Published on the Dec. 19, 2011 DiagnosticImaging.com website
By Whitney L.J. Howell
It can happen to any practice. You have a full patient load scheduled for the day, but then a patient — or two — doesn’t show up for a study. Suddenly, not only is your schedule thrown off, but you’re also out the cost of any supplies dedicated to that appointment.
Patient no-shows have long plagued the industry, according to experts, with anywhere from 1 percent to 20 percent of patients either failing to cancel or simply failing to appear for scheduled visits. Anecdotally, radiology leaders estimate most practices have between a 2 percent and 5 percent no-show rate, and these absences can cause significant problems, they said. The Medical Group Management Association puts the national average for all specialties at 5.5 percent.
“I do think patient no-shows can be a tremendous disruption to practices,” said Christine Mayo, vice president of operations for PremierScan, a San Jose-based MRI/CT imaging center. “Some practices consistently see offenders from the same payer source or referring physicians. Regardless of the reason, it’s a great hassle.”
Why Patients Stay Away
A 2004 Annals of Family Medicine study pointed to three main reasons why patients don’t show up to see their providers. Some harbor negative feelings about seeing a doctor; others feel the clinic staff doesn’t respect their time and emotions; and many don’t understand the havoc a missed appointment can wreak on a practice.
But Casey Wheeler, a mobile PET/CT technologist with Idaho-based IsoScan, LLC, chalks a significant portion of patient no-shows up to one factor: human nature.
“People are afraid of bad news, so they operate on ‘If I don’t deal with it, then it’s not there,’” Wheeler said. “Many people don’t show up because they feel like they take back some control over their lives if they don’t get the test done. It doesn’t make sense.”
Others, he said, may view the studies as unnecessary. Those who have undergone repeated scans often contend an additional test won’t show anything new and opt to skip it.
The current economic climate also plays a role in many patients’ healthcare decisions, practice management consultant Elizabeth Woodcock wrote in a column for Medscape News. Lack of insurance or an inability to pay medical bills could push patients to forgo preventive services or delay elective procedures, such as diagnostic imaging tests.
What Happens When Patients Don’t Show
A practice with a daily (and common) average of four no-shows stands to lose nearly $150,000 annually, according to a 2009 Physicians Practice article. While all radiology practices feel the financial pinch when patients miss appointments, nuclear medicine practitioners are often at the greatest financial risk, Wheeler said. Unused radiopharmaceuticals, he said, can’t be used for studies at a later date. It’s a medical supply and money down the drain.
To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/2008579
Published in the December 2011 AAMC Reporter
By Whitney L.J Howell
As a surgeon, Robert Feezor, M.D., never expected he would eat earthworms at work. But as a father, he was thrilled to have the chance.
“It was Father’s Day, and they gave the dads earthworm ice cream,” said Feezor, assistant professor of vascular surgery at the University of Florida College of Medicine. “Basically, it was gummy worms in brownies, so it looked like earthworms in dirt. My son loved giving it to me.”
The treat came courtesy of Baby Gator, the medical center’s on-site day care facility where Feezor sends his three children—ages 5, 3, and 2—daily for a “stimulating educational child care experience.”
Accessible child care is one of the things that can add to the workplace attractiveness of an academic medical center. Baby Gator opened its on-site facility two years ago, joining other academic medical centers that have offered the same benefit—some for as long as 50 years. Many, including Yale and Stanford universities, have housed child care near hospitals and clinics for decades.
According to Sarah Bunton, Ph.D., AAMC research director of organization and management studies, longer hours of operation, close proximity to the hospital or clinic, and the possibility to see a child during the day make on-site day care a priority for faculty—both male and female.
“A dramatic change in the desire for on-site day care has been the increased number of fathers who want to be more involved with arranging care for their kids,” she said. “Through anecdotal reports from faculty affairs administrators and focus groups with select groups of faculty, more male faculty are also asking about and lobbying for this benefit.”
Baby Gator Director Pamela Pallas, Ph.D., said it was the medical school’s dean who first requested a location closer to the hospital.
“The dean called to tell me that top-notch residents were turning him down because he couldn’t guarantee he could offer appropriate child care,” Pallas said. “He was shocked child care was a deal breaker, but he wanted to know how we could get a Baby Gator close to the health sciences center.”
Within six months of opening, Pallas said, the center was at full capacity with112 children. There is now a waiting list 200 children long.
On-site child care is so popular, and the need for quality services so great, that parents scramble to put their children on waiting lists before birth. Some even make the attempt before conception. Jane Grady, Ph.D., associate vice president for human resources at Rush University Medical Center, once had a faculty member contact her upon getting engaged to ask if it was too early to put a yet-to-be-conceived child on the waiting list.
While the question amused Grady, who served as the first director of Rush’s Laurance Armour Day School, she was not surprised. Day care facilities at academic medical centers are more likely than other child care centers to have an educationally focused curriculum, making them a good choice for parents who already value extensive academic training, she said. Facilities on medical center campuses are also more likely to have highly educated staff.
“All our teachers have master’s degrees in early childhood education,” she said. “They are here to help the kids learn and have fun. We want to make sure they are well prepared for school at the same time we provide the excellent care the parents are looking for.”
During the 2008 presidential election, Feezor’s children learned about the various candidates and flags from different countries. When they learned about gardening, his 3-year-old enjoyed showing off the watermelon every time Feezor picked him up on the playground.
From the faculty perspective, paying for medical center-connected on-site day care can be easier than paying a center in the community, Grady said. Faculty can often choose from payroll deduction, using their health savings accounts, or monthly check.
Although these centers are coveted and provide an appreciated benefit to faculty, starting a day care facility is not always simple, said Phillips Kerr, director of compensations and benefits for the University of Massachusetts Medical Center-Worchester, which opened its facility in August 2010. The biggest stumbling block is finding an adequately sized space, as well as the funds to complete renovations, hire staff, and purchase necessary resources. In fact, he said, the best option could be outsourcing the day care’s administration.
“Fortunately, the university owned the space we used for the school,” Kerr said. “But rather than build everything from the ground up, the university decided to partner with an existing company to run the school. It’s been a positive experience.”
To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268878/childcare.html
Published on the Dec. 6, 2011 DiagnosticImaging.com web site
By Whitney L.J. Howell
Over the past 20 years, not only has clinical instruction during radiology residency changed, but so has the practice life that comes after it. Even as a growing number of medical students select radiology as a specialty, practice-setting preferences have shifted for your younger colleagues. They also have a different set of priorities to consider.
Unlike generations past, most radiology residents don’t transition directly into practice. Almost all continue on to fellowship training, preparing themselves for sub-specialty practice. The extra training prepares young practitioners for clinical care, but it does little to get them ready for the realities and complexities of day-to-day practice.
“As an industry, radiology doesn’t do enough to prepare our residents,” said Keith Smith, MD, former director of the radiology residency program at the University of North Carolina at Chapel Hill School of Medicine. “Largely, residents are very focused on passing their board exams and have very little mental energy left for other things. We do talk about life in private practice and billing and documentation, however.”
And, from those conversations, he said, it’s appears that the majority of radiology residents are forgoing private practice for the security of an employment position with a hospital or larger physician practice.
Be Cordial and Cooperative
After residency, the first priority for new practitioners must be changing how their view relationships with referring physicians, Smith said. Residents often maintain an “us versus them” mentality, fostering contentious interactions.
“Many residents look at requests for service from other departments as additional burdens,” he said. “They react with dread when asked to do things when, once they’re out in practice, they begin to see it as a paycheck. Having a good working relationship with referring physicians and understanding their needs can be very helpful.”
Ben Huang, MD, a UNC radiologist who finished residency in 2005, said he once viewed requests from referring physicians as a waste of his time. As an attending today, however, he appreciates the need for collegiality between radiologists and other specialties.
“When I was a resident, I tended to be more obstructionist,” Huang said. “I let the attendings make the final calls, so it didn’t matter if I were diplomatic with the referring physicians.”
But cultivating relationships with referring physicians has been advantageous for him. Primary care providers and other physicians have gotten a clear sense of who he is as a radiologist over time and are comfortable sending their patients to him for diagnostic imaging services. This is increasingly more important as radiologists are becoming a more involved partner in patient care, advising on image appropriateness, a new role spurred by healthcare reform and patient safety initiatives.
To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/2001863
Published in December 2011 MedMonthly Magazine as Cover Story
By Whitney L.J. Howell
Step inside an office in a long-standing San Francisco financial building, and you’ll see smooth, heavy timber columns and exposed wood joists. The brick walls are accented by modern colors, and three large lamps strike a dramatic image over a wood veneer reception desk.
With this sleek appearance, any visitor would be forgiven for assuming he or she had entered the headquarters of a progressive venture capital firm. But this is, in fact, the home for One Medical Group, a patient-centric, primary care medical office that offers longer, same-day appointments.
“There’s been so much buzz in San Francisco about One Medical Group,” said Justin Martinkovic, principal and co-founder of MMA Medical Architects, a San Francisco-based architectural firm that specializes in designing modern medical offices for all specialties. “People have been known to walk in and think they’re in the wrong space. It’s just not what you expect a doctor’s office to look like.”
And, that’s exactly the intent, he says.
For so long, medical offices have been seen as sterile, functional spaces. Today, however, the health care environment is shifting toward boosting patient satisfaction, and your reimbursement rates will soon be tied to how happy your patients are with the time they spend with you. The impact on your bottom line has prompted many of you to search out innovative ways to set yourselves apart from your competitors.
This is where firms like MMA Medical can help. Over the past decade, they’ve redesigned nearly 50 medical offices.
“We’ve detected a pattern among doctors who are more concerned with how they are perceived and the image they project,” Martinkovic says. “They want to distinguish themselves while still showing patients they have a high level of competency.”
Through a collaborative process, MMA Medical work closely with their doctor-clients to design a welcoming space to not only make existing patients feel more at home, but to also help attract a new, broader clientele.
How It Works
Doctors are often very particular, Martinkovic says. They come to the firm with a clear idea that they want – something. This is where the interview process truly begins. A design team sits down with the physician and runs through a litany of questions. What are your priorities? What is the culture of your office? What specific needs do your staff have? What is the ultimate goal of this redesign? These conversations help the team suss out any space or capital investment challenges.
“The initial interviews are our most intense interaction with the doctors. Through our conversation, we find out what they want and what their routine is,” Martinkovic says. “It’s also a chance for them to really identify what systems they have in place that they like and that work well and what things they need to shed.”
During the next three phases – schematic design, design development, and construction – doctors watch their original office spaces transform into more efficient, patient-focused, streamlined medical facilities. Team members usually present three or four potential designs, and doctors have the final word on which features they want to include, which materials they want to use, and which contractors will do the work.
Beyond that, they can be as involved or as laissez-faire as they choose.
What Changes You Can Expect
At every turn, the health care system is revamping how you practice medicine – the biggest change being the push toward increased health information technology adoption. With the expanding use of digital tools has come a greater need for you to be mobile with laptops, iPads, or tablets.
MMA Medical’s latest design efforts focus on accommodating those needs and making the most efficient use of your space. For example, at Golden Gate Ob/Gyn in San Francisco, most of the private offices have been eliminated. Instead, the design team created work stations – 2 ft x 2 ft spaces with a spot to plug in their laptop and printer – where multiple providers can transfer notes from their mobile devices and input data into patient charts.
Design teams have also made changes to take advantage of cloud-computing. Electronic records once meant you had dedicated space for your system server. Keeping your records in the ether means architects have two options: they can either slice the space devoted to your back-up system to a small closet or move it offsite completely.
“By using the work stations, moving away from private offices, and devoting less space to housing technological equipment, we’re able to focus on patient areas,” Martinkovic says. “Waiting rooms are getting elaborate designs, and it’s all enhancing the patient experience.”
The days of worn upholstery and sliding windows that separate receptionist from patient are gone. Doctors are now looking to infuse part of their personality into the office design, and patients are beginning to expect spaces that are more relaxing and less intimidating.
It’s an added plus, he says, when the design can play off of the doctor’s specialty, as it did with Holland Medical Eye Center in Daly City, Calif. The retail space is often integral to an optometrist’s office, so the architects mimicked the look and feel of glasses when designing the curvature of the walls and desks and orchestrating the lighting so it reflected off surfaces as it does off spectacles.
Healthy Design for the Health Care Provider
Your initial capital investment might be higher, but perhaps one of the biggest benefits that comes with modernizing your office space is the opportunity to go green. Although medical offices are considered to be places that promote health, they have historically been constructed out of “sick” materials, Martinkovic says.
“If you’re going to be charged with keeping people healthy, then a good step is to remove as many toxic pollutants as you can from your office,” he says. “We can also take things a step further and increase an office’s energy efficiency.”
Vinyl flooring, because it is constructed from harmful petrochemicals, is a major culprit in releasing toxins into your office, he says. Any new design should offer you one of three choices for flooring: wood, linoleum, or cork. When properly cleaned and sealed, wood is very resilient. Linoleum is inexpensive and safer than vinyl because it is made from non-toxic linseed oil. Cork can also be easily cleaned and is softer to stand on during an eight-hour day.
In addition, MMA Medical redesigns only use low VOC (volatile organic compound) paints. Removing the VOCs eliminates the chemicals that could induce breathing problems, headache, burning and watery eyes, or nausea in your patients.
Green design can also lower your utility bills. Energy-efficient lights, such as LED or fluorescent lighting, and an energy-efficient HVAC system can reduce your electricity consumption. Martinkovic says designers also build in low-flow water systems to control the amount of water medical offices use each day.
Things to Consider
Giving your office a facelift can be exciting and revitalizing for both you and your staff. But there are many things to consider before you jump in, Martinkovic says.
First, have a frank discussion with your design team about your budget, what the design and construction will cost, and how long it will take. Be prepared for a four-to-six month process. If you haven’t re-outfitted your office before, you could be in for sticker shock. The cost to you will vary by what features you select and by your regional location.
Second, identify your new location and how it will affect your existing and new clients. In this process, you should also determine who your ideal patient is. That model can help you decide which design features will be most appealing to your clientele, he says.
Last, think through the image you want to portray.
“Consider your office to be your suit,” Martinkovic says. “It’s the first impression your patients have of your practice and who you are as a physician.”
To read the story in magazine form: http://issuu.com/medmedia9/docs/mm-decemberweb/27
Published in the December 2011MedMonthly Magazine
By Whitney L.J. Howell
Everywhere you look, the recent economic downturn has forced budget cuts. Health care is no different – and it’s likely that your practice or hospital has also been obliged to trim its spending. There are, however, ways to work within your means and still meet the necessary patient care and safety standards.
One hospital system, the University of Iowa Hospitals and Clinics, found its answer in a pathology lab call center. Manned by official lab staff, the call center gives its health system physicians immediate access to expert pathology information without pulling lab scientists away from their duties.
“Asking a scientist to leave his or her work when a call came in left whatever sample was being analyzed just sitting on the table,” says Sue Zaleski, pathology lab manager. “Dedicating people and a space to answering calls helps with efficiency, quality control, and error prevention.”
So, in 2005, with support of her administration, Zaleski launched the call center in a room adjacent to the lab. She hired a telemarketing professional to structure the center and train the scientists to focus on customer
service. Merging telemarketing expertise with the intricacies of a highly technical environment is the bedrock of why the call center has been so successful, she says.
Each day, 10 certified lab scientists field, on average, more than 150 calls from health care provider offices. The questions vary widely, including inquiries about which type of blood draw is best for a particular test or how to transport certain samples.
The scientists rotate through the call center on a schedule, and these shifts are an added responsibility on top of their work with analyzing samples. Zaleski says she has been surprised by how much taking on call center duties has improved her lab scientists’ job satisfaction.
“The scientists love it when their turn for the rotation comes around,” she says. “It gives them a nice break – the call center is quiet. They can sit down for a few hours, and they get to pair their research skills with their technical knowledge to help people.”
While the scientists enjoy a break from their regular routine, the benefit to the University comes from the increased efficiency in analyzing samples, she says. There’s no cost savings, but boosting the number of samples scrutinized daily is an improvement in lab productivity.
The call center is also valuable because it allows the scientists to focus their attention and speak directly with providers. This is particularly important with urgent requests about high-priority samples. Under federal health care regulations, certified lab scientists can only provide critical value notifications to licensed care providers. The call center’s single focus has helped the lab truncate its response time on high-priority samples to less than 15 minutes.
Fielding calls from health care providers also gives the lab scientists an opportunity to share their pathology knowledge one-on-one. Not only can they pull from their own extensive knowledge, but they have access to an arsenal of research sources that can augment the answers they provide.
Thanks to the telemarketing professional, each scientist has received extensive customer service training, including how to speak articulately and with empathy, listen closely to the caller and master the available reference materials to find information quickly.
Despite being in operation for a few years, Zaleski says the health care providers who contact the call center haven’t offered much feedback. At first, the silence bugged her, but she now says it’s not a negative sign.
“We were initially deflated because no one gave us any idea of what their experience with the call center had been,” she says. “But we soon realized that when you do something well, especially for a group as busy as health care providers are, you don’t leave much of an impression. It’s when you do things poorly that you hear about it. So, we’re taking no reaction as a good thing.”
That doesn’t mean the call center isn’t keeping track of its own performance. Each call is recorded to keep tabs on how long it lasts, the number of times the caller is transferred, and how long it takes the scientist to supply an answer. The audio files are also used to protect the scientists who speak with providers. They can support the accuracy of provided information or reveal if a caller demonstrated problematic behavior, Zaleski says.
If you’re considering a lab call center to increase productivity and smooth communication between your health care providers and the pathology scientists, there are a few points to remember, Zaleski says. First, take a look at your certified lab staff and how they go about their daily work. What do they do with their existing resources? How would the additional responsibility of working in a call center affect their current responsibilities and job satisfaction? If all signs point to the need for a call center, take the idea to your administration and get proper buy-in from facility leaders. Ultimately, the long-term impact for your institution could be very positive.
To read the story in magazine form: http://issuu.com/medmedia9/docs/mm-decemberweb/13