“The doctor’s job is to go from CPT code to CPT code as efficiently as possible,” said Richard C. Haines, Jr., president of Medical Design International (MDI) in Atlanta. “That doesn’t mean doctors have to hustle, but you should organize your systems to reflect each doctor’s production, whether four patients an hour, six an hour or more, so the doctors can move easily and succinctly through their patient encounters.”
Explore this issue:October 2011
Rethink Exam Rooms
To determine how to improve coordination of care, Michael Benninger, MD, chair of the Head and Neck Institute at the Cleveland Clinic, modeled the number of staff and exam rooms needed to optimize efficiency in an otolaryngology office. A solo physician in an office setting should have three exam rooms and “one-plus” medical assistants (MA) to manage the rooms, Dr. Benninger said. A practice can select 1.25, 1.5 or 2.0 full-time equivalents, “but you need someone who’s moving patients in and out of each room and another individual who can help clean scopes and handle anything that falls behind.”
The model is designed for otolaryngology practices that perform procedures on a majority of patients, since the additional staff member’s role includes cleaning and preparing scopes and setting out instruments and sprays. “I can go into an exam room, say hello to the patient, take a quick history, spray them and then go to the next room while the first patient is decongesting,” Dr. Benninger explained.
Having three exam rooms and two MAs per physician “is fairly expensive,” he conceded, “so a more cost-efficient model is to have two physicians in the office at the same time, because you can get by with five rooms and two or three support staff.”
You should also make sure to allow sufficient exam room space. Layout is critical to physician productivity, because “there’s a finite amount of work that a given number of exam rooms can produce,” said Haines. “If a doctor has a high production capacity, the exam rooms might be the limiting factor.”
An otolaryngologist who can see eight patients an hour should have a dedicated exam module that contains at least four exam rooms, a physician’s station, and sufficient MA support, according to Haines. The practice should have different sizes of modules depending on the physicians’ subspecialties and practice styles. If your practice is unable to make large renovations, consider small changes that might improve efficiency. In Dr. Benninger’s exam rooms, the computer screens and terminals are located on a rotating scaffold that is attached to the wall and can be moved 180 degrees and pushed out of the way to accommodate patients on stretchers or in wheelchairs.