Pulling up charts. Phone tag. Prior authorizations. Rinse, repeat.
Reminiscent of Groundhog Day, the daily grind in running a mental health private practice rarely gives way. Some days may have more faxes to be processed than others; some may require more phone screening of prospective new patients. But on the whole, there’s no escaping the tedium and time evaporation that these less than gloomy chores necessitate. In some practices, an assistant has to be hired to absorb the barrage; if not, it is left to the psychiatrist or therapist him/herself to handle – at the expense of time for patient care, or life outside of practice.
Compounding matters, reducing time spent on administrative matters can feel like a Sisyphean task: the energy required to improve systems is seemingly more than what is already being expended. For example, switching from paper-based to electronic systems can be tantalizing, but incurs its own learning curve and has its own set of issues, namely security and financial cost. Likewise, hiring administrative help demands a significant investment in training time, and expense, and if patient contact is part of the job description, trust must be built up over time as the employee becomes the public face of your practice. Fortunately, both of these options eventually pay dividends in the long run.
Even with some basic strategies, though, what seems like the inevitability of inertia can be reshaped into a more efficient, less quotidian experience. Here is a basic checklist that covers the most common private practice time wasters:
Patient-care related time wasters
The typical process is to call the insurance company and have the paperwork faxed, or to talk with a pharmacist on the phone. Either way, at least 15 minutes can be burned simply being placed on hold or being transferred. Instead, ask the patient to call the insurance company (they should get the phone number from the pharmacist, and be given your fax number), and request the paperwork be faxed to your office. If s/he is told by the insurance company that the doctor has to make the request, instruct him/her to explain they are merely facilitating the faxing; but to call again and speak with a different agent if necessary.
Even the act of listening to a long voicemail can take time. Using a transcription service may be expensive, but actually less expensive than the time you are spending if you get lots of voicemails. Or, use a service that provides computerized transcriptions – while less accurate, they are much less expensive, and often allow you to skim adequately.
If not scheduled while in session (and using clinical care time to do so), booking followup appointments with patients can be tedious. As an alternative, offer on-line scheduling through your EMR or a standalone service that allows you to retain tight control over what times you are available and how soon and far out patients can book. Be sure that only your current patients (and perhpas colleagues to schedule phone calls) have access to your calendar.
Patients routinely opt-in for auto-refill requests at their pharmacy, believing it to be a no-brainer for conveience sake. However, for psychiatrists who are only prescribing enough refills to last to the patient’s next appointment, these requests can become a burden as they shouldn’t be ignored, but shouldn’t necessarily be acted upon, either. Often time is spent clarifying with the patient if a refill is really needed; and patients sometimes use these requests as a way to bypass having to come in for an appointment (either consciously or unconsciously). As an alternative, request your patients to opt-out at the pharmacy, and to contact you directly if they are about to run out of medication – which more than likely is an indication an appointment is needed, which they should book.
An inordinate amount of time can be spent making sure a prospective patient requesting your services is a good fit, both clinically and from a scheduling and payment perspective. Save time by having a simple pre-screening process that conveys that you are concerned, yet want to make sure certain criteria are met before you engage in a deeper consultation. This is where having a trained assistant, or an electronic pre-screening option, can come in very useful.
Pulling up (and using) electronic charts
A common complaint of users of EMRs is that they are clunky, convoluted, slow and that the EMR “flow” does not match the provider’s. While each extra click may only take a few seconds, it is the loss of rhythm that is most draining and leads to a dissatisfying, tiring feeling. Make sure when selecting an EMR to begin or switch to, that the “user experience” is treated as importantly as the actual ability to produce a record is.
Write or print, fold, place in an envelope, put a stamp on the envelope, address the envelope, take it to the mailbox. Need more be said about how inefficient this is? Use your EMR, a biller, or billing software to send statements automatically.
Of course, make sure that any method that employs technology or outsourcing to a service has appropriate Health Insurance Portability and Accountability Act safeguards.
Keep private practice time wasters in check
Running a practice gives psychiatrists at least some freedom to set their own schedule and policies, and to do the kind of work they enjoy doing. With that freedom, however, comes the responsibility of processing all of the administrative tasks that accompany psychiatric care. While some of these can be delegated, finding ways to handle them efficiently means improved morale and more time for patient care.
This post originally appeared in Current Psychiatry 2015 August;14(8):47-48.