The Other Side of the Business Coin

To many physicians, the business of healthcare means monitoring accounts receivables, measuring relative value units, and reducing overhead expenses. This article discusses other sides of the multifaceted business coin that have become imperative to the success of every medical practice.

Effective physicians should only do what cannot be done by anyone else in the practice.

Moving forward, we will need core competencies that were not taught in medical school. All physicians are trained to know how to diagnose and treat medical conditions. But do we know how to manage other physicians and our staff? Leadership requires setting the example (e.g., getting to work on time and learning the art of delegating to others). Effective physicians should only do what cannot be done by anyone else in the practice. All else should be delegated. For example, we should use a scribe to take the history of the patient’s current illness, the review of systems, and the medical history. It is not necessary to go to medical school to ask about surgical history, enter a list of the patients’ medications into the chart or the electronic medical record, or record how many cigarettes or alcoholic drinks are consumed each day. This can be delegated to someone else while the doctor performs procedures or makes decisions that can be done only by someone with a doctor’s skills and training.

Patient/Customer Satisfaction

The word “customer” is not a dirty word and should be permitted as part of our medical lexicon. Let’s be honest with ourselves: patients (aka customers) are doing us a favor by allowing us to take care of their medical problems. Doctors and staff have to go out of their way to ensure that every patient has a positive experience at each and every interaction with the doctor and the practice. This includes even the first telephone interaction between a new patient and the receptionist. A potential patient who is put on hold or directed through a complicated phone tree and has to wait 20 or even 30 minutes to speak to a human is very likely to hang up and go elsewhere for medical care.

Measuring patient satisfaction is good for business. Patient satisfaction scores soon are going to be used as part of the reimbursement formula for physicians. Those with higher scores are going to receive more compensation than those with lower scores.

Reputation Management and Transparency

What is the physician’s most precious possession? Some might answer that it is his or her patients. Others might respond it is the training and education that the physician has obtained to practice his or her craft. But the real answer is that it is the physician’s reputation. Doctors live and die by their reputation. These reputations take years to build but are so fragile that they can crumble in a matter of minutes or even with the mere click of a mouse.

In today’s digital age, news is instant thanks to social media, blogs, and search engines, and your practice reputation can take a turn for the worse almost instantly. The Internet has dramatically altered the way people gather information, and word-of-mouth now can quickly send patients to your office or drive them away. Because it is so easy to use social media and online reviews, it is possible that a patient, or even a fellow physician, can target your practice and wreak havoc on your reputation. What can you do to protect yourself?

At a minimum, physicians should be monitoring their practice’s reputation by conducting periodic searches—”Googling” their name—to identify what information about their practice is already visible online. You may find that 3, 4, or even 10 reviews have already manifested in various review sites online. If you are lucky and have made yourself and your practice welcoming to your patients, these reviews will be positive. But don’t be surprised if one or two reviews are negative. Let’s face it—even the most accredited and experienced physician cannot possibly satisfy every patient who walks through the door.

Patients are seeking and leaving reviews about you and your practice online. It’s time to embrace the digital age and actively manage your online reputation. Do not let one disgruntled patient ruin your reputation. My advice is to take an active role and generate positive reviews to drown out any negative remarks made by an occasional disgruntled patient. Protecting your valuable reputation is important for the business of your practice.

Our patients are demanding the same high-quality service they would expect from any other service provider, such as hotels, airlines, or hairdressers. No one would make a reservation for a hotel without knowing the cost of the room. The same applies to airline tickets and any other service, including medical care. Therefore, we need to make our services more transparent.

Throughout the healthcare industry, we hear a call for greater transparency. But what exactly does that mean?

It’s no surprise that access to information about the price and quality of healthcare services can help patients (customers) make better decisions about their care. What is surprising is how difficult it has been for patients to get this information. The truth is that patients rarely know the real cost of care until after they’ve received it. And the price—and quality—of a particular service can vary considerably by provider and even by geographic location. Furthermore, higher price does not necessarily equate to higher quality or improved outcomes.

Today, patients faced with high-deductible health plans and increasing out-of-pocket expenses demand quality and cost information. They seek answers to questions such as:

• What will my true out-of-pocket costs be?

• Where can I get the best care for my money?

• What if I can’t pay?

• If my doctor ordered this test or drug, does my insurance cover it? If not, why not?

My take-home message on transparency is that it is good business to give patients a reasonable estimate for the cost of care.

Consider Wellness As Well As Illness

It is good business to think about moving from “sick care” to “well care.” As physicians, our training focused on treating medical problems and conditions. Today, the public is very interested in staying well, and it is good for business to focus on wellness as well as illness. Examples include teaching young men about testiclular self-examination; discussing kidney stone prevention; discussing the role of diet in various medical diseases, such as prostate cancer; and motivating patients to participate in smoking cessation programs, because this wellness behavior may improve their quality of life and, in the case of my urologic patients, even their erections!

Moving Forward

Here are a few suggestions to improve our business and the quality of our healthcare.

The E-patient

Become comfortable with the idea (and reality) of the e-patient (electronic patient). These are the patients of tomorrow, who will be accessing resources outside of the traditional healthcare system. Wayne Gretzky, “the Great One,” was once asked how he always skated to the puck. His answer resonated with physicians, “I skate not where the puck is but where the puck is going to be!” Where is the healthcare puck? It’s on the Internet. A patient arriving with a briefcase of downloaded information from the Internet is a common sight in most medical practices. Today the e-patient is a health consumer who participates fully in his or her medical care. Sometimes referred to as “Internet patients,” e-patients see themselves as equal partners with their doctors in the healthcare process. E-patients gather information about medical conditions that affect themselves and their families, using electronic communication tools (including Web 2.0 tools) in coping with medical conditions. It is not good business to dismiss the patient’s interest in learning more about his or her medical condition and its care. Instead, we should embrace this desire and provide them with credible information

Patient Portal

Have a patient portal and offer patients copies of their records. A patient portal is a secure online website that gives patients convenient 24-hour access to their personal health information from anywhere with an Internet connection. Using a secure username and password, patients can view health information such as recent doctor visits, discharge summaries, medications, immunizations, allergies, and lab results.

Some patient portals also allow patients to exchange secure e-mail with their healthcare teams, request prescription refills, schedule non-urgent appointments, check benefits and coverage, update contact information, make payments, download and complete forms such as demographic information or health questionnaires, and view educational materials.

As healthcare professionals, we may build better relationships with our patients and take better care of them when we share our visit notes. Patients have the right to read the doctor’s notes during or after a doctor–patient encounter. Having the chance to read and discuss those notes with a doctor or family member can help patients take better control of their health and, perhaps, improve patient compliance and even their outcomes.

Shared Decision-Making

Engage in shared decision-making (SDM). SDM is a key component of patient-centered healthcare. In this process, doctors and patients work together to make decisions and select tests, treatments, and care plans based on clinical evidence that balances risks and expected outcomes and, most importantly, takes into consideration patient preferences and values.

With SDM, patients are more knowledgeable and better prepared for discussions with their physician. SDM builds a lasting and trusting relationship between doctor and patient. SDM helps doctors and patients agree on a healthcare plan. When patients participate in SDM and understand what they need to do, they are more likely to follow through and be compliant.

In many situations, there is no single “right” healthcare decision, because choices about treatment, medical tests, and health issues come with pros and cons. SDM is especially important in the following types of situations:

• When there is more than one reasonable option;

• When the discussion involves prostate-specific antigen screening or a treatment decision for localized prostate cancer;

• When no single option has a clear advantage; and

• When the possible benefits and harms of each option affect individual patients differently.

SDM helps doctors and patients agree on a healthcare plan. When patients are active participants in SDM and understand what they need to do, they are more likely to follow through and be compliant.

Embrace Technology

Doctors are comfortable with the use of technology to treat patients clinically. Now we have to use technology in our offices to care for patients. At a minimum, every doctor must know how to type and use a computer!

Change Our Style of Caring for Patients

We need to change our current style of caring for patients. Some changes might include, for example, the use of shared medical appointments, where several patients are seen in a small group. Another change could be the use of e-mail instead of a phone call to follow up or answer patient’s questions instead of a face-to-face interaction with the patient.

Telemedicine

Telemedicine involves the use of technology to communicate medical information electronically from one site to another. Telemedicine includes a growing variety of applications and services using two-way video, e-mail, smartphones, wireless tools, and other forms of technology.

Initially, I worried that there would be compensation issues with the use of telemedicine. However, there usually is no distinction made between services provided on site and those provided through telemedicine, and often no separate coding is required for billing of remote services.

Telemedicine can provide a wide range of remote healthcare. Some of its possibilities include the following:

• Patient consultations via video conferencing;

• Transmission of still images;

• E-health applications, including patient portals;

• Remote monitoring of vital signs;

• Continuing medical education;

• Consumer-focused wireless applications; and

• Nursing call centers.

It is imperative—and good business—to listen to our patients and see what services and kind of care they would like to receive from their healthcare providers. Over the past 15 years, study after study has documented patient satisfaction and support for telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances.

Bottom Line: Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because those challenges will all be still here tomorrow. . . . and the day after tomorrow. The patient is not going away. The patient is now more sophisticated and more interested in participating in his or her own care, and doctors have to change their behaviors and be sure to take a serious look at the “other side of the business coin.”