Making a List & Checking it Twice

Making checklists can make your workday run more smoothly.

By Eric Cardin, PT

Each day a physical therapist’s private practice is open is a day patients are gained or lost, referral relationships are strengthened or weakened, and our individual successes or failures add up to determine our longevity—and our sanity. Practice management, when integrated effectively, can foster a strong employee culture that breeds success.

Where to start or what to identify as important are common challenges shared by practices both new and more established. As physical therapists, a simple step is to establish a list of problems, or areas for improvement, in your practice with some short- and long-term goals. Naturally a problem list can initially be a “reactive” list. Problems have already occurred, and you and your team try to prevent them from happening again. Experience and careful analysis of patterns and problems can result in a more proactive management approach.

Author and physician Atul Gawande is a fierce advocate for checklists. In his books Complications and The Checklist Manifesto, he makes a strong case for taking the thinking out of making sure important tasks are completed. From the first moment of patient contact (phone intake or walk-in), your front office personnel must collect important data accurately and efficiently. Looking at payment denials can reveal common mistakes, and this information can help you identify items for your intake checklist. Communication with your staff can identify best practices for collecting information effectively as patterns emerge. “Checkboxes” or other visual aids combined with proper training can make your staff (or you) adept at data collection. As many practices adopt electronic medical record (EMR) systems with practice management components, a feature to consider is a method for catching missed information. Most EMRs have fields to complete during new patient registration, and a function that should tell the user if you have all the information. (Whether or not that information is entered correctly is another challenge.) Complete and correct information allows the charge to go out and keeps cash flow up.

Once you have a patient accurately entered into your system, there is a trove of useful information. Who sent the patient? Where do they live? Where do they work? How did they hear about your practice? Monitoring and responding to those four questions are essential parts of practice management. This information drives your marketing efforts and is the key to building your referral base. For a new practice you are serving two demographics—physicians and the public. Over the first five years of your practice you can work diligently to grow your referral base and to provide a high-value, positive physical therapy experience. Every patient becomes a “brand evangelist,” advocating for our profession, for you, and your practice.

Measuring referral sources is another important part of the intake process. How did you hear about us? Have you been a patient before? Were you referred to us by a former patient? Did the doctor specify our practice? These are simple and powerful questions to ask. Understanding why someone chose your practice is the key. If you are spending marketing dollars in the wrong place, then you are wasting money, as well as missing an important demographic—the returning patient. Nothing is more important than the person already in your office. Creating a lifelong “customer” who recommends your practice is the key to growth. EMR functions for practice management should include a method for collecting and analyzing this information. Understanding how someone got from “I need physical therapy” to your office is invaluable. Like many important parts of practice management, this information has to be collected at intake and inputted into your EMR or a spreadsheet. Raw numbers or percentages can identify areas of strength and areas for improvement. It is important to educate the staff involved as to what this information is used for and why it is necessary so that they value it and complete the task.

Once the patient is in the examining room, we often put on our clinical hats and lose sight of practice management, but the clinical side of things contains even more information that is just as important. Customer service, compliance, documentation, and productivity are all key components to consider.

Productivity can be a “four-letter word.” For some of us it is why we left other settings to go our own way. Meeting a productivity standard or relentlessly pressing your staff for meeting goals can wreck morale and create an environment that is tilted too far toward profitability; employees may feel that the dollars are valued above them or above patient care. However, there is not a long line of folks looking to work for free so measuring productivity (or how much revenue is generated while you are being paid) is important. The key is to be realistic, to educate staff as to how data is computed, and to take a long view.

In its most simple form, productivity is the number of visits seen during paid hours. Visits are essentially revenue, and paid hours are essentially expenses (and usually the largest expense). So productivity is revenue gained per dollar spent to run the practice. Educating staff members on this is a simple step, but it must go hand in hand with a realistic number. Put another way, productivity is a measure of burnout. Individual therapists have different levels of tolerance for being busy. Defining for your group what “busy” means is your job as it should be derived from a thorough understanding of your revenue needs. It does, however, beg the question: Should you or your colleagues work 25 percent or 50 percent harder each day because of failures to obtain authorization or collect copays? Will you require a higher productivity to meet higher costs of doing business (rent costs, utilities, health insurance)? Each year the practice owner/manager should revisit productivity goals and ask if the number works. It is important to remember the equation P (productivity) = Visits (Revenue)/Hours (Expenses). If productivity is down, visits need to go up or expenses down. It is extremely useful to dig into your eighth-grade math skills and move the factors in this equation around and consider their relationships to each other and to set time aside to think about how you can affect each variable. Finally, it is important to take a long view. Today’s poor productivity will soon be erased if you have the right fundamentals. The key is to look at the day, the week, the month, the quarter, and the year. Learn to anticipate trends and understand how to manage these key variables with the goal of finishing the quarter and the year at the target productivity. Educate your staff on this and reach a consensus on what the goal is and how the individual and the team can make progress toward that goal. Educate yourself on seasonal trends, and keep calm and carry on as productivity ebbs and flows.

Clinical information is also very important. What was the outcome? Was the patient satisfied? Was the referral source satisfied? Was the payer satisfied? We are no longer talking about a future where our outcome will be considered when payment is made. That time is already here. Larger practices, corporate practices, and hospital groups are shifting their focus toward documentation that is intensely focused on data—objective information. “Big data,” or the analysis of large amounts of data to reveal trends and patterns in human behavior, is already making its way through marketing, sales, professional sports, and crime prevention. Billions of dollars will be made as our digital life tells us what we do, what we want, and how we got where we are going. Health care data will not resist this trend. We must prepare for this future now by integrating outcome measurements and demographic analysis into our practice management. Vendors exist who can “mine” our existing medical records for data to look for patterns.

Finding patterns in everyday metrics such as referrals, payment issues, outcomes, and productivity is an essential part of understanding your practice. Owners of small-scale clinics can look at this information by collecting it simply in a spreadsheet. Having greater amounts of data lends itself to more powerful answers, but starting now by understanding the importance of this information is a fundamental part of practice management.

Eric Cardin, PT, is the executive director of South County Physical Therapy Inc, and member of the Private Practice Section’s editorial board. He can be reached at ecardin@sc-pt.com.