Inside Secrets For Maximizing Efficiency

By Robert Smith, Contributing Editor

   When a practice’s bottom line is not as strong as it should be, one should take a serious look at overhead costs but it is also important to look at how you and your staff are doing your jobs. There are things podiatrists can do to make more efficient use of staff, technology and process, and accordingly rein in runaway costs. Indeed, there are few practices out there that could not benefit financially from being more efficient.     “The idea is to look from the outside in,” says Hal Ornstein, DPM. “You are always inside the operation and you cannot see what is going on around you. If you were a bug on the wall and could see yourself, the results would be amazing.”    Dr. Ornstein suggests practitioners take a look at every process they perform in the course of a day from the moment they enter the building in the morning to the minute they lock up at night. For example, when using forms or brochures on a regular basis, Dr. Ornstein says it can be helpful to keep them in the most likely place they will be needed.     “We have five places in our office where we keep forms in order to make them easily accessible when we need them,” says Dr. Ornstein, the President of the American Academy of Podiatric Practice Management. “The ideal situation is having everything you need right in the treatment room.”    Dr. Ornstein recognizes that efficiency is relative and one practice’s efficiencies might be of little use to another practice. However, the meaning of efficiency is universal. Whether it is in the context of a doctor’s office or a household appliance, efficiency is using less energy in an effort to produce more output.    Stephen Peltz, of the Brewster, N.Y.-based Peltz Practice Management and Consulting Services, LLC, suggests an area where almost any office can improve.     “If you must double-book appointments, do it at the top and bottom of the hour,” recommends Peltz. “Add walk-ins at the end of the session. This allows the patients to be seen closer to the time of their appointments.”    He also suggests offices use an automated service to call patients the day before their appointment to remind them. Peltz says this reminder can reduce the number of no-shows.

What You Can Learn From The ‘Heel Pain Bag’

   Dr. Ornstein offers another example of improved efficiency. He sees many patients with heel pain and the remedies he uses to deal with the pain include prescriptions, air heels from an air cast, physical therapy and brochures with tips on exercises. Dr. Ornstein devised a way to avoid running around the office gathering the various treatments while a patient is waiting.     “We have a heel pain bag that we put in every room,” says Dr. Ornstein. “Everything is right there. Not only am I saving money creating it, I am moving the patient out faster and enabling my staff person to get to his or her next job more quickly.”    Not only does a “heel pain bag” help get information into the hands of patients quickly and efficiently, it also provides a consistent presentation and message, a practice Dr. Ornstein lifted from a familiar source. McDonald’s, he explains, owes its success to consistency and efficiency. He says DPMs can learn a few things from corporate America.

Emphasizing The Importance Of Excelling At Communication

   Dr. Ornstein’s practice extends the “heel pain bag” concept to other areas of patient care, noting that excelling at communication is key to handling patients in an efficient manner. He says it boils down to communicating to patients what disorder they have, why they have it and what options they have. After taking down their history, one should provide a brochure that is pertinent to the patient’s problems.     “This reduces the number of questions patients have and enables us to take care of them without taking up an excessive amount of their time or ours,” says Dr. Ornstein. “For example, if we see a patient for an ingrown toenail and he or she has to soak afterward, we get the patient to read the form ahead of time. Then when I am with the patient, he or she doesn’t have to ask me, ‘How many times do I need to soak?’”    Visual aids can also enhance communication with patients as some people have a more visually oriented learning style. To that end, every treatment room in Dr. Ornstein’s New Jersey practice features a poster of the foot and ankle.     “People understand and learn things in different ways,” points out Dr. Ornstein. “Some people have to read material to understand it while others have to hear it. Some people understand concepts only after they have seen some sort of visual representation of them. If you can address each of those groups as efficiently as possible through those multiple vehicles, you reduce the amount of time you need to spend with them and you make that time more efficient.”    Peltz concurs that there is always room for improvement when it comes to communicating with patients. When DPMs run late, he suggests having someone from the front desk tell patients the doctor is running late but will be there as soon as possible.     “This dials down the anxiety of the patient and eliminates them from being angry at the staff,” notes Peltz. “Practices should have the medical assistant do as much of the work-up and discharge of the patient as possible. This frees up more of the doctor's time.”

Does Technology Help Or Hurt The Practice?

   While one may consider the Internet to be a boon to DPMs looking to keep their patients informed, Dr. Ornstein says that is often not the case.     “The Web causes patients to ask more questions than they otherwise would,” he explains. “It gives them too much information on things that don’t really tie into their problem.”    Dr. Ornstein adds that patients may see or read about things that may be pertinent to them “further down the line” but start asking questions that are a bit premature for the here and now.     “I tell them, ‘Let’s not talk about how we are going to breathe on the moon when we have not even gotten in the rocket ship yet,’” says Dr. Ornstein.    However, one positive aspect of the Web is the fact that patients are more educated about their problems.     “The Web is an easy-to-use encyclopedia,” notes Peltz. “It is better if patients understand their condition and can talk intelligently to their doctor about their condition and treatment. The problem is when the Web information or what the doctor tells the patient is contradictory. In that case, the doctor has to explain to the patient why what he or she says is correct. It takes time and that is in limited quantity.”    Dr. Ornstein does concede that a practitioner’s Web site can boost one’s efficiency by providing access to patient information forms that patients can fill out prior to their visit. Giving patients information about common conditions on the Web site can also save DPMs time explaining things when patients come to the office.    Using technology such as electronic medical records (EMR) can also lead to cost savings, according to Dr. Ornstein. Even with the added efficiency and cost savings, Dr. Ornstein says some doctors may still be reluctant to embrace technology in their office. However, he says there are some ways to ease the transition. Dr. Ornstein started his transition by using digital dictation. He dictated information about a patient and uploaded it to a service, which returned the information as an e-mail Word attachment. He subsequently printed out the document and inserted it into the patient’s chart.     “Any podiatrist will tell you that charting is one of the toughest things to keep up with from an efficiency standpoint,” says Dr. Ornstein.

How Staff Efficiency Fosters Practice Efficiency

   In order to save costs and be more efficient, you need good staff, whether they are in the front office, back office or billing office.    Empowering staff is essential to Dr. Ornstein’s success. However, he notes that sometimes, podiatrists do not know how to use their resources either because they do not trust staff or feel they are not good enough. If a DPM hires good people but doesn’t train them, this is a “significant problem,” according to Dr. Ornstein.     “If you hire people who want to do well and you don’t train them and they mess up continuously, they will leave because nobody wants to feel like a failure,” continues Dr. Ornstein. “You need to trust your people. If my people are not making mistakes, it means they are not growing. I never feel like I am working hard because I have two staff people who are incredible. I appreciate them and I tell them that.”    Peltz suggests having weekly meetings with medical assistants as a way to improve efficiency. At each meeting, he says the doctor would teach staff a new concept and then test them on that concept at the following meeting. While the medical assistant is prepping the patient, he or she can then explain the condition to the patient. The patient can subsequently call the assistant rather than the doctor regarding easy medical questions, suggests Peltz.    Dr. Ornstein agrees that staff should be given more direct responsibility for patients when it comes to more common issues.     “Is the doctor losing control? No, he or she is gaining control,” claims Dr. Ornstein. “I don’t have to sit there and tell Ms. Jones how to change her bandage or where she needs to buy her sneaker. My staff can do that.”

How New Practices Can Develop Maximum Efficiency

   One of the biggest challenges for new DPMs is they quite literally must learn on the job. Years of training and education will not bring a single patient through the front door so new practices by necessity must be as efficient as possible. It is never too early to develop efficient habits and emphasize cost-cutting measures as these approaches can reap benefits throughout the life of a practice. With this in mind, Hal Ornstein, DPM, provides a few tips for new DPMs.    • Seriously consider investing in new technology. While it may be tough initially coming out of one’s residency, Dr. Ornstein says spending money on technology is the best investment one can make. He notes that EMR is one option, but there are other efficient technologies to look into as well.     “I started using digital X-ray about nine months ago,” points out Dr. Ornstein. “It cost a lot of money, but it was one of the best things I have done from the perspective of efficiency. I don’t lose X-rays anymore. Before, one might get misplaced or I wouldn’t be able to read the names on the X-rays. Now everything is on my computer. I won’t run out of chart space again.”    • Get a mentor. Dr. Ornstein suggests finding someone whom one can call or e-mail for advice.    • Stay informed. Dr. Ornstein is a voracious reader and suggests new DPMs get into the reading habit if they have not already. It is helpful to go through every magazine possible and rip out articles that can be helpful to the practice.    Reading magazines outside of medicine can also be helpful. To prepare for a recent lecture on customer service in medicine, Dr. Ornstein read about customer service in corporate America.     “I have read about American Express, USAA Insurance, Starbuck’s, Southwest and others,” he says. “There is tons of stuff out there for new practitioners and they should use as much of it as they can. Learn from the pros.”    • Go mobile. Dr. Ornstein suggests that new DPMs visit as many offices in the area as possible to pick up efficiency tips.    • Consider the impact in-office dispensing has on your efficiency. If the practice is selling a $12 or $15 bottle of BioFreeze, how long does that transaction take the front desk person to complete? Dr. Ornstein recommends having an internal structure to handle that growth in the practice. In some practices, he notes in-office dispensing will increase the bottom line by 10 to 30 percent.     “That is a great addition to your bottom line,” says Dr. Ornstein. “However, what is going to happen to you when your reputation suffers because of the wait people have to endure so you can dispense those things in house?”

Final Notes

    “Ultimately, you need to want to be more efficient,” concludes Dr. Ornstein. “It is not about moving patients in and out as fast as you can so you can bill more. It is about increasing your efficiency to better serve those patients. The rest will come. Your bottom line will be better and your patients will be happier. Increasing efficiency helps you do this, control overhead and improve the quality of your care.” For more information on practice efficiencies, cost cutting, and mentoring, check out the American Academy of Podiatric Practice Management Web site at Mr. Peltz is the President of Peltz Practice Management & Consulting Services, LLC. He can be reached via phone at (845) 279-0226, via fax at (845) 279-4706 or via e-mail at For a related article, see “How To Incorporate The PDA Into Your Practice” in the February 2004 issue of Podiatry Today or check out the archives at

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