Transcript Proposal for Merck for AUA Atlanta, Georgia

Practice Management for
the Millennium
How to Improve the Efficiency
of Your Practice and Enhance
Referrals From PCPs
Dr. Neil Baum
New Orleans, Louisiana
Goals and Objectives
• Identify the needs and wants of the
American urologist
• Techniques to market and promote
incontinence to potential patients
• How to attract physician referrals for
urinary incontinence
• Use of new technology-Electronic
Medical Records
Needs and Wants of Physicians
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Maintain existing patients
Attract new patients
Improve reimbursements
Decrease overhead
Decrease litigation
Improve morale of the staff
Improve the efficiency of the practice
Put the “manage” into managed care
Add new technology to your office
practice
The Four Pillars of a
Successful Practice
Patients already in
your practice
Your relationship with
referring physicians
Attracting new
patients
A highly
motivated staff
The Two Secrets of
Success
1. Find out what the patient
wants and give him/her
more of it
2. Find out what the patient
doesn’t want and avoid it
Secret #1. Find out what
the patient wants and give
him/her more of it.
“Ask and you shall receive!”
Patient surveys
Give your practice a check-up
How do patients perceive your practice?
• Conduct personal interviews
• Create a focus group
• Use a suggestion box
• Commission a mystery shopper
• Conduct patient surveys
Secret #2.
Find out what the patient
doesn’t want and avoid it
Patients do not want to wait
to be seen by the doctor
Effective Scheduling
“Languishing
in the waiting
rooms causes more patient
dissatisfaction than any other
aspect of medical care
including fees.”
Study by AMA
Time and Motion Study
____ Time patient arrive in the office
____Time patient taken to the exam room
____ Time spent with the provider
____ Time patient left the office
____
Total time in office / total time with MD
Effective Management of
Delays
• Anticipate delays
• Apologize
• See patient at end of daycoffee coupons and beeper
Effective Management of
Delays
• Call patient at home
• Apology letter
• (Don’t charge the patient)
Second Take Home Message...
• FEW of us can change health
care policy
• ALL of us can be more
sensitive to the patient’s time
Who Are the Key
Patients?
• Patients receiving out-patient
studies or procedures
• Other
• Recently discharged patients
Advantages of Calling
Your Key Patients
• Fewer calls from your
patients
• Efficient use of your time
• Very appreciated
Response From a Key Patient
“This is the first time a member of
your profession has taken the
time to call me at home and
check on my condition.
Undoubtedly it will foster a better
relationship between you and
me.”
Attracting New Patients
Public Speaking
• Seminars
• Lectures
– AARP
– Junior League
– Church groups
– Service organizations
Writing to attract new patients
• Local magazine
• Newspaper
• Health publications
Using the Internet
• 33 million patients are willing to switch
to a physician who has practice Web
site and offers E-mail access to the
practice*
*Cyber Dialog, 2004
Internet
• Must be more than an electronic version
of your brochure
• Looking for outstanding clinical content
– Credentialed by a legitimate medical
sources
– Academic sites
– National organizations and societies
Provide value-added services
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Secure messaging
Appointment scheduling
Insurance verification
Prescription refills
Access to patient’s medical record
Procedure-specific information
Notify Current Patients of Your
Web Presence
• Stationary
• Brochures
• Calling cards
What will the Internet do for
your practice?
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Increase revenue
Decrease expenses
Improve office efficiency
Improve the quality of care
Can communicate with most patients in
your practice
Final Advice On Attracting New
Patients
• Make certain that they have easy
access to your practice
• Do not allow a new patient to wait 4-6
weeks for an appointment
The 3rd Pillar of a
Successful Practice
Enhance your relationship with
referring physicians
Some Eye-Opening
Opportunities
• Each urologist has approximately 10
loyal referring PCPs
• Average PCP sees 30 patients\day
• Approximately 15 are women, and 10
have risk factors for UI
• Bottom Line: 100 women could be
screened each day!
How to Screen 100
Women\Day?
• Need to educate PCPs to ask questions
about UI
• Need to educate PCPs to treat mild to
moderate UI and when to make
appropriate referrals to a urologist
Potential income from 100
screened women\day
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IOVs
FU visits
UA, urine C & S
Urodynamic studies
Cystoscopies, BUS, Flow Rates
Surgery (Needle Suspensions, Slings)
Other urologic conditions (UTI, Stones,
Cancer, IC)
• Opportunity to treat family and friends
(vasectomies, BPH, CaP, ED)
Marketing To Referring
Physicians and Their Staffs
Educating Referring
Physicians
Lunch and Learn Programs
Meet with PCPs and their office staffs to
discuss evaluation and treatment of UI
“UI-When to Treat and When to Refer”
10-12 minute informal presentation
Follow-up letter
Suggestions for “Lunch and
Learn”
• No slides or computer
• Informal
• Leave a handout with your name and
contact information
• Ask pharmaceutical companies to
sponsor the lunch
Enhancing Communication
With Referring Physicians
Why Do Physicians Refer?
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Returns patients
Reports back promptly
Availability
Friendliness
Scientific talks
Give RPs an active role
Teaching in hospitals and schools
Entertaining
Publish professional articles
• Gifts
38%
33%
13%
11%
7%
5%
7%
1%
1%
1%
Traditional Referral
Letter
•Long
•Arrives in 10-14 days
•Expensive
Key Ingredients of
a Referral Letter
•Diagnosis
•Medications
•Treatment plan
Computerized “Boiler Plate”
Referral Letter Example
Dear <Name of Doctor>
<Name of Patient> was seen for a problem of
<diagnosis>.
I recommended <medications and treatment plan>.
I anticipate <number of additional visits>
additional visits and appreciate your authorizing
the continued care in my office.
I will keep in touch with you regarding his progress.
Sincerely,
Neil Baum
Advantages of boiler plate
letter:
• Reduces the cost ($15-$1)
• Increases the efficiency of your
practice
• Keeps the referring doctor as
the captain of the patient’s
health care ship
The 4th Pillar of a
Successful Practice
Motivating your staff
Highly motivated staffs
follow a mission
statement
What is a mission statement?
A truth told in advance
that tells where you and
your practice are going
Our Mission
Statement
• Commitment to providing the
best health care for our patients
• Commitment to exceeding
patients’ expectations regarding
their health care
• Commitment to the attention to
the LITTLE details because they
make a BIG difference
Where to display the
mission statement
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Reception area
Exam room
Employee lounge
Brochures
Newsletters
Stationary
Web site
“I could conquer the world
if I had enough red ribbon.”
Napoleon
ABCD Awards
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Above and
Beyond the
Call of
Duty
Second Take Home Message
• If you take outstanding
care of the staff, they will
take outstanding care of
your patients!
Performance Review
• Can’t be done once a year at salary
review
• Suggest every 3-4 months
• Complete worksheet before the review
– What do you like the most about this job?
– What would you like to improve?
– Where do you want to be professionally in
the next 3,6, 12 months?
– What can I do to help you reach your
goals?
Surprise the Staff
Surprise is the spice of life
• Office closes for lunch
• Limo picks up staff
• Box lunch provided on the way to the
mall
• Each staff member receives $100 which
must be spent during one hour at the
mall on gifts for themselves
Improve the Efficiency of
the Practice
• In the past, we enjoyed the luxury of low
volumes of patients and high profit
margins
• Today, we can expect large volumes of
patients with narrow profit margins
• Therefore, we will need to see more
patients in the same amount of time
without sacrificing quality and patient
satisfaction
Improve the EfficiencyOffice Videos
• Topics-medical discussions that are done
one or more times a day or several
times\wk
– Annual exam
– Evaluation of ED
– Use of Viagra
– Vasectomy
– Treatment of localized prostate cancer
– Evaluation of incontinence
Equipment for Office Videos
• Video camera
• Tripod
• Script
Getting Started
Gather information
• Tape record a conversation with a pt.
• Review pamphlets and educational
materials from pharmaceutical and
medical manufacturing companies
• Review other videos
Prepare the Script
• Describe the topic
• Why is it important to your health?
• What are the risks and
complications?
• What are the alternatives?
• “I will return to the room after you
have completed the video to answer
any questions that you may have and
provide you with a summary of the
video.”
Advantages of Do-ItYourself Videos
• Improves efficiency
• Medical-legal protection
• Nice take-home value
• Can use to demonstrate
patient understood the
material
Examples of My Office Videos
Please check my website:
www.neilbaum.com
Do our colleagues appear a
little sullen and sad?
Lost LHRH Agonist Income
2003
2004
2005
Reimbursement/
Injection
$1784
$1504
$697
Cost/Injection
$658
$658
$658
Net /Injection
$1126
$846
$39
Injections/Patient/
Year
4
4
4
# of Patients
200
200
200
Income per Year
$900,800 
$676,800
$31,200
$224,000 
$869600
Income
Reduction
from Prior
Year
Income By Size of Group
2003
2004
2005
4 man
$900,800
group/200
$676,800
$31,200
2 man/100 $450,400
$338,400
$15,600
1 man/50
$169,200
$7,800 

x
$225,200
Identify what it takes to make
your practice financially
successful
Gross Collections of $1m\year
Projected expenses + M.D.
Salaries
• How much is required month\week\day\hr?
Assume $1million\yr\phy to run practice
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Need to collect $83,333\month
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$20,833\week
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$4166\dayor…..
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$416\hr (based on 10 hour
day)
Average amount
collected\patient encounter
• $83,333\month
collections\physician
• 500 patients seen each
month\physician
• $106? collected for each pt
encounter
• Need to see only 4-6 patients\hr to
generate $416\hr or $1m\yr
EMR
• Doctors must document normal findings
in Hx and PEx in order to receive E & M
credit for their codes
EMR
• Doctors must document normal findings
in Hx and PEx in order to receive E & M
credit for their codes
EMR-Fact!
• 85% of all E & M records contain normal
values
• If you don’t document what you did, you
didn’t do it!
• With EMR, documentation is a click
away
ROI-Return on Investment
• Can easily, ethically, and honestly move
from level 2-3 E & M to level 4-5…and
be able to sleep at night!
Before and After EMR-NP
50
40
30
Before EMR
20
After EMR
10
0
Level 1 Level 2 Level 3 Level 4 Level 5
Before and After EMR-EP
60
50
40
Before EMR
30
After EMR
20
10
0
Level 1 Level 2 Level 3 Level 4 Level 5
Take Home Message
• There are a lot of opportunities, i.e., a
“big pie,” for urologists
• We just need to “grow the pie”
Summary
The Chinese symbol for crisis is the
same as the symbol for opportunity
Do we see the glass of milk as half
full or half empty?
Let Me Hear From You
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[email protected]
www.neilbaum.com
FAX: 504 891-8505
Office Phone: 504 891-8454
Suggested “Lunch and Learn”
Talk to PCPs
Urinary Incontinence
When To Treat and When To
Refer
Goals and Objectives
• Discuss the incidence and
pathophysiology of UI
• Review the evaluation of the patient
with UI
• Describe the medical management of UI
• Provide indications for urologic referral
Urinary Incontinence
• Affects 14 million Americans
• Affects 50% of all patients in nursing
homes
• More common in women and the elderly
• Not a normal part of the aging process
• Less than 5% seek help from the
medical profession
Common Causes of
Incontinence
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UTI
Childbirth injuries to the pelvic floor
Surgical injuries to the urinary tract
Hormonal deficiencies
Medications
Birth defects
Diabetes
Neurologic disorders
Physical Capabilities-lack of mobility
Risk Factors for UI
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Immobility
Impaired cognition
Morbid obesity
Smoking
Environmental barriers
Diabetes, stroke, estrogen deficiency,
pelvic muscle weakness
• Medications
Medications Causing UI
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Diuretics
Caffeine
Anticholinergics
Psychotropics
Narcotics
Alpha adrenergic blockers and agonists
Alcohol
Types of Incontinence
• Stress incontinence-outlet fails to
remain closed
• Urge incontinence-detrusor over activity
• Mixed-stress and urge incontinence
• Overflow incontinence-failure to empty
• Functional incontinence-factors outside
of the urinary tract
Evaluation of UI
• History-drug history
• Physical examination-abdomen,
pelvic, DRE
• Measurement of PVR
• UA, C & S if there is pyuria or
bacteruria
Medical Management of UI
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Anticholinergics
Smooth muscle relaxants
Alpha adrenergic agonists
Estrogens
Exercises
Mechanical compression
Indications for
Urologic\Gynecologic Referral
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Failed pharmacologic management
Hematuria
Recurrent UTIs
Overflow incontinence
Large post-void residual
Urinary retention
Incontinence associated with anatomic
abnormalities
Summary
• UI is a common conditions that affect
millions of American men and women
• UI can be evaluated in the primary care
setting
• Most patients with UI can be medically
managed by PCP
• Urologic\gynecologic is referral is
indicated in appropriate circumstances