Clinic Ins and Outs- MA’s, Scribes, APP’s

Started by TeslaCoil
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TeslaCoil

TeslaCoil

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Its looking like Im going to be building a HOPD clinic up from the ground. There is a strong internal referral base. Id like to be at around 10,000 wRVU’s by the end of year 2. Looking for any tips on how other places have achieved this. Im hoping to maybe get them to agree to at least 2 patient facing MA’s who will also function as scribes. They are already looking to hire an APP as well. Would love to hear from colleagues what strategies work well for running an efficient and productive clinic. Thanks!
 
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TeslaCoil said:
Was thinking they would function independently for med refills whilst also feeding me procedures. Why what structure do you have/envision?
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Depending on set up, med refill is level 4 visit. If you can make those 10 minutes each, it’ll be quick wRVU.
Highest pay/time is mbb/RFA. So if you get NPs, they can feed those to you more and let you do more procedures. That’ll take some time to build so don’t do NP from get go is what I believe bobbarker is trying to say
 
SpineandWine said:
Depending on set up, med refill is level 4 visit. If you can make those 10 minutes each, it’ll be quick wRVU.
Highest pay/time is mbb/RFA. So if you get NPs, they can feed those to you more and let you do more procedures. That’ll take some time to build so don’t do NP from get go is what I believe bobbarker is trying to say
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I do agree. But how many MA’s do you have rooming patients and are they charting etc. how many patients per day? News vs follow-ups? Block schedule? Etc
 
If it’s hospital based, and you are not responsible for paying salaries, then you need lots of mas and rns. There is the endless check in for even follow ups. I m sure the nurse takes longer to check in a new patient than i did to do a new patient consult. So you want two nurses checking in clinic patients for just you. Otherwise you are waiting for patients
 
TeslaCoil said:
Its looking like Im going to be building a HOPD clinic up from the ground. There is a strong internal referral base. Id like to be at around 10,000 wRVU’s by the end of year 2. Looking for any tips on how other places have achieved this. Im hoping to maybe get them to agree to at least 2 patient facing MA’s who will also function as scribes. They are already looking to hire an APP as well. Would love to hear from colleagues what strategies work well for running an efficient and productive clinic. Thanks!
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If you are doing all of that just start your own practice and you will make more than 10000wrvu x whatever in two years
 
TeslaCoil said:
Its looking like Im going to be building a HOPD clinic up from the ground. There is a strong internal referral base. Id like to be at around 10,000 wRVU’s by the end of year 2. Looking for any tips on how other places have achieved this. Im hoping to maybe get them to agree to at least 2 patient facing MA’s who will also function as scribes. They are already looking to hire an APP as well. Would love to hear from colleagues what strategies work well for running an efficient and productive clinic. Thanks!
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Not gonna happen
 
Agreed, absolutely do not need a midlevel. I am HOPD, I have 1 MA (who does not scribe), 2 receptionists, and a small army over at the hospital for procedures. You do not need much staff in the clinic itself to be highly productive, but if HOPD employed certainly not a bad to ask for as much as you can get. Procedures are where it’s more beneficial to focus on having them hire more. The quicker patients are in and out, the more procedures you can do. I have circulator, scrub, fluoro tech, and 2 other people helping with tasks (including my MA) over in the room, plus the hospital pre-op/PACU staff. I do about 7 injections per hour (including bilateral RFA) with this setup. I hit 15,000 RVU this year working 4 days a week, in my 2nd full calendar year at this job.

I do have about 1/3 of my procedures who come from another doc in our clinic (internist who does med management and in-office joint injections/TPI) who was there when I started. But you certainly don’t need anybody else when you’re just starting out. Wait until you’re seeing 40 a day and then look into getting another doc.
 
See all the patients yourself until overwhelmed with volume. You only need 4000 encounters to get there(10kwrvu). If you do med management you only need a few hundred chronic refill patient s to get you halfway there. 200 pts times 10-12 visits a year times 2.5.

I always have 1 ma and 2 nurses on the clinic side and the same on the procedure side not counting X-ray tech and reception etc
 
Ronin1 said:
See all the patients yourself until overwhelmed with volume. You only need 4000 encounters to get there(10kwrvu). If you do med management you only need a few hundred chronic refill patient s to get you halfway there. 200 pts times 10-12 visits a year times 2.5.

I always have 1 ma and 2 nurses on the clinic side and the same on the procedure side not counting X-ray tech and reception etc
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Alright so lets say I wanted to see 20-25 pts per day in clinic. How would I get that to be functional without taking documentation home with me? See right now I have MA’s cross trained as scribes, but Im not sure the HOPD would allow for that. Are you preparing charts ahead of time or what?
 
mdo1738 said:
Agreed, absolutely do not need a midlevel. I am HOPD, I have 1 MA (who does not scribe), 2 receptionists, and a small army over at the hospital for procedures. You do not need much staff in the clinic itself to be highly productive, but if HOPD employed certainly not a bad to ask for as much as you can get. Procedures are where it’s more beneficial to focus on having them hire more. The quicker patients are in and out, the more procedures you can do. I have circulator, scrub, fluoro tech, and 2 other people helping with tasks (including my MA) over in the room, plus the hospital pre-op/PACU staff. I do about 7 injections per hour (including bilateral RFA) with this setup. I hit 15,000 RVU this year working 4 days a week, in my 2nd full calendar year at this job.

I do have about 1/3 of my procedures who come from another doc in our clinic (internist who does med management and in-office joint injections/TPI) who was there when I started. But you certainly don’t need anybody else when you’re just starting out. Wait until you’re seeing 40 a day and then look into getting another doc.
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Damn thats insane. So how are you not drowning in documentation?
 
TeslaCoil said:
Damn thats insane. So how are you not drowning in documentation?
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I do most notes and orders in the room. Heavy use of dot phrases that auto populates templates that meet LCD criteria. Will use Dragon for about a minute as needed in between patient rooms to quickly state other pertinent details specific to the patient and pull that into the note. On particularly busy days I do end up with about 30 minutes of dictation to finish up at home.

If I don’t finish a note in the room, I will come back to it later when I have a patient with less documentation needs. Stable chronic med management patients are good times to catch up on finishing other notes while letting them tell you a little story about what’s going on in their life for a few minutes. Meemaw is happy you listened to her talk about her granddaughter’s Christmas play while you were typing a couple comments on the previous patient’s chart about prior treatments he has tried and why he now needs MBB.
 
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It’s going to depend on your system. My ma or nurse dos all intakes including history and ros. I only adjust that then do PE and plan as well as billing. Heavy template usage for all. Maybe 1-2 minutes to finish a chart. Learn to be efficient in this it makes a huge difference.

I 100% generate more wrvus in clinic as opposed to procedures
 
our MA’s and the patient do the HPI. I might add a sentence or two. PE is templated. Macros for procedure lcd criteria. Notes done by 4:00 everyday. I see 2-3x per day the amount of patients you have as your goal.
 
mdo1738 said:
I do most notes and orders in the room. Heavy use of dot phrases that auto populates templates that meet LCD criteria. Will use Dragon for about a minute as needed in between patient rooms to quickly state other pertinent details specific to the patient and pull that into the note. On particularly busy days I do end up with about 30 minutes of dictation to finish up at home.

If I don’t finish a note in the room, I will come back to it later when I have a patient with less documentation needs. Stable chronic med management patients are good times to catch up on finishing other notes while letting them tell you a little story about what’s going on in their life for a few minutes. Meemaw is happy you listened to her talk about her granddaughter’s Christmas play while you were typing a couple comments on the previous patient’s chart about prior treatments he has tried and why he now needs MBB.
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How are you doing 7 procedures an hr? That would be impossible with my staff. Do you have 2 c arms?

And to the original post. @TeslaCoil , if you can get an MA to be your scribe or get a scribe, that will be the most valuable thing you can do. Charting is what kills me, however I think I over document for the billers and lawyers.

Had an epic specialist out a few weeks ago to help efficiency and she said I had more thorough documentation than 99% of the other docs she works with, for better or worse
 
clubdeac said:
How are you doing 7 procedures an hr? That would be impossible with my staff. Do you have 2 c arms?

And to the original post. @TeslaCoil , if you can get an MA to be your scribe or get a scribe, that will be the most valuable thing you can do. Charting is what kills me, however I think I over document for the billers and lawyers.

Had an epic specialist out a few weeks ago to help efficiency and she said I had more thorough documentation than 99% of the other docs she works with, for better or worse
Click to expand...

I only have 1 injection room. That’s where the lots of staff part comes in handy. I have a scrub tech who helps set up the tray, open needles and probes, and helps draw some meds. Nurse who pushes the bed/wheelchair back out to post procedure bay while my MA wheels the next patient in. Rad tech who cleans the bed and puts a new sheet on. I’m basically just doing the procedure, spend less than 1 minute after signing the prepopulated note and signing 4 redundant discharge orders the hospital needs, then moving on to the next one.
 
6 injections/hr. Little more if a lot of joints, little less if there are RFs

Bob is an overachiever.
 
We use eClinicalWorks.
6-7 procedures per hour is good. No matter the setting. I typically book 6/hr. Bilateral rf takes longer but we catch up with single cell TFESI and other similar procedures. You can go faster but that requires having more staff.
 
SpineandWine said:
anyone who doesn’t use AI scribe - technology is insane.
No scribes ever necessary.
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I feel like AI scribe adds unnecessary stuff and leaves out the stuff that’ll protect me in court and prevent me from having to do peer to peers. Templates and dot phrases seem to to better for the specifics I need
 
clubdeac said:
I feel like AI scribe adds unnecessary stuff and leaves out the stuff that’ll protect me in court and prevent me from having to do peer to peers. Templates and dot phrases seem to to better for the specifics I need
Click to expand...
I use a combination of the two.
You can program most dot phrases into the AI scribe (like saying insert SI medical necessity and physical exam)
 
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So far the best plan Ive heard is having MA’s who check patient in and grab a scripted hpi before I see pt. My question is how many MA’s or nurses do I need on check in per patient with this method?

Also like the idea of using the kiosk pre-check in with smart forms that the patient fills in themselves.

And of course, will heavily be using dot phrases, macros and dragon dictation for my portion of the documentation.
 
SpineandWine said:
I have Heidi for ECW
On ECW can utilize “script” tab and therefore just a simple one time ctrl c and ctrl v into note if you have templates set in a specific format without any integration needed
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Ok thanks. Also have ecw, looking for something that integrates well. Have a deepscibe trial coming up
 
TeslaCoil said:
So far the best plan Ive heard is having MA’s who check patient in and grab a scripted hpi before I see pt. My question is how many MA’s or nurses do I need on check in per patient with this method?

Also like the idea of using the kiosk pre-check in with smart forms that the patient fills in themselves.

And of course, will heavily be using dot phrases, macros and dragon dictation for my portion of the documentation.
Click to expand...
I use this system and work at a hospital. At 25-38 a day for office visits or in office injections I need at least 2, but everyone is happier at 3. Best combo 2 MAs and one nurse. 2 are checking in patients, one checking out + wiggle room for people calling out or patient calls/procedure scheduling.

At 20-25 you can make do with 1-2.

You should ask who will do auths for you and what your cut will be from APP. Having APP now def doesn’t make sense until you see what is the true volume.

For a hospital better to sell them on the dream / make the business case for more. It can be pain to ask for more once you get started.

I’d worry more about where you do procedures. Every time I want HOPD suite to go faster it feels like pulling teeth
 
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What’s the most efficient way people have found to utilize their MAs who want to take a brief hx on the patient when they room them? I’m starting a new job and the culture is that that like to do this—I like the idea but it takes some of them a long time which is annoying.

They also insist on writing things on an intake sheet which seems redundant.
Anybody have the patient/MA populate a basic history in the chart? If so, any words of wisdom on this?
 
au bon pain said:
What’s the most efficient way people have found to utilize their MAs who want to take a brief hx on the patient when they room them? I’m starting a new job and the culture is that that like to do this—I like the idea but it takes some of them a long time which is annoying.

They also insist on writing things on an intake sheet which seems redundant.
Anybody have the patient/MA populate a basic history in the chart? If so, any words of wisdom on this?
Click to expand...
Right now my MA’s have rolling computer desks so they go in with a laptop and take a history using a script I wrote for them. In other words a list of questions that I would normally be asking(i.e. where is the primary site of pain?, how would you describe the pain?, how would you rate the pain? Have you had imaging? When? Where? What have you tried previously? Etc). I find this method works well because the patient is less likely to dilly dally and engage in random conversation or nervous banter with the MA as opposed to the doctor.
 
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