Medical Office Management in an Era of Administration Overload

By Clark Veet, MD, MS

The changes that affect medical practices keep coming. Pressures range from new technology, remote work, and an aging patient population to more administrative requirements and metrics from insurers. While the concerns are many, administrative duties tend to top the list when speaking of physicians and the chronic fatigue they’re feeling. Results from a recent Doximity poll show that 46% of physicians believe decreasing administrative burden would be the most effective intervention in reducing exhaustion, followed by improving work-life balance (27%), and reducing clinical caseload (21%). (1)

As health care systems continue the large-scale task of morphing themselves into more streamlined organizations, employed and independent practices have exercised innovation to make improvements in their own offices. It’s no longer just a smart thing to do, supreme efficiency has become a matter of survival. In this overview of what’s been changing, we’ll start with a look at some general steps any practice can take to increase office efficiency, but these mostly apply to private practices that are operating autonomously.

The Basics

Independent, private practices need to work smarter to meet requirements and keep everything running smoothly. These clinicians may not have supportive organizations with economies of scale that can make it easier to handle administrative tasks, maintain adequate IT support, reduce costs, or deal with other challenges. However, certain basic actions can benefit the independent – or employed physician – in ways that are simple yet effective. For example:

• Map out the Patient Journey. Sketch out how a patient moves through the practice and note every point of contact and documentation requirement. Look for bottlenecks, unnecessary actions, and steps that fail or that require rework. These are the areas you’ll need to expend effort on to find better, faster, or more successful approaches.
• Match Capacity with Demand. When your practice team knows its capacity constraints and demand patterns, it can make changes to align with demand. When both are matched, delays in care can be reduced. Having the right staff to handle all aspects of the practice, and ensuring accurate training, will help things flow more efficiently.
• Dictate Whatever You Can. Technology has lent a hand when it comes to taking time to write everything down. There’s no need to with the digital tools available today. Make it normal practice to dictate exam notes – ideally when you’re still in the exam room with the patient so you can remember every detail – as well as notes made during hospital rounds. The more you can dictate, the less work later.
• Create a Team Culture (Even with a Few Employees). Communication among the practice team is essential. Meet regularly, at a consistent time, with clear focus, frequency, and format. Use agenda templates to keep the conversation on point. An assigned recorder for each meeting can keep track of action items, assigned point persons, and due dates that come out in discussion.
• Manage Pharmaceuticals. Drug purchasing contracts should be aggressively negotiated for the best available prices, making sure that you are not paying more than what’s reimbursed according to the average sales price. Because these amounts can change every quarter, contracts for drugs should be reviewed quarterly and may need to be negotiated more than once a year.
• Lengthen Prescriptions for Chronic Medications. If you’re in the habit of authorizing prescriptions for 90 days, consider a one-year authorization instead. (Continue to see your patients at the same frequency so you can monitor their care and medication use.) By extending prescriptions, you will cut down on phone calls and messages related to refill requests.
• Get Clear on Coding. Practices that utilize EMRs have assistance with coding and documentation, with alerts and notifications that will pop up and provide information. Even if you don’t, practitioners need to be up to speed on how to code accurately and with specificity, as this makes everything from patient exams to reimbursement more efficient. For assistance: Comprehensive Listing ICD-10-CM Files
• Focus on Patient Satisfaction. Independent practices can make it easy for patients to leave feedback by automatically sending survey requests via text or email. Surveys capture patient input and allow medical practices to make continual improvements in the care they provide. Making changes that relate directly to the patient experience will add to efficiency.
• Join a Physician Organization. Larger entities like PHOs, ACOs, and IPAs can help small and medium-sized, physician-owned practices in areas such as network access, timely receipt of performance data, and sustainable and fair payment rates. Some organizations provide education on the business of running a practice. Being part of an organization also aids in the ability to assemble a cache of legal, financial, real estate, and marketing advisors.(2)

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