners-up: Practice of the Year

November 15, 2006

Three of our competition's runners-up deserve a tip of the hat. We tell you why.

EMPIRICALLY SPEAKING: GEORGIA CANCER SPECIALISTS LISTENS TO STAFF AND PATIENTS. AND IT'S WORKING.

Atlanta has a big academic medical center and hundreds of oncology practices, all with similar names. So how does an individual practice differentiate itself?

The 35 physicians of Georgia Cancer Specialists decided to embark on a branding initiative. They chose "The Cancer Answer" as a tagline, and for them, it's much more than a motto. It underscores how they run the practice. According to Wendy Hawke, the practice's chief operating officer, "The messaging keeps us focused."

Investing in employees

Each staff member who joins Georgia Cancer Specialists receives a CD the practice created to teach new employees what it means to strive to be "The Cancer Answer." "It immediately gives one the feel of an innovative practice on the move," says Hawke. The CD is part of a standardized new-employee orientation program the practice offers every six weeks. Staff members also enjoy a wide variety of perks and programs, including the opportunity to join a 401(k) profit-sharing plan, the chance to register to vote on-site, and the option to join wellness programs. Georgia Cancer Specialists also trains staff in customer service, communication skills, and conflict management. By taking care of its employees, the practice aims to enable them to provide the best care for their patients, says Hawke. Of course, generous and thoughtful HR policies cannot prevent gossip and the occasional bad day. "We are people," says Hawke, "but I think we do provide an atmosphere where staff can say, 'I don't want to talk about that right now. Our patients have bigger problems.'"

The reward for all this effort? Staff turnover has dropped 50 percent.

Listening to patient feedback

Georgia Cancer Specialists also wanted to reduce patients' wait times. Patients with cancer already spend a lot of time managing their disease and dealing with the exhaustion that results from rigorous treatment therapies.

In its first time-motion study, staff members completed charts that noted how long it took patients to check in, get lab work completed, be set up in an exam room, etc. "Perhaps not surprisingly, it appeared our patients barely waited," says Hawke. "However, our reception areas and filled exam rooms seemed to indicate otherwise."

The practice then conducted another study, this time giving their patients forms, a watch, and a coupon for a fresh-baked cookie when they completed the survey. This time, the practice identified some common problems. For one thing, staff members were scanning patient insurance cards at check-in, which created five-minute delays as they waited for a free machine. To solve that problem, Hawke purchased individual insurance-card scanners, dropping that part of the intake process to 30 seconds. Overall, patient wait times dropped 20 percent thanks to simple interventions like that.

The patient surveys also revealed that those who needed simple injections or blood work were sometimes waiting much longer than necessary. Because such patients were scheduled at the same times as patients who needed chemotherapy or a physician visit, they were obliged to wait for staff to process more time-intensive appointments before being seen. Now, patients who visit the office for quick, single interventions are scheduled during low-volume times. Wait times for these patients have subsequently dropped 75 percent.

Ancillaries that enhance patient care and the bottom line

Georgia Cancer Specialists has also added new services to provide more comprehensive patient care. It now employs social workers and nutritionists to address the many needs of patients with cancer. The practice's four CT scanners perform approximately 800 scans a month, a PET/CT scan performs an additional 150 images a month, and new mobile echocardiograph units test for heart damage. The practice projects that its new equipment will generate added annual revenues of more than $4.6 million.

The practice has also established its own retail pharmacy. Georgia Cancer Specialists currently fills 60 prescriptions per day. The program enables better patient convenience and compliance and nets the practice an additional $10,000 per week.

At a time when many oncology practices are fighting to stay afloat, Georgia Cancer Specialists is swimming boldly upstream.

HERSPACE, HER WAY: A SOLO RADIOLOGIST FLOURISHES BY PROVIDING PERSONALIZED CARE TO SELF-PAY PATIENTS.

It's tough to imagine a medical practice that inspires a Girls' Day Out - particularly when that outing involves a potentially unpleasant screening procedure - but HerSpace Breast Imaging in West Long Branch, N.J., does just that. "For years, I've gotten together with 12 of my girlfriends. We all go together for our mammograms to Dr. Deutch because we only want the best for each other," reads a patient testimonial on the practice's Web site.

Radiology is an unusual specialty for a solo practitioner, but that's not all that stood out about HerSpace in the eyes of our Practice of the Year judges. Its "patient-first" philosophy, its business structure that rejects third-party payers (except Medicare, an arrangement the practice views as a service to its older patients), and its spa-like allure that helps patients feel pampered as well as cared for impressed our judges enough to secure HerSpace a ranking in our annual contest.

Radiologist Beth Deutch struck out on her own in 2002, frustrated with what she saw as the impossibility of providing truly high-quality, "respectful" care within the traditional radiology system. In typically high-volume practices, mammograms aren't read immediately. Patients with abnormal results usually receive a call after about a week, and if a follow-up is deemed necessary, scheduling one can take an additional two to three weeks. "Before you know it, a month has gone by, maybe more, before the woman has resolution," says Deutch. "That time period - the unknown and the waiting - is the hardest." Deutch says such a drawn-out process constitutes "inhumane" care. In her practice, she personally meets with every patient, even those who are there for routine mammograms.

Private pay, personal touch

At HerSpace, patients can get a screening appointment within weeks rather than months, and they never have to wait more than two days for a diagnostic appointment. Deutch reads all mammography results on the spot, and if she deems that a biopsy is necessary, it's performed immediately. Such a protocol requires a flexible schedule, and Deutch contends that - along with personal attention from the radiologist - this can only happen in a fee-for-service setting.

Practice manager Lorna Vaughan has been with HerSpace since it opened four years ago. She has strong feelings about the way the nation's healthcare system should operate. When she worked in a hospital, she says, "The malpractice was through the roof, and reimbursements were being cut, and I would go to the CFO and say, 'Why are we accepting this insurance? It's insane!' I personally am a firm believer in fee-for-service because I feel strongly that insurance companies are taking advantage of the patients and the doctors."

Vaughan thinks her practice's fees align with most carriers' going rates, but she says, "If we accepted insurance, we'd have to see twice as many patients." With an average of 48 patients per day, Deutch and her four technologists have plenty of time to devote to each woman.

In addition to perks like thick robes - which, in response to patient feedback, are available in all sizes up to XXL - and thoughtfully designed waiting areas, the practice offers a menu of related services, including needle localization and bone densitometry. Deutch was the first radiologist in New Jersey certified to read digital mammography, and she says patients have grown discerning enough to appreciate the availability of technologically advanced options.

With patients traveling from as far away as Maine and Kentucky to see her, Deutch maintains, "Women are more willing to pay out of pocket for this level of service." That statement is reflected in the practice's books: Total accounts receivable for Deutch's self-pay patients (excluding her Medicare patients) amount to less than $10,000.

"I think what's unique about the practice is that it wasn't set up simply to enable the physician to practice medicine," says Deutch. "There really was a philosophy behind it, and we really live up to it."

SIMPLE SOLUTIONS. BIG RESULTS: VIRGINIA MASON'S LEAN MANAGEMENT APPROACH MEANS MORE CASH AND HEALTHIER PATIENTS.

My first impression upon reviewing Virginia Mason Satellite Clinics' application for Practice of the Year was that here was a practice that had transformed its management into a science. Its eight primary-care practices have spent the past four years implementing the lessons of "lean management" (the theory behind Toyota's success), and it shows.

Virginia Mason's net revenue shot up from $2.9 million in 2003 to $3.5 million in 2005. Its number of patient visits grew 13 percent. And at one site, the percentage of patients leaving the office with overdue preventive care needs dropped from 38 percent to nearly zero.

That's much more than most practices ever consider taking on. Yet much of what Virginia Mason has accomplished can be easily replicated by other groups. So even if you aren't a practice that boasts 120 primary-care physicians serving the oh-so-hip Seattle area, here are some of Virginia Mason's principles that you too can implement.

Use your staff

"We've always worked in a physician-centered style in which the doc really does everything," says Brian McDonald, a physician and chief of Virginia Mason Satellite Clinics. "But if you really look at it, we've all got talented people in our offices. ... Use your team better. You can do that not only to share work, but to improve quality as well."


So Virginia Mason's nurses and medical assistants not only room patients, take basic health histories, and measure blood pressure - they also line up needed preventive services based on a pre-set, physician-approved template stored in the practice's EMR. If a patient comes in the door complaining of heartburn, the nurse will ensure that patient also gets the pneumonia or tetanus shot he's due for. She'll even schedule a mammogram or colonoscopy if appropriate, or she may discuss smoking cessation options.

And Virginia Mason is always open to modifying operations to best streamline work flow and patient care. It recently stepped back from requiring nonphysician staff to complete the social history part of exams. Physicians liked this task, and not all staff members were entirely comfortable talking to patients about their sexual history or conducting depression screenings - so sometimes these questions went unasked.

You may conclude that having physicians record social health histories would mean longer patient visits, but in fact, the clinics were able to reduce their patients' time in the office by 26 minutes. And that's without reducing patients' time with clinicians.

Don't let work pile up

What are Virginia Mason's physicians doing while their RNs are giving pneumonia shots? Completing patient documentation, processing lab results, and answering messages. The clinics all have low-tech counters set up right by their exam rooms. They call them "flow stations." Each station contains a phone and a computer connected to the group's EMR, which can display new lab results and clinical phone messages awaiting reply. Physicians stop at these stations after each office visit to complete the documentation relevant to their previous patient encounter.

Control your inventory

Here's another simple idea that can pay off big. In practice, supply management is usually an oxymoron. A physician opens a drawer and can't find what she needs. She runs into the hallway looking for someone to help her. No nurse in sight. So she raids another exam room, perpetuating the cycle.

Sound familiar?

At Virginia Mason, if a physician detects that she is starting to run low on something, she sticks a little index card outside the exam room door that instructs staff to resupply that specific item in a specific quantity. "The end result is that we don't run out of things in our rooms," says McDonald.

This uncomplicated system reduced Virginia Mason's total supply expenses by 30 percent between 2003 and 2005.

That's not rocket science, but it sure works. Sometimes simpler is better.

Pamela L. Moore, PhD, is senior editor of practice management for Physicians Practice and Laurie Hyland Robertson is a managing editor for Med-IQ, the parent company of Physicians Practice. Moore can be reached at pmoore@physicianspractice.com. Robertson can be reached at lrobertson@med-iq.com.

This article originally appeared in the November/December 2006 issue of Physicians Practice.