Scheduling far out

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Vie221

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I'm reaching out to everyone to get some advice on scheduling and wait times. My practice consists of me and one PA. I believe we are quite busy as is with a week consisting of four procedure days for me with some follow ups thrown in and one day of all new patients. We get about 160 new patients a month. Our wait times are getting out of hand with a new visit being something like 2 months out and injection visits after that evaluation being another month. Does anyone have any advice on how to improve these wait times with the current staffing?

Some ideas that I had were:

1. Stop taking new patients for some time. However, this can lead to loss of referral sources.
2. Holding injection blocks for new patient evals so that they can have a procedure quickly if needed.

Any input would be appreciated.
 
How many patients do you see on your clinic day? What about your PA? How many procedures a day?
 
When Chick-Fil-A had a line around the building they didn't tell people they were too busy and to go to KFC, they added a second drive thru line. If you want to grow the business, keep referral sources, and make more money then you have to figure out how to increase your throughput. Either faster at procedures or adding a doc or a midlevel, anything really. I see the same amount of new patients you do in a month and do injections 4 days per week. I have two midlevels and my wait times are just a couple of days to get in. Where we excel is efficiency on the injection side so the midlevels are seeing patients all day and I'm always available to jump in and help them or answer questions throughout the day.
 
Vie221 said:
I'm reaching out to everyone to get some advice on scheduling and wait times. My practice consists of me and one PA. I believe we are quite busy as is with a week consisting of four procedure days for me with some follow ups thrown in and one day of all new patients. We get about 160 new patients a month. Our wait times are getting out of hand with a new visit being something like 2 months out and injection visits after that evaluation being another month. Does anyone have any advice on how to improve these wait times with the current staffing?

Some ideas that I had were:

1. Stop taking new patients for some time. However, this can lead to loss of referral sources.
2. Holding injection blocks for new patient evals so that they can have a procedure quickly if needed.

Any input would be appreciated.
Click to expand...

Hire another doctor ASAP.
 
dont limit your injections or new patients. any aything has to give, it should be the f/u patients.

f/u wait times on 2 months isnt ideal, but a new patient will not wait to see you and will not wait >2 weeks or so for a shot
 
RoloTomassi said:
How many patients do you see on your clinic day? What about your PA? How many procedures a day?
Click to expand...
I see about 22 news on a Friday and a few follow ups. PA is around 20 per day including around 4 news. On an injection day I’m at about 25 including 2 RFA’s. This is with one room. I have floated the idea of hopping over to see follow ups between injections. However, I talk too much and tend to spend too long in the follow ups. This could definitely be a spot we could make more efficient.

I honestly don’t want to do any more procedures than I do already. It already feels like too much. I’m not in the most desirable area, so recruiting is tough.
 
gdub25 said:
When Chick-Fil-A had a line around the building they didn't tell people they were too busy and to go to KFC, they added a second drive thru line. If you want to grow the business, keep referral sources, and make more money then you have to figure out how to increase your throughput. Either faster at procedures or adding a doc or a midlevel, anything really. I see the same amount of new patients you do in a month and do injections 4 days per week. I have two midlevels and my wait times are just a couple of days to get in. Where we excel is efficiency on the injection side so the midlevels are seeing patients all day and I'm always available to jump in and help them or answer questions throughout the day.
Click to expand...
@gdub25 what specifically are you doing to be efficient with your procedures? What is your staffing for the suite and how many can you do in an hour?
 
I would try to increase efficiency, which may require hiring MA/scribe to help you and your mid-level.

If that doesn't cut it then add a second mid-level.

I don't think you're at the point you need another physician just yet. If you don't want to do more procedures because you are already feeling rushed or burnt out, you probably just need more help--prepping trays, drawing meds, patient transfer. Again, fairly low cost labor.
 
High quality problem. Good for u.

If burned out. Renegotiate contracts and drop low paying.

Stop prescribing meds to open up schedule.

Start telemed for follow ups or new patients without imaging. Way more efficient than having staff walk the lol in a walker down the hall who needs a potty break right before u walk in

Hire a new doc and take more vacation while making $ at the beach

Like other posters i see shy of 600 visits a month and Im booked out about day as I have been for close to 15 years.

Available affable and able.
 
@BobBarker . Can you walk me through your patient flow from when your patient checks in. I just can’t see how we can get to 35 much less 35 with 3 trials and 10 RFA but I could definitely be more efficient. Any pearls would be appreciated.

@nvrsumr Does Medicare and all advantage plans cover telemedicine? I was doing some during COVID but wasn’t sure if I was getting paid after. This is definitely something we can do to get people evaluated faster.
 
For goodness sake, don't do telemedicine. It's not any faster and you get paid less vs an office visit. You can solve your problems and make more money by being smart and thinking critically about the bottlenecks in your service. Think to yourself, how can Bob Barker do 35 with 10 RFA's yet you can only do 25. There's a problem there and the solution is not telemedicine.

BobBarker said:
You have to have to have to increase your throughout on procedures. I have 35 today and 10 are bilateral RF and 3 trials of those 35.
Click to expand...


I agree with Bob here, your efficiency on procedure room has plenty of room for improvement. The PC seeing 20 patients a day can also improve, with the right staffing support they ought to be able to see 30+.
 
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How are people doing 35, 40, 50+ procedures in one day with just one MA? How many hours is this over?

I feel that I run a pretty efficient practice, but sometimes an old lady who takes 5-6 minutes filling out paperwork/consent, 3-4 minutes to get situated on the procedure table, 2-3 minutes to get off the bed and a minute or two slowly walking out really slows things down. Or decides she has to pee right before the procedure. I have a hard time rushing people as it just doesn't feel right, I try to make up for it by doing my parts as quickly as possible. Do you just decide it's not worth the slow-down to even offer procedures to slow-moving people? Do you just rush these kind of people and push them along?

Also, with just one MA, who is checking vitals before the procedure? Or skipping that altogether? Checking any vitals during or after the procedure?

I want to hear as much nitty gritty on this thread as possible. Sometimes it's good to hear what other people are doing. You can only optimize a particular work flow so much; I want to hear exactly how this many procedures can be done logistically, maybe I need to drastically change things up and I'm okay with that.
 
No vitals. No sedation. No chatter about the procedure. I joke with them and have a good time. I worked from 8-1200. Probably had a 30 min break at lunch. Maybe longer. Argued with the pool guy for 15 minutes sometime in the morning also. I finished by 3:30. Could have done an easy 10 more injections in that time.
 
If they need to pee, they get skipped. I don’t really give anyone the opportunity to suck me into a conversation. The MA’s that are helping the other doctor load the two exam rooms closest to the procedure room with my upcoming procedures and go over allergies, consent. I help just as much as my procedure room assistant flipping the room. As she is wrapping up, I go to the exam room and cheerfully greet the upcoming patient and immediately escort them to the procedure room where I help them lay down. I am very fast with procedures. But I should be. I have been doing the same 3 procedures over and over again for 10 years and I’m not old yet.
 
I'm about the process as Bob. I help flip the room, set up the trays, help the patient onto the bed, don't check vitals, no sedation. Of course we still have little old ladies that move slow, but that might be 1 out of 10 patients. If they are slow filling out paperwork or have to pee that should not hold you up. Just do the next patient. You should always have 2-3 patients ready to go.

I worked 8am to 12:18 yesterday (made a phone call as I was walking out the door to go have lunch at the Thai place). Got back a little after 1pm and finished a little before quitting time which is 4:30.


We did 25-30 injections a day in fellowship and I thought we were very streamlined there until I got out into the real world and got exposure to different clinics and workflows.
 
You need to also pay attention to one specific thing said by nvsmr, and that is—-drop your worst insurances.

Drop Medicaid, even drop Medicare advantage plans that don’t pays as much as straight Medicare. Drop any commercial insurance that pays less than straight Medicare, or that is even close to Medicare rates.

If you are in that much demand, you can be picky about which insurance you take.
 
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nvrsumr said:
High quality problem. Good for u.

If burned out. Renegotiate contracts and drop low paying.

Stop prescribing meds to open up schedule.

Start telemed for follow ups or new patients without imaging. Way more efficient than having staff walk the lol in a walker down the hall who needs a potty break right before u walk in

Hire a new doc and take more vacation while making $ at the beach

Like other posters i see shy of 600 visits a month and Im booked out about day as I have been for close to 15 years.

Available affable and able.
Click to expand...

?
 
For the people doing 30-50 procedures in a day, how do you guys streamline your op notes?

This brings up a separate question. Does someone have a list of what needs to be included in an op note? My note is pretty standardized (patient name, diagnosis, name of procedure with side and level documented, description of procedure). At the bottom there is a space to document pre and post procedure pain scores and I also document the fluoro time. I took my templates from my partner but honestly not sure if all of this is technically required.

It doesn't take much time to ask pre and post pain scores and document total fluoro time but if this isn't actually needed it will save time if I can cut it out.

I'm about 1 year out of fellowship and where I trained (Cleveland Clinic), although the training was excellent we were pretty slow. Complex patients, only saw about 12-15 patients per day and typically about 20 procedures in a day. In academics, they were paid the same no matter how many people they saw. I have a lot of things I can do to increase efficiency and I really appreciate this forum. Thanks
 
Scottie_Dog said:
For the people doing 30-50 procedures in a day, how do you guys streamline your op notes?

This brings up a separate question. Does someone have a list of what needs to be included in an op note? My note is pretty standardized (patient name, diagnosis, name of procedure with side and level documented, description of procedure). At the bottom there is a space to document pre and post procedure pain scores and I also document the fluoro time. I took my templates from my partner but honestly not sure if all of this is technically required.

It doesn't take much time to ask pre and post pain scores and document total fluoro time but if this isn't actually needed it will save time if I can cut it out.

I'm about 1 year out of fellowship and where I trained (Cleveland Clinic), although the training was excellent we were pretty slow. Complex patients, only saw about 12-15 patients per day and typically about 20 procedures in a day. In academics, they were paid the same no matter how many people they saw. I have a lot of things I can do to increase efficiency and I really appreciate this forum. Thanks
Click to expand...
why are you doing a pre and post on ESIs, hips, etc? flouro time can be documented but it doesnt have to be in the op note itself.

you should have separate procedure notes for ALL of the shots you do. that means a different note for a right L5 TFESI and a right L4 TFESI.

you should be at 5 injections/hour. i will say that most docs i know cant do that. but that should be where you should be aiming
 
SSdoc33 said:
why are you doing a pre and post on ESIs, hips, etc? flouro time can be documented but it doesnt have to be in the op note itself.

you should have separate procedure notes for ALL of the shots you do. that means a different note for a right L5 TFESI and a right L4 TFESI.

you should be at 5 injections/hour. i will say that most docs i know cant do that. but that should be where you should be aiming
Click to expand...
I have a separate procedure template for every type of injection I do. I do my procedures at an ASC, my op notes are printed out by my MA the day before the procedure so all i have to do on the day of the procedure is sign/date. The ASC requires me to put a patient sticker on the op note, this is why i print them out. When I mark the patient I ask pain score 1-10 and then I ask again immediately following. I then write down the fluoro time and the op note is given to the ASC nurse and put in the chart. Very easy.

My op notes don't take much time at all, again I have templates for everything I do. My main question was is there some sort of insurance requirement for op notes (pain score, total fluoro time, etc). If these things don't need to be documented I will get rid of them. It doesn't take much time to document these things but any time you ask patients questions it opens up the floor for chit chat which can slow things down. I'm all about increasing efficiency.

I typically do about 4 procedures in an hour. 15 minute slots. I have some time constraints by the ASC staff. Transporting patients to the procedure room, getting them on the table, prepping patient etc. They are actually pretty quick overall, not sure I could get to 5 patients in an hour but this would be a good goal
 
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4 per hour is pretty typical for a ASC.

I don’t document any of the things you mentioned. Didn’t at the hospital either.
 
Scottie_Dog said:
I have a separate procedure template for every type of injection I do. I do my procedures at an ASC, my op notes are printed out by my MA the day before the procedure so all i have to do on the day of the procedure is sign/date. The ASC requires me to put a patient sticker on the op note, this is why i print them out. When I mark the patient I ask pain score 1-10 and then I ask again immediately following. I then write down the fluoro time and the op note is given to the ASC nurse and put in the chart. Very easy.

My op notes don't take much time at all, again I have templates for everything I do. My main question was is there some sort of insurance requirement for op notes (pain score, total fluoro time, etc). If these things don't need to be documented I will get rid of them. It doesn't take much time to document these things but any time you ask patients questions it opens up the floor for chit chat which can slow things down. I'm all about increasing efficiency.

I typically do about 4 procedures in an hour. 15 minute slots. I have some time constraints by the ASC staff. Transporting patients to the procedure room, getting them on the table, prepping patient etc. They are actually pretty quick overall, not sure I could get to 5 patients in an hour but this would be a good goal
Click to expand...
I have a similar set up and flow. 4/hour. My MBB and SIJ templates have a pre and post VAS of 8 and 1, respectively, changed when necessary as well as a blank for the fluoro time. I don't know that it's a requirement, but some insurance is asking for this info, so it makes sense to have the above present at least for mbbs.

I can't imagine this is where time is lost.
 
nvrsumr said:
Telemedicine and in person mandated by state to pay the same where I practice
Click to expand...

That's great. Definitely not the case where I live.

In our office we measure everything at a very granular level. We do 8.9 injections per hour in one room. Goes up to 13 per hour if using 2 rooms.
 
I’m a newer solo private practice, and will typically do about 30-35 procedures a day, from 8-4ish. Will include ~2-3 RFAs. I have an X-ray tech and an MA helping. No sedation other than occasional PO. Seems like I have some room to improve
 
Painologist said:
I’m a newer solo private practice, and will typically do about 30-35 procedures a day, from 8-4ish. Will include ~2-3 RFAs. I have an X-ray tech and an MA helping. No sedation other than occasional PO. Seems like I have some room to improve
Click to expand...
how many days a week do you to procedures?
 
Painologist said:
I’m a newer solo private practice, and will typically do about 30-35 procedures a day, from 8-4ish. Will include ~2-3 RFAs. I have an X-ray tech and an MA helping. No sedation other than occasional PO. Seems like I have some room to improve
Click to expand...


30-35 is solid work. Sure you can improve but it takes a really long time to get faster because you're already operating at a very good pace. Don't underestimate small changes. There is no silver bullet, more like 1000 BBs to get to maximum efficiency.
 
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