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Fam Pract Manag. 2006;13(6):69

Identify patients who need a checkup

On slow days in the office, I pull charts looking for patients who are overdue for a checkup. I start at one end of the chart rack and gradually work my way to the other end. I used to have one of my staff do this, but I've found I can do it more quickly and easily myself. I give my receptionist the charts of patients who need to be seen, and she calls the patients to schedule appointments. We get quite a few visits this way, and it helps even out seasonal fluctuations.

Remember to consider 99214

After missing the opportunity to code many level-IV visits simply because I hadn't documented the review of systems as thoroughly as the Documentation Guidelines for Evaluation and Management Services require for a detailed history, I took a new approach. I now write “ROS” in the margin of my progress note when I sense that an office visit is more work than the average. As the visit evolves, this reminds me to document the encounter in a format that meets the requirements for a 99214 and, when it's time to choose a code, to consider whether 99214 is appropriate.

Reconsider records requests

When requesting old records, stop and ask yourself, “What do I really need to review?” Processing a comprehensive request often entails an incredible amount of effort for your office, as well as that of the patient's former physician, with little productive yield. After years of shuffling through transferred records, I have determined that faxes of handwritten notes are practically useless. Typed history and physical documentations, discharge summaries and consultation notes are of greatest value. Diagnostic test results and lab reports no more than five years old generally round out the useful data. If all practices instituted conservative records request policies, it would save everyone time and money.

Create an electronic filing cabinet

I like to provide patient information, but I don't like to waste unused copies and spend extra time keeping the handouts up-to-date. I've found that storing links to Web-based patient handouts on my computer works best. I store Web addresses of my favorites in a file I created using Microsoft Word. To make your own list, create a new document using your word processing software. Open your Web browser (e.g., Internet Explorer) and go to the patient handout you want to include in your list. Click on the icon that appears next to the Web address in your browser's address bar, and drag it into your word processor page. The word processor can even keep the list alphabetized for you. (In Microsoft Word, go to the “Table” drop-down menu and then choose “Sort.”) Patient handouts that aren't accessible online can be incorporated into the file by scanning them. Then they can be copied and pasted into the file, and stored alphabetically with the Web sites.

Using this method, I can easily access the list, click on the link, print the handout and give it to the patient as I escort him or her to the door.

Build staff morale

I recently implemented an “Employee of the Month” program where employees vote for the staff member they believe deserves this recognition. I collect responses via e-mail and tally the votes before our monthly staff meetings. At the meeting, the chosen employee is presented with a certificate from our nurse practice manager, and I explain why the employee was awarded the recognition, using the comments written by the other staff. The staff member also “wins” a special parking space reserved for Employee of the Month. This effort has produced huge dividends in increasing morale in our clinic.


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Copyright © 2006 by the American Academy of Family Physicians.

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