Best Practices the Front Office

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Best Practices:The Front Office

Removing the Roadblocks to Efficiency

Kathie Huttegger, MBA,, CMPEAdministrator

St. Louis Pediatric Associates, Inc.



• Define Reality

• Identify the bottlenecks

• Increase efficiency


The Right Questions– What is a “best practice?”

– What are the functions of the “front office?”

– Definitions of some key principles


Defining Reality

• Max DuPree – Leadership Is An Art

• “The first responsibility of a leader is to define reality. . .”


Wrong Jungle


Defining Reality - Differences• Primary Care versus Specialist• Single Specialty versus Multi-specialty• Number of sites• Ancillary service offerings• Use of midlevels• Cost or accrual based accounting• Physician compensation• Payor mix• Many other variables (triage, billing, etc.)


Defining Reality - Similarities• Provide medical services• Face increasing costs• Struggle with reduction in payment• Patients• Staff• Physicians


MGMA Best PerformersIn Three Critical Areas

• Profitability and operating costs

• Productivity, capacity and staffing

• Accounts receivables and collections

See “Key Indicators” Handout – Expanded Quantifiers of Better Performing Practices


What are the functions of the front office?


Front Office Multi-Functional


Director of First Impressions


Can Help or Impede Patient Flow


Touches Revenue Cycle at Multiple Intervals


Removing Roadblocks to Efficiency

• Throughput = Money coming in (profit)

• Operating Expense = money going out to make throughput

• Inventory = Money stuck inside


Bottleneck• A resource whose capacity is equal

to or less than the demand placed upon it.

• The flow through the bottleneck must equal the demand from the market.

• Capacity of a process is the capacity of its slowest resource


Bottlenecks or Roadblocks• Crowded reception area

• Irritable patients

• Financial underperformance

• Burnt out staff


Causes of Bottlenecks• Too much paperwork• Poorly planned processes• Inefficient office design• Miscommunication between staff• Poor scheduling


Productivity• Accomplishing something in terms of

goals• Meaningless if you don’t know the

goals


The Goal• Reduce operational expense

• Reduce inventory

• Increase throughput– More important to increase volume– Expand hours with providers with no

increase in fixed costs– Incorporate efficiencies to increase

patient volume


What is Our Goal?• The Right Number of Staff• In the Right Place• With the Right Skills• At the Right Cost• With the Right Behavior• With the Right Rewards• With the Right Outcomes• No More – No Less

Deborah L. Walker 2003


The Goal Defined by Jim Collins

• Get the wrong people off the bus

• Get the right people on the bus

• Get the right people in the right seat on the bus

In “Good to Great” the bus doesn’t leave

until . . .


“Count what is countable,

measure what is measurable,

and what is not measurable,

make measureable”

Galileo Galilei (1564-1642)


“You cannot manage what you

cannot measure and

what gets measured gets done!”

Bill Hewlett


Dynamic Relationship of Staffing Levels With

Accounting Functions


Physician Time• Data suggests that

most critical resource in a medical group is physician time • Profit is a function of

productivity and the cost of the resources that enable productivity


Waiting Room Time

“Yes, I have an

appointment. Should I also have made a

reservation?”


Standard Production Measures• Telephone calls w/messaging 180-200

• Appointment scheduling 75 – 125

• Check-In with registration Verification and copay collection 75 – 100

• Check-Out with schedule of return appointment and charge entry70 - 90


The Peasant and The King


Management’s job is not to see

the company as it is . . .

But as it can become.

John W. Teets


RE-ENGINEERING THE FRONT OFFICE

• R eliable• E fficient• S ervice• P atient-Focused• E nergy• C ustomization• T rust

• Click to edit Master text styles• Second level• Third level• Fourth level• Fifth levelPut the Cookies on the Lower

Shelf


S N A P• Smile

• Name

• Ask “May I help you?”

• Parting comment


The Five Whys



• Define Reality

• Identify the bottlenecks

• Increase efficiency


You are NOT Alone . . .• Books

– The Total Service Medical Practice by Vicky Bradford, PhD– Mastering Patient Flow by Elizabeth Woodcock, MBA, FACMPE– Good to Great by Jim Collins– The Goal by Eliyahu M. Goldratt– The Fifth Discipline by Peter Senge– All books by John Maxwell

• Medical Group Management Association– Local www.mgma-sl.org– State www.mgma-mo.org– National www.mgma.com

• Other Organizations– American Academy of Family Practice www.aafp.org– Organization of your specialty– The Journal of Medical Practice Management

http://www.mgma-sl.org/

http://www.mgma-mo.org/

http://www.mgma.com/

http://www.aafp.org/


Our Role As Leaders . . .

Finding the gifts people have to give

Inviting them to give them, and

Honoring the result when they do


DON’T GIVE UP . . .

Best Practices the Front Office

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