Preparation key to putting out "fires"

When the COX-2 inhibitor Vioxx was recalled a couple of months ago, many practices felt the brunt of panicked patients and extra phone calls. That meant loads of unexpected work for office staff.

The staff at Tri Rivers Surgical Associates Inc. in Pennsylvania, however, was ready and waiting.

Shortly after the recall was announced, the group had information posted on its Web site. It sent letters to patients taking the medication, a list of whom was efficiently extracted from the group's database. And just in case calls would still come in droves, a toll-free number to provide recorded information about the drug was ready to be activated.

"We wanted to protect our human assets," said D. Kelly Agnew, MD, an orthopedic surgeon and managing partner of the group. "Because of the letters and Web site, we kept it from being a telephone disaster."

When it comes to running a practice, there are very few offices that go beyond the bare-bones approach. To protect margins, you can't afford to pay overhead expenses you don't need, like superfluous office staff to help out on busy afternoons. So what happens when there are fires to put out, such as the Vioxx recall or flu vaccine shortage, or extra tasks to do?

The key, physicians said, is to have a plan in place before you're overwhelmed. Anticipating questions and preempting any panic with a coordinated plan can keep disruptions to a minimum.

"What's interesting is you're trying to respond within the same set of resources that you've already trimmed," Dr. Agnew said. "There's not much capacity beyond the normal day-to-day work."

There are plenty of pitfalls that cost office staff time during even a normal day. A study conducted by the Medical Group Management Assn. revealed a 10-physician group spent an average of $247,500 per year on redundant and duplicative administrative tasks, much of which is a result of the complicated health care financing and delivery systems.

The MGMA study says a 10-physician group spends nearly $20,000 a year just trying to resolve prescription issues.

"It's a time waster for a practice," Dr. Jessee said. "A call comes in to the receptionist, who has to ask a nurse, who has to pull a doctor out of an exam room to solve this."

Many physicians were probably repeating that same routine many times over the last two months, as calls rolled in regarding Vioxx and the flu vaccine shortage. But at Family Practice Partners in Murfreesboro, Tenn., the patients received information before they could call the office.

Using its electronic medical record system, the four-physician family practice group was able to identify the patients taking Vioxx, determine how to change their medication, and have nurses call them -- all within 24 hours.

The group received its flu vaccine, but it still had to deal with questions from nervous patients. It posted conditions for receiving a shot on its Web site, and prepared the staff to advise individual patients whether they could receive the vaccine based on their risk factors, said Susan Andrews, MD, a family physician with the group.

"We had a lot of calls for the flu vaccine," Dr. Andrews said. "The way we had it set up, if someone was insecure with having the front-desk person telling them if they could get a shot, they could talk to one of us."

While anticipating concerns is a key to surviving the unannounced crises that pop up, reliance on technology also is an important factor. A practice can be prepared to answer questions about a drug recall. But if it has a way to quickly find patients who need to be notified, it doesn't have to take such a reactive approach, doctors said.

"I'd rather do it before they start calling," Dr. Andrews said. "You can do it on your own time and schedule then. It's a lot more convenient that way."