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Your Top Questions Answered
Providing Interpreters; Front-Desk Duties; Shorter Visits
PROVIDING INTERPRETERS
QUESTION: A patient with limited English skills arrives for an appointment with a physician. What are our requirements no member of our staff can interpret, and the patient did not bring someone along to interpret?
ANSWER: The answer depends on whether you accept patients in programs funded by federal money, including Medicare, Medicaid, and your state's Children's Health Insurance Program, and, if so, how many of those patients are limited English proficient (LEP).
Revised guidelines issued by the Department of Health and Human Services (HHS) in August 2003 allow a more flexible approach than before; you are no longer required to hire a translator any time a non-English-speaking patient shows up. The revised rule also makes it clear that accepting Medicare Part B patients alone does not trigger the interpreter rule.
Under the revised HHS guidelines, a practice that accepts patients covered by Medicaid or other public programs (but not Medicare Part B alone) can take into account how many patients the practice sees and its own resources before choosing a form of translation. In other words, a small practice seeing one or two LEP patients a month might be able to use the patient's family members as translators if the medical problem was not highly sensitive to the patient. A large practice seeing dozens of LEP patients a week might have to go another route. The new rules also downplay sanctions and urge voluntary compliance.
Once again, seeing private-pay patients or Medicare Part B patients does not trigger the rule. And, as before, any translation services required cannot be charged to the patient.
For more information, see the updated policy guidance document from HHS at www.hhs.gov/ocr/lep/revisedlep.html.
More practically, search the Web for phone-based translation services. It will cost you something, but you'll be able to help the patient in short order.
FRONT-DESK DUTIES
QUESTION: What are the typical duties of a receptionist/check-in staff member for a practice?
ANSWER: Here is a partial list, though requirements can vary quite a bit from practice to practice.
For all patients:
- Collect copays, deductibles, past amounts due, etc.
- Welcome patients
For new patients:
- Get signatures on HIPAA and other forms
- Create new charts
- Photocopy/scan insurance cards
- Collect and enter accurate and complete patient demographics for billing
For established patients:
- Schedule follow-up appointments
- Handle scheduling
- Make sure charts are complete for the next day's patients
Other duties:
- Answer the phone
- Manage pharmaceutical reps
- Sort mail
SHORTER VISITS
QUESTION: We are a geriatric, internal medicine clinic practice, and we are considering moving from a 20-minute appointment schedule to a 15-minute appointment schedule. What insights can you offer?
ANSWER: I certainly think 15 minutes is doable. Many in internal medicine (though not necessarily geriatrics) set a 10-minute schedule, though heaven knows it's tight. You obviously don't want to hurt patient safety.
You may want to create three appointment types - allowing longer time slots for new patients and those coming in for preventive exams, and establishing shorter time slots for those coming in for quick follow-up visits.
Keep in mind that it will not do to shorten patient visits in your schedule book even as your physicians continue to practice at the same pace as before. You'll just produce long waits and lots of staff frustration rather than heightened
productivity.
If you want to shorten your appointment times, you'll also have to change some of your work flow practices to accommodate the short times. For example, physicians can be more efficient if support staff is really supporting them - that is, if exam rooms are always fully stocked, if nurses do a thorough intake and handle all follow-up, and if someone is previewing patient charts to ensure everything that is needed is there. Your physicians will need to stay "in the paint," or the exam rooms, at all times - no more escorting patients or leaving exam rooms to look for a missing piece of equipment.
If you have an in-office lab, make sure you don't create a backlog of orders for your phlebotomist as a result of the increased patient flow. Measure the actual cycle time for your patients - from time in to time out - not just the time spent waiting for physicians. For example, I routinely visit my primary-care practice, and I see the physician fairly quickly. But then it's back to the crowded waiting room for 30 minutes to wait for a blood draw.
You also might want to get permission to sit in on some exams with your physicians and time them - can patient exams really be completed faster? How? Base any changes on reality, not just your desire to see more patients.
It may be that in a longer session physicians can actually generate more RVUs [UN&WR1]and more revenue than they would by seeing additional patients each day. You'll want to keep a very close eye on outcomes, by RVU and revenue, to see if any scheduling changes are having the effect you want. You can always change back next month.
It is important to share all the numbers you track with your physicians so they can immediately see the results of working faster and more efficiently.
You might also consider whether it would be more effective to extend your office's workday rather than cramming more visits into the same amount of time.
Finally, I strongly urge you to consider using the "fourth virtual appointment." What this means is that your schedule is set up so that a physician performs three 15-minute patient sessions. During the fourth 15-minute block of time, rather than seeing another patient, the physician completes documentation on the first three patients and returns any phone calls. That means that even if physicians are technically working longer (say, seeing patients up to 5 p.m.), they still get to leave the practice shortly after their last patient leaves - no documentation backlog or waiting messages to return at the end of the day.
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