Enhancing the Patient Experience EXCELLENCE IN PRACTICE MANAGEMENT Embracing the Process of Effective and Patient Flow Jill Maher, MA, COE Senior Eye Care Business Advisor Disclosures Jill Maher, MA, COE Senior Eye Care Business Advisor, Allergan, Inc Allergan Access Expertise Includes: Allergan Access Program Allergan Access Program: Core competency for Allergan in business consulting to the eye care community. Enhance Allergan s reputation and customer relationships by delivering practice management solutions that help address our customers needs. Marketing Business operations Service-line management ASC management Staff management Patient satisfaction Financial management Clinical operations Strategic planning Optical services Practice assessment Industry update Allergan Access Program Learning Objectives Practice Management Services Practice assessment/ development Financial discipline Feasibility analysis Business planning Eye Care Business Advisor Business Consulting Services Training and Development Leadership skills Industry trends Practice operations Customer service Practice Enhancement Programs Online patient satisfaction survey Website assessment EMR adoption Practice needs assessment Telephone Mystery Shopping AllerganAccess.com Resource Center Business management tools and resources Archived articles Dynamic training videos Website assessment programs A Suite of Sophisticated Customer-Focused Practice Management Programs and Services to Help Further Your Success The ability to identify Flow and Efficiency Red Flags specific to your practice. Assessment skills for evaluating: Office layout and capacity Time management Practice comparison to Patient scheduling Clinical Operations Benchmarks Tech assessment Tips to improve efficiency Change Management: Start a PILOT 1
What s On Your Mind? True or False What did you think when you received the invitation to this meeting? What is the biggest challenge your practice faces regarding the issue of patient wait time? Wait times are the most destructive patient complaint. What do you hope to learn from this session? TRUE Patient Flow Is very complex Is a constant challenge Changes constantly Flow and Efficiency Red Flags But it can be optimized if approached analytically. Top 10 Signs You May Have a Problem! Top 10 Signs of Flow Efficiency Problems Top 10 Signs of Flow Efficiency Problems 1. 2. Patients, technicians or physicians consistently arrive late. There does not seem to be enough exam lanes. 6. 7. Tasks and skills are not aligned. Techs spend more than 20 minutes for comprehensive work ups. 3. 4. s are frequently interrupted while seeing patients. Exam lanes are not properly equipped or ready. 8. 9. Practice does not use a Writer or Scribe. Check-In and Check-Out areas are congested during peak hours. 5. Patients and clinical staff walk long distances to the preliminary exam area. 10. s escort patients to Check-Out area. 2
Considerations to Maximize Physical Space Exam Spaces Needed Do you have enough exam rooms? # of s # of Techs Minimum Spaces Needed Reconfigure exam room size. I 1 0 2 Use pre-test areas and/or hallway. II 1 1 3 Configure a quick check room. III 1 2 4 Use flag or lighting systems. Reduce wasted steps. IV 1 3 5 Three Types of Patient Flow Circular Reception Three Types of Patient Flow In and Out Check Out Check In Check In & Out Reception Three Types of Patient Flow Clinical Operations Benchmarks Linear (Assembly Line) Step 3 & 4 Step 1 & 2 Check In & Out What concerns do you have regarding clinical operations benchmarks? Reception 3
Clinical Operations: Flow & Efficiency Benchmarks A Well-Trained Technician Can Check in to Exam Start Tech Work-up Time (including refraction) Wait Time for the (not including dilation) Dilation Time (if applicable) Exam Time General Ophthalmology Exam Time Retina & Refractive Check Out Time Total Elapsed Time (without dilation) Total Elapsed Time (with dilation) Source: Allergan Access & BSM Consulting 15 minutes 16.5 minutes 10 minutes 15 25 minutes 5 8 minutes 10 12 minutes 2 minutes 48 63 minutes 63 76 minutes Take a relevant patient history, visual acuity Perform auto-refraction, auto-keratometry Conduct diagnostic testing Complete subjective refractometry Test pupil reflexes Perform lensometry Conduct IOP checks Complete contact lens checks and instruction Take photographs, and much more Check your state board to be sure your office procedures are within the limits of the law. Clinical Operations: Flow & Efficiency Benchmarks Technician Time Management Benchmarks Clinical Operations: Flow & Efficiency Benchmarks Technician Time Management Benchmarks Patient History & Notation of Chief Complaint 2.5 minutes Tonometry (Goldman) 1 minute Visual Field (automated) 12 minutes External Evaluation 1 minute Confrontation Field 0.5 minutes Angle Assessment 0.5 minutes Visual Acuity (far and near) 2 minutes Refractometry (D&N) 4.75 minutes Near Point of Convergence Measurement 0.5 minutes Lensometry (Auto) 0.75 minutes Keratometry (non-automated) 3 minutes A-Scan 15 minutes Topography 2.5 minutes HRT/OCT 4.5 minutes Color Vision, Stereopsis 1.5 minutes Source: 2009 ASOA Technician Benchmarking Survey compiled by Jane T. Shuman, COT, COE, OCS of eyetechs and Derek Preece of BSM Consulting Source: 2009 ASOA Technician Benchmarking Survey compiled by Jane T. Shuman, COT, COE, OCS of eyetechs and Derek Preece of BSM Consulting Case Study: Time Management Obtain Data: Proof for and Staff : Why am I always so far behind at mid-morning and mid-afternoon? Appointments: Time spent per exam: At end of 1 st hour: At end of 2 nd hour: 10 patients per hour Average 10 minutes 6 exams done; 4 waiting 12 exams done; 8 waiting So what s the problem? Time Tracking Sheet: Use this tool to determine the average length of each type of exam: 100 short exams in 400 minutes = 4 minutes/exam 60 medium exams in 480 minutes = 8 minutes/exam 40 long exams: in 480 minutes = 12 minutes/exam Appointment Tracking Sheet/Appointment Schedule: Use this tool to determine the percentages of each type of exam: Example: 50% short, 30% medium, 20% long 4
Key Principles The 4 Types of Delegation Type I Type II Type III Type IV Tech Tech Tech Tech The doctor s time is a scarce resource. You can t schedule more than 60 minutes of doctor time in an hour. The same is true for a tech s time. History VA Lensometer K s Muscles Pupils Conf. Fields External Dilation Drops Tonometry Refraction Fundus Slit Lamp Counseling Time Tracking Sheet Quality Improvement / Time Study Date: Appt Time: Exam Type: Time Initial N/A Reception Check In: Patient: Exam type: Test( ) Start: Test End: Tech Exam Start: start time: start time: end time: end time: Tech Exam End: Cyclo Start: Cyclo End: Put in Dr. : Start: End: Counselor Start : Counselor End: Check Out: Patient Patient Benchmarks Indications of a Problem Assessing Your Current Schedule Tips and Recommendations 5
Patient Benchmarks Indications of Problems Wait Time for Scheduled Appointment New Patient Visit Established Patient Visit Emergency Visit 10 to 14 days 14 to 21 days 2 to 3 hours No Show Rate No more than 5% of appointments scheduled. Cataract Surgery Benchmark 1 to 3 Weeks The practice experiences peaks and valleys in patient flow during the day. Patients are squeezed in or overbooked. s and staff routinely finish late. Patients complain about long wait times. Staff stress levels, or turnover rates, are high. Refractive Surgery Other Surgery 7 to 10 days 10 days Source: BSM Consulting Assessment of the Current Template Templates Does person creating master template understand the time constraints? Are patients being scheduled in the wrong slots because the scheduling staff is not aware of scheduling protocols or do they ignore them? Are new patients scheduled back-to-back? Does the number of scheduled patients vary from hour-tohour? Does the practice overbook patients instead of leaving open slots available for referral and emergency patients? Proportional Traditional approach based on tech workup. Each appointment is allotted the same amount of time. Wave Schedule multiple patients in the same time slot. First come, first served. Clinic Patients assigned time blocks by type. How are tests scheduled? Templates Types of Appointments Proportional 8:00 Short, Long 8:10 Medium 8:20 Short 8:30 Short, Medium 8:40 Short 8:50 Medium Wave 8:00 Short Long Medium Short 8:30 Short Medium Short Medium Clinic 8:00 8:10 8:20 Dry Eye 8:30 Post-op 8:40 Refractive 8:50 Retina Injection BRIEF < 5 minutes Brief Follow-Up Visits Infection Recheck Foreign Bodies Some Emergency Visits Quick IOP Checks (medication change) 1 Day Post-Ops INTERMEDIATE 5-9 minutes Dilation or Refraction (but not both) Interval IOP Checks VF Followed by MD Visit Subsequent Post-Ops Minor Surgery/ Laser Follow-Up LONG > 9 minutes Complete Exams Dilated Exams Cataract Work-Up Refractive Work-Up FAA Flight Exams Disability Determination 6
Sample Template 10 Patients Per Hour Consider a Return to Office Form Brief Visit Intermediate Visit Long Visit RETURN TO OFFICE 8:00 - B 9:30 - L 11:10 - L 1:40 - L 3:20 - B CEE HVF 8:00 - B 8:00 - B 9:30 - L 9:40 - B 11:20 - L 11:20 - I 1:50 - L 2:00 - B 3:20 - I 3:30 - L INT OCT 8:10 - L 9:50 - L 11:30 - L 2:00 - I 3:30 - L 8:10 - I 8:20 - L 10:00 - B 10:00 - I 11:30 - L 11:40 - B 2:10 - L 2:10 - L 3:40 - B 3:50 - L SHT PHOTOS O 8:30 - L 8:30 - I 10:10 - L 10:10 - L 11:40 - B 11:50 - B 2:20 - B 2:20 - I 4:00 - L 4:10 - I LAS O CLI 8:40 - L 10:20 - B 1:00 - B 2:30 - L 4:10 - L 8:50 - L 9:00 - B 10:20 - I 10:30 - L 1:00 - B 1:00 - B 2:30 - L 2:40 - B 4:20 - L 4:20 - I PT #: MD1 MD2 MD3 MD4 9:00 - I 9:10 - L 10:30 - L 10:40 - B 1:10 - L 1:10 - I 2:50 - L 3:00 - B 4:30 - L 4:30 - L RTO: DAYS WK MO YR 9:10 - L 10:50 - L 1:20 - L 3:00 - I 4:40 - B 9:20 - B 9:20 - I 11:00 - L 11:10 - I 1:30 - L 1:30 - I 3:10 - L 3:10 - L 4:40 - B 4:50 - B DX: The Process of Change Change Formula for Success: Define the objective for the change + Train people and give them the proper tools + Communicate expectations at all levels + Re-evaluate + Reward success Evaluate your process in this order: Considerations when transitioning to EMR 1. 2. 3. 4. Walk the office as though you are the patient. Conduct a time study. Develop a rational appointment schedule based on the time the doctor needs to see the patients, considering only 60 minutes per hour. Provide techs with tools to achieve benchmarks. This is the most significant change to medicine that affects patient flow processes Schedule adjustments, reduction Staff training on basic computer skills - not just EMR functionality Website/web portal: Accessibility of forms Placement of equipment and review stations Documentation: Use of a Scribe Printing glass prescription and Patient Education Material (e-rx, glass Rx to optical) 7
Propose Changes: a.k.a PILOT Your Practice is Different New appointment schedule Delegation of tasks between doctor and techs Number of techs, rooms, equipment, etc. FIRST Standardize as much as you can in the office (forms, chart organization, basic flow, etc.) NEXT Customize to each doctor s preferences and characteristics. How special tests are done Educate doctors and staff of proposed changes It s hard to exceed 80% of theoretical maximum Many factors affect the exam times: Size and layout of office Tech productivity preferences and characteristics Keep in Mind Summary You will need to keep an eye on the new template changes will be imminent. Use of scribes and/or techs will affect scheduling. This is a work in process. Different for each practice. At times there will be a need to override the schedule. Review, and if necessary, adjust your current scheduling template. Remember The goal of an ophthalmology practice should be to provide high quality, professional care, in the most efficient manner possible. It is 6-10 times more expensive to find a new patient than it is to keep an existing one. Objectives Revisited Questions? What 3 things will you do tomorrow, to improve your patient s experience, as a result of this program? 8
Thank You! 2012, Allergan, Inc., Irvine, CA 92612 marks owned by Allergan, Inc. APC70RF12 9