Make scheduling job No. 1
Make your best office staff person responsible for scheduling. Think of your schedule as your wallet. You wouldn’t hand your wallet over to just anyone, and you should afford your schedule the same care and protection.
Implement disease-specific dictation reminders
I have devised dictation reminders that reduce errors by helping me adhere to evidence-based guidelines for chronic disease care. I keep them taped to the edge of my computer screen. It’s not fancy or high-tech, but it certainly helps me provide better care.
For example, one reminder reads as follows:
Type 2 diabetes – (controlled or uncontrolled) on (medications). Last A1C (result) on (date). Blood pressure (controlled or uncontrolled); currently on (medications). Last FLP shows LDL of (result) on (date). Urine microalbumin (result) on (date). ACE inhibitor ________. Ophthalmologist examination (result) on (date). (Is or is not) currently taking daily aspirin. Monofilament foot exam (result) on (date). (Smoker or non-smoker).
When dictating a note on a patient with diabetes, I simply fill in the blanks as I go. I know that if I address everything in the template, I am providing good care. Dictating the first note for a patient can be a bit cumbersome as I look through the chart to find the necessary information, but that’s what good diabetes care entails. If I don’t know all of this information, then I don’t really know if the patient’s diabetes is being treated appropriately. If I find that the patient is not to goal for his or her LDL or is not taking a daily aspirin, I note that in the plan so that it can be addressed at the next visit.
Find the Medicare allowable for a particular service
To determine what the Medicare fee schedule allows for any service, use the Centers for Medicare & Medicaid Services Web-based tool at http://www.cms.hhs.gov/physicians/mpfsapp/step0.asp. Enter a procedure code (you’ll be instructed to enter a HCPCS code, which includes Level I CPT codes), and you’ll find pricing amounts, global periods, payment policy information and relative value units. You can limit your search to a specific Medicare carrier or a particular region, or you can get national results.
Surprise your staff with extra paid time off
From time to time, we offer our staff some unexpected paid time off to participate in events that are important to them, such as a child’s school play or a family occasion. We can’t do this for every event, and of course we have to be equitable, but we find it well worth the effort to make this work whenever possible. Try this statement: “You need to be there for your family. Get out of here and enjoy your time.” Your employees will thank you with extra productivity, a more positive attitude and a willingness to go the extra mile for you, just as you did for them. At my former practice, our original staff was still going strong after four years.
Systematize exam room restocking
The file cabinets in our exam rooms are stocked with frequently used patient education handouts, requisitions and other forms. The third-to-the-last copy in every file folder is marked with the exam room number; it’s marked with a highlighter pen, so it won’t reproduce when additional copies are made. When the supply dwindles to this point in a particular room, the physician attaches this “master” copy to the chart-holder just outside the exam room, which notifies staff of the need to replenish that supply. A laminated card that we store in the speculum drawer is used the same way. This allows staff to restock rooms in a targeted fashion with a quick glance down the corridor, and the labeled “master” copy helps staff remember which room needed the item if they get interrupted.
Don’t let your numbers tell the story
To effectively communicate financial or performance data to your staff, be sure you distinguish the key points you want to make from the evidence that supports them. Too often, leaders present the evidence before the message or present the evidence alone. Follow this approach for clearer communication: 1. Make your key points. 2. Present your supporting information (and be selective). 3. Deliver a message that is consistent yet sensitive to the needs of the audience. 4. Follow up to make sure your key points were understood.
Make well-informed decisions
Recognize that your position as a leader might hinder you from getting the best information on which to base important decisions. To counter this, stimulate dialogue and debate among your staff by asking Socratic questions, listen carefully to the answers, encourage independent thinking and value the disagreement that develops before making the call.
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