A revenue-building practice

You can have all the patients you have time to see. Just open your clinic to all comers, pay or no pay, and your roster will be full. Probably you’d prefer a practice full of paying patients who need the services you feel best qualified to provide. The process of getting to that point is called “adjusting your patient mix.”

The best way to start is by understanding your current patient mix. For example, you may need to know how many of your current patients are over age 65–or under age 30, live in a wealthy–or poor–part of town, have diagnoses that match–or are outside–your primary area of expertise. You might also want to track how often your current patients call your office to request medical care, what percentage of your patients are new to your practice within the past three years, and how many of your newer patients are also new to the community.

After you’ve studied your current client roster, it’s time to start digging for ways to reach your “ideal” patient. You may want to engage the services of a business such as PracticeBuilders, a healthcare practice consulting firm for thirty years. At least part of the solution may be as close as the office telephone. In a recent newsletter, PracticeBuilders calls the office telephone the “biggest black hole of lost revenue” for medical and dental practices and offers useful ways to deal with this problem.

If you can’t afford a “mystery patient” just now to analyze the weaknesses in the way your phone is used, at the very least start spending some of your time listening to how your staff answers the phone and what they say to the caller. Here are some ill-advised actions people hear too often when making calls to medical or dental practices.

* Clicking and clacking of computers can be distracting to both sides of the conversation.

* The sound of swallowing food or chewing gum carries through the telephone.

* Rapid speaking to the other person may not be rude, but it sounds rude.

* Letting the phone move away from the speaker’s mouth creates causes and indistinct speech.

* A hurried, breathless, greeting can make the caller feel unimportant.

* Sneezing and coughing can be irritating to the caller.

These may sound like elementary points, and they are. From basic telephone hygiene you need to move to more appealing speech that will convey a spirit of friendly concern to the caller. But without listening for these common pitfalls and gently working to bring the entire staff up to a higher standard, you risk turning away patients who could be your valuable clients for years to come.

Brought to you by Griffith Publishing and Physician Publishing

Now it’s a surgeon shortage

Just as we’re getting used to the idea of delivering medical services without enough primary care physicians to go around, we learn that some categories of surgeons will be in short supply if current trends continue.

The Business Courrier, a national business journal published in Ohio, reports we may face a shortage of general surgeons within two years.

In the specialty journal, Surgery, Dr. Tom Williams says that the shortage could reach 6,000 by 2050. This would be a huge blow to hospitals because 68 percent of hospital revenues come from surgical procedures, not counting laboratory and other services directly related to surgery, according to reports by the actuarial firm, Towers Perrin. The OR is not a cost center, although most hospitals consider it as such, but should be seen as the primary revenue-generating unit of the hospital.

Sometimes the shortage is market driven. Joint replacement surgery, for example, will soon be needed by more people who require the procedures than there are surgeons to provide them. If the number of surgeons qualified to perform total joint replacement surgery grows at the same rate as now, by 2016 there could be as many at 46 percent of hip replacements and 72 percent of knee replacements that will not be offered due to the surgeon shortage.  More than 700,000 primary total hip and knee replacements are done each year, and the number will double by 2016. Information from a news release posted by the American Academy of Orthopedic Surgeons.

Presented by Physician Publishing

Which doctors work hardest? Get paid the most?

Did you know that…

Orthopedic surgeons rank at the very top of the pay scale with an average income of $323,000 a year.

At the other end, family practice physicians and psychiatrists vie for the lowest average income with the family practice physicians earning an average of $132,000 a year and psychiatrists $124,000.

How hard do doctors work?

No way to know that, but if we measure doctor input by the number of hours per week, we learn that physicians specializing in obstetrics/gynecology, anesthesiology, general surgery, or urology all work more than 60 hours every week.

Dermatologists and pathologists work the fewest hours on the list, just 45.5 a week, but specialists in emergency medicine (46.0 hours/week) and ophthalmology (47.0) hours put in only slightly more hours a week.

Now put them together. Which physician specialists yield the highest dollar amount per hour worked?

No surprise. Orthopedic surgery earns an average of $107.10 per hour, while family practice physicians earn only $48.35 per hour.

Most interesting, perhaps, is the average:

Average $$ per year: $208,000

Average $$ per hour: $74.21

Average hours worked per week: 53.9

These numbers come to us from the American Medical Association.

Remember that these hours and dollar amounts are for fees allocated to individual physicians. The cost of running a medical clinic includes not only physician revenues, but also clinic costs and other expenses of practicing medicine in calculating the profit margin.

Brought to you compliments of Griffith Publishing

Who needs more patients?

“We don’t need to announce our new internal medicine docs,” a hospital manager told me. “They’re filled up within two days of opening their doors.”

We have a doctor shortage in the U.S., and it’s getting worse. We’re relying more and more on nurse practitioners and physician assistants, and trimming time with patients for more efficiency.

A recent report by the Association of American Medical Colleges reveals the following state-by-state facts about physician supply and demand:

Alaska: The state needs 59 new physicians (MD’s or DOs) every year to replace those who are retiring or leaving. Alaska has only 205 physicians per 100,000 population compared with 238 nationwide.

Arizona: Rapid population growth puts a higher demand on doctors with specialties in allergies, cardiovascular surgery, endocrinology, gastroenterology, hematology, and infectious disease.

California. Most doctors (60%) practice medicine in only five counties. A rapidly growing population could cause a growth in demand of 4.7% to 15.9% by 20015.

Florida. Population is expected to grow 60% by 2030; during that time the aged population will grow by 124%.

Georgia. Predictions are that without changes in medical education facilities, Georgia will be dead last in physicians per 100,000 by 2020.

Idaho. This state ranks 49th out of 50 states in physician supply, with only 198 physicians per 100,000 population. It is 48th in the number of first-year medical students per 100,000 residents.

Iowa. Aging population points to need for physicians in five specialties: psychiatry, neurosurgery, general internal medicine, orthopedic surgery, and cardiology.

Kentucky. Almost half of Kentucky’s counties are designated as Health Professional Shortage areas (HPSA) for primary care.

Maryland. Now at 16% below the national average for the number of physicians available for clinical practice,

Maryland has the greatest shortage of physicians in Southern Maryland, Western Maryland, and the Eastern Shore.

Massachusetts. The Massachusetts Medical Society produces a physician workforce study every year, and this year is another that shows a “strained” medical system.

Michigan. Growth in demand will outpace growth in available physicians in the state, with a projected shortage of 4,400 physicians by 2020.

Minnesota. Only 5% of Minnesota’s physician practice in rural areas although 13% of Minnesotans live that. Too few specialists are available especially in northern and southern rural areas.

Mississippi. Two out of three counties in Mississippi are labeled as Health Professional Shortage Areas. Over half (56%) of all of Mississippi’s physicians practice in four counties.

Nebraska.  Only 9 of Nebraska’s 93 counties have more than 214.09 physicians per 100,000 population, the average for all states in 2004.

Nevada. This state has one of the lowest physician-to-population ratios in the nation and one of the highest population growth rates.

New Mexico.  More than half of New Mexico’s physicians are located in Bernalillo County. Only Los Alamos County, with a rate of 2.41 physicians per 1,000 population, came close to the national average of 2.42, and all other counties were far below.

North Carolina. A Task Force convened by the North Carolina Institute of Medicine concluded that without major changes in the health care delivery system or significant increases in the number of physicians, the state is likely to face a severe shortage of physicians.

Texas. While the number of Texas medical school graduates has remained relatively flat over the past twenty years, the state’s population has grown by 50% in the same time.

Oregon. 2004 data suggests a “looming shortage of physicians.” The state is already experiencing shortages in rural areas and in several specialties, including rheumatology, nephrology, gastroenterology, cardiology, allergy-immunology and pediatrics.

Utah. There are currently shortages in Utah for physicians in pediatric neurology, child psychiatry, adult psychiatry, obstetrics & gynecology, general surgery, dermatology, urology, and cardiology. The state will need to recruit up to 270 physicians a year in order to keep up with growth.

Virginia. By 2020 there will be a shortage of approximately 1,500 physicians in Virginia. By 2030, 25% of the state’s population will be over the age of 60 meaning more people will be making more frequent doctor’s visits.

Wisconsin. A 2004 report from the Task Force on Wisconsin’s Future Physician Workforce, concluded that Wisconsin has current unmet needs for physician services that are likely to worsen in the foreseeable future. Shortages in primary care physicians, general surgeons, and radiologists already exist in rural areas of the state.

10 top innovations in medicine

Doctors at The Cleveland Clinic have continued a tradition launched three years ago by announcing their pick of the 10 top innovations in medicine.

For the complete story, read the full account from the Plain Dealer. Here’s a summary of the doctors’ choices for the best of the latest innovations in the treatment of patients:

1. Circulating tumor cell technology
2. Warm organ perfusion device
3. Diaphragm pacing system
4. Multi-spectral imaging systems
5. Percutaneous mitral valve regurgitation repair
6. New strategies for creating vaccines for avian flu
7. LESS (laparoendoscopic single-site surgery) and NOTES (Natural orifice transluminal endoscopic surgery)
8. Integration of diffusion tensor imaging
9. Doppler-guided uterine artery occlusion
10. National health information exchange

Brought to you by Physician Publishing

Changes in medical practice

Medical practice is on the edge of fundamental changes in the way patients are selected, evaluated, treated, and billed. Physicians who put management and financial issues to one side may find themselves wondering how they got left behind.

A major change that most physicians have felt has been the shift from small, independent clusters of physicians to integrated networks of care providers. Doctors are more likely than ever to be employees of hospitals or networks of health care provider rather than members of a solo or group practice. They are also more likely to be working shoulder to shoulder with “physician extenders” and seeing more of their traditional hands-on methods taken over by other members of the health care team.

Technology is penetrating the practice of medicine even as costs have soared beyond the ability of individuals, insurance providers, or the US government to pay for fully. From computerized patient records, to distance conferences with super specialists, from the sharing by computer of images and data to complex pre-birth surgery, doctors are challenged as never before to tune their skills to the latest changes.

There are plenty of bumps on the high-tech road, but ignoring innovations in the way information is collected, stored, and utlilized can lead to deep ruts as competing organizations learn how to use technology for greater efficiency and higher bottom line performance.

—brought to you by Griffith Publishing

Now what? You’ve got the basics. It’s time to grow.

Build credibility for your medical practice

To put your medical group or solo practice into a solid, revenue-producing mode, you need to center in on building a higher degree of credibility than the competition. Credibility leads to trust, loyalty, repeat business and word-of-mouth referrals.

You contribute to your credibility every time a patient walks in the door, sees an attractive waiting area, is greeted in a timely and courteous way, sees the doctor within a reasonable time, is treated with respect during the doctor visit, and leaves feeling good about what the doctor has said and actions they’ve been asked to take.

Pharmacists, dentists, and chiropractors work hard at achieving a higher degree of loyalty and often choose among scores of programs “guaranteed” to help them build a loyal clientele. Medical doctors rarely need to attract new patients because their practices fill up so soon after opening an office. They need something more than an influx of new patients. In a word, physicians need to build credibility with–

• Colleagues who will refer patients
• Patients and family members
• The public 

More on these important topics later…

For more information, go to Griffith Publishing or, for information for doctors who are also writers, go to our physician publishing site.  

Practice building services: a summary

Following are some of the services that specialize in building a client base for medical practices. This is an informational list only, and, unless otherwise noted, comments are based only on a cursory visit to web sites. No payment is solicited or accepted for listing.

Practice Builders.  The company says it is “the nation’s leader in healthcare-practice success since 1979.”  They offer a free marketing assessment to determine which of their services could benefit your most.  Be sure to take the time to review the 13 questions on the opening page. Practice Builders also offers training workshops for practice representatives, workshops, on-site consulting and many other services related to medical practice growth.

Building Your Ideal Practice. This company offers a variety of free seminars, a free newsletter, and a 6-week practice monitoring service, among other things. They also offer an Affiliate program. No physical address. The business is owned by David Steele, “a California-based licensed marriage and family therapist and relationship coach.” Programs feature the owner as the speaker.

I won’t even link to this one…It’s a garish web design touting a patient-getting service for chiropractors that “gets you an additional 23-35 new patients every month and requires no work at all!”

Healthcare Success Strategies. Not limited to medical practices, this company promises to “grow your revenues with the cases you want most.” Services are listed in three categories: Free and low-cost, expert guidance consulting options, and marketing and creative services. Like many companies in this category, no physical or mailing address is given, but an area code of 949 reveals a southern California address.

One Source Consultants Group. This company bundles practice management with architectural services for medical practices. They also offer medical billing, insurance contracting, web hosting and design, and many other services needed by a growing medical practice. They are located in Colleyville, Texas.

I thought I would find more practice-building consulting services, and I’m sure that there are dozens more if I were to keep searching.

There are plenty of articles, books, newsletters, and web pages dedicated to suggestions for building a medical practice, and in another edition of this blog I’ll reference as many of those as I can.

This information is brought to you as a complimentary service of Griffith Publishing, producers of books and newsletters for health care providers.

Step 2: The physician-patient bond

Think of strong bonds in our society: the bond between mother and child, between man and woman, between boss and worker. But the bond that underlies the work of building a strong client base for your medical clinic is the doctor-patient relationship.

People who choose your practice for their medical care want to like and trust you. They may be nervous at the first visit or two because they want so much to avoid getting in the way of a helpful relationship. If you as the physician can set your new patient at ease, both of you will enjoy a higher level of success.

The most direct way to establish a healthy bond with your patients is to have an honest appreciation for each one and a genuine desire to help them achieve better health. If you’re growling inside, it doesn’t matter how big the grin is on your face, people can tell you’re upset. Your patient knows that all is not well. On the other hand, if you have a sincere sense of cooperation toward your patient, it will show.

Instead of bursting into the exam room where your new patient is waiting and blurting out, “Are you Joe Jones? What is your complaint?” You will say, with hand extended for a handshake, something like this: “Joe Jones. I’m Dr. So-and-so. It’s a pleasure to meet you. Let’s see what we can do for you…”

The other people your patient sees are also important in setting the trust level for your visit. You can’t expect a person who stands at the counter waiting for ten minutes while the desk people take care of their telephone calls to feel that good about seeing you. A friendly encounter by the receptionist can come across as rudeness if her voice is shrill or if she barely allows one second to tell the patient that she’ll be right with him or her and then goes back to the phone.

You will never have patient flow with no waits, no interruptions, no mistakes. You can’t afford to have so many workers that they only have to move when a new patient walks in the door.

You don’t want to be the personnel manager for your clinic, but there is one thing you can do that will help set a friendly, helpful, professonal tone in the office: be the leader. Your clinic staff will borrow your attitude towards them and your patients. If you’re business-like but happy, they’ll ease in that direction.

It doesn’t hurt once in a while to compliment a nurse or assistant who goes out of his or her way to deliver what you need on time. “Thank you” still works as a great way to express gratitude.

As you speak positively to your staff about how well they are doing keeping the mood upbeat in the clinic, they will subconsciously work harder to do just that. Of course it has to be sincere. Issue your compliment when you see good work.

In future blogs we will talk about the way you can take the doctor-patient relationships to new heights as you share health-boosting information with your patients, your staff, and the public.  

Step 1 to building your client base

The first step to achieve a broader client base is to look within to see how your practice can do a better job meeting the needs and expectations of your current patients.

Put yourself in the shoes of a patient at your practice. What does that person see first when entering the waiting room? What is the first exchange of words? How does the receptionist or nurse explain the possibility of a delay in seeing the doctor?

For an excellent checklist of items to include in a thorough pracice assessment, go to the website of a professional medical practice consulting service, Healthcare Facilitators. These pages break down the areas of your practice and show you what to look for in your own practice. By studying these points you can perform a self-evaluation that will help you make changes or decide if consulting services would be a good investment for your clinical practice. Here is a sampling from the list:

• Lobby image
• How the receptionist greets the patient
• How the physician enters and exits each encounter

and more…

Whatever your position with the practice, you will pick up comments from patients about their care. You may hear a disgruntled patient complaining about how long he had to wait, or a desk person commenting to another worker that Dr. So-and-so is late getting to the clinic on Monday morning, again. Pay attention to these comments, but don’t reorganize your practice because of one remark. Ask questions, listen, and make or suggest changes accordingly.