Here are five tips for spine surgeons to make room for higher patient volume in their clinic.
1. Block interruptions during clinic sessions. It's tempting to check email or make quick phone calls in between patients during office hours, but these distractions can quickly put your schedule behind. "Try to avoid meetings in the middle of the day, conference calls and anything else that would slow the day down and break it up," says A. Jay Khanna, MD an Associate Professor of Orthopaedic Surgery and Biomedical Engineering who specializes in spine surgery at Johns Hopkins Medicine and is based in the Washington D.C. region. "Along those same lines, avoid multitasking during clinic. This is likely the mistake I am most guilty of."
Seek help with administrative and other non-clinical tasks from staff members whenever possible. "Getting help from your staff with non-clinical tasks will allow you to focus more on patient care including a more thorough discussion clinical and imaging findings and the ensuing clinical decision making and discussion of treatment options," says Dr. Khanna. "Physicians also end up having more time to interact with referring physicians and other professional responsibilities."
2. Avoid a formal lunch break. Office sessions have a ramp-up and ramp-down period as patients arrive for their appointments, fill out paperwork and get into a room so that they can be seen by a physician. Taking a formal lunch break adds another ramp-up and ramp-down period every day. A 30 minute formal lunch break can cost a physician an extra hour-and-a-half of clinic time.
"Avoidance of the formal lunch break allows the provider to eliminate two additional ramp-up and ramp-down sessions," says Dr. Khanna. "Instead, order lunch for yourself, your PA, residents and/or fellows and occasionally your office staff to thank them for helping you see patients and keep things moving. Of course, have your office staff take their formal lunch breaks since they can cross-cover each other during these breaks and keep the office running smoothly."
3. Cut down hospital responsibilities. Some physicians are changing their practice to spend more time in the clinic and less time at the hospital with post-surgical patient rounding, which can be done by other staff members. There are surgeons who have decided not to participate in emergency care and take on fewer administrative responsibilities.
"This allows surgeons to see more patients in the office setting," says John Finkenberg, MD, a spine surgeon in private practice with Alvarado Orthopedic Medical Group in San Diego. "We don't know whether this is a good or bad trend yet because we haven't seen a scenario quite like this before."
Spine surgeons are also bringing physician extenders and non-surgical spine specialists aboard to conduct initial visits with patients and direct them to the appropriate specialist for their symptoms.
4. Schedule your time to stay fresh. Spine surgeons have many demands on their time — demands that are only increasing with healthcare reform mandates such as electronic medical records. Proper time management is the key to finding the right balance between quality patient care and a successful business.
Adam Crowl, MD, a board-certified orthopedic spine surgeon with Advanced Orthopaedics in Richmond, Va., suggests scheduling clinic days in half day increments. "Spine patients can be exhausting to evaluate in the clinic. Days that are half-day office and half-day surgery helps keep you fresh and more efficient," he says. Trying to cram in additional cases while battling fatigue does nothing to improve the quality of patient care.
Dr. Crowl has a full day in the operating room on Monday and then splits Tuesday and Wednesday between the clinic and the OR. He saw a significant increase in productivity and patient access. "Many patients have difficulty with access to a spine surgeon's care. Most patients who have an acute disc herniation with weakness are not going to wait two weeks to come see you in the office. Being able to capture these patients requires availability," says Dr. Crowl.
5. Use automated and electronic technology. There is a wealth of technology available to allow surgeons a more efficient workflow. Transcription and dictation services have been available for several years, but new platforms allow surgeons to access real-time clinical information from anywhere at any time.
Practice management software and electronic medical records can help gather patient information and organize it for the physicians before the patient's visit.
"We have an intraoperative project management software to coordinate tests that need to be done to ensure we have the right people in the right place. The software assigns a task we need to collect patient information and alerts us of the due date so we can gather the information before the patient's visit and minimize wait times. We've incorporated that software into the EMR.," says Ty Thaiyananthan, MD, founder of BASIC Spine in Newport Beach, Calif. "We also identified a workflow algorithm to really quantify the way we clinically evaluate patients. We are trying to integrate that into our software as well to cut down on work and repetition. Patients get the care they need faster with less expenditure and surgeons aren't wasting their time with patients who don't need their expertise."
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