By Pascal Helou
New York, NY – The best way to dramatically reduce your costs is to fully understand where your costs are generated. The cost to process a patient is your single greatest costs other than your fixed costs such as equipment, rent, utilities and salaries. We need to determine the time spent by each person involved in processing a patient from the fist time the appointment is made to the payment of the encounter.
Focus on the following:
o List all forms used for each step.
o Identify who handles these forms and how much time they spend performing the process.
§ Time spent pulling, filing, and locating patient charts.
§ Handling prescription refill requests.
§ Mailing patient notes.
§ Processing patient check-in/check-out.
§ Transcribing dictation and recovering lost dictation due to misdirection or data corruption.
§ Time spent trying to locate lost charts.
The following table lists the typical steps involved from the time a patient calls for an appointment till the time the encounter is paid. Go through this table and add the time spent by each staff member at each step that applies.
Typical Patient workflow
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Pre Patient visit |
Physician |
Clinician |
Nurse |
Front Office |
Back Office |
Other Staff |
Admin |
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1. patient calls and makes appointment |
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2. scheduler gathers demographic information |
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3. precertification is required if patient is covered by managed care |
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4. process referring information if patient was referred |
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5. patient folder is prepared |
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Patient Encounter |
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6. insurance card copied, demographics verified |
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7. medical assistant gathers vitals, allergies and current medications |
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8. physician encounter |
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9. patient scheduled for lab, tests, follow-up |
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10. precertification is required if patient is covered by managed care |
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11. ABN must be defined and signature required |
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12. collect co-payment |
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Post Patient Visit |
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13. physician documents patient encounter through dictation and/or notes |
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14. physician interprets test/lab results |
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15. nurse calls patient with lab/test results |
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16. dictation transcribed by transcriptionist |
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17. patient documentation forwarded to referring physician |
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18. coding reconciles procedures and diagnoses |
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19. claim filed to primary insurance |
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20. patient receives primary EOB |
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21. primary claim processed and adjusted |
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22. claim filed to secondary insurance |
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23. patient receives secondary EOB |
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24. secondary claim processed and adjusted |
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25. statement sent to patient |
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26. patient receives statement |
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27. billing staff handles patient questions and calls |
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28. patient submits payment |
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29. patient payment processed |
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30. encounter paid |
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Total hours spent by each person involved in the process |
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Hourly rate for each person involved in process |
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Total cost in hours for person involved in process Hourly rate x total hours spent by each person |
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Total cost to process a patient (add the above row) |
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Number of patients process per month |
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Total costs to process patients (number of patients per month x cost to process a patient) |
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Once you quantify the total cost to process a patient, you can begin to indentify the areas for the greatest potential for cost savings. Take a look at technologies such as EMR. Perform the same exercise with the notion that you have already implement the EMR solution. Run through the numbers again in the above chart with an EMR process flow to see what kind of savings you can expect.
You will see that the total cost to process patients can be reduced by 50%-85% by implementing an EMR system. Transcription costs can either be eliminated or drastically reduce in a well designed template system.
Conclusion
You cannot begin to reduce your costs unless you understand where your costs are coming from. Perform an audit and document everything involved in processing a patient including every system and form used. Once you determine where the greatest costs are generated, you can begin to look at technologies that will reduce those costs.
Tags: NYC consulting, Pascal Helou