Don’t forget these things as your medical practice expands

When Wendy C. Elliott, corporate compliance and ethics officer at Berger Health System in Circleville, Ohio, added obstetrician-gynecologists to a practice a few years ago, patient volume went up, just as everyone hoped.

But one critical thing that got overlooked became a big problem for their patients: The practice didn’t add any more toilets to accommodate the larger crowds. “When somebody is pregnant and they have to go, you better have a restroom available for them,” said Elliott, who is also the former head of the health system’ employed physicians program.

With an expected 14 million newly insured patients arriving in the health system as of Jan. 1, 2014, thanks to the Affordable Care Act, many practices are thinking about adding physicians, physician assistants or nurse practitioners to handle an expected bump in patient traffic. But practice management consultants say that if physicians think only about new hires — and not about the marketing and infrastructure changes additions will bring — there will be “plenty of opportunity to screw up something in that situation,” said Jeffrey B. Milburn, a principal with MGMA Health Care Consulting Group.

The most common mistake, say practice management consultants, is neglecting to tell the community that the practice has additional capacity or new services. This information should be transmitted to local media, area health institutions, the current patient population and staff at the practice to reduce the chance that patient traffic doesn’t grow as expected.

“The waiting room is a great place to announce expansions and practice news,” said Doug Graham, senior management consultant at DoctorsManagement, a practice management firm based in Knoxville, Tenn. “It’s a captive audience.”

Building a bigger infrastructure

Once patients are in the door, though, the practice needs to have the appropriate facilities to handle the load. Not having them in place can annoy new and established patients alike.

Elliott addressed her practice’s restroom deficit by adjusting schedules to prevent too much overlap. The practice eventually moved to a bigger space, with more bathrooms.

When a practice Milburn was working with added a physician and two physician assistants, the biggest unexpected problem was outside the office’s four walls. The practice had enough exam rooms and support staff to manage the increased volume. But patients couldn’t find a place to park in a more crowded lot.

“All went well inside, but not outside,” Milburn said. “The limited parking space quickly overflowed, and required immediate and costly expansion.”

Don’t forget IT expansion

Paying license fees for an extra user of an electronic health record also can get lost in the transition, practice management consultants said. For instance, the practices run by Elliott purchase user licenses in batches of five. This means that she doesn’t have to expand the licensing every time someone new is brought on board, but it does mean she periodically hits an upper limit that needs to be raised.

“You can forget about that pretty quickly,” Elliott said.

But although practice management consultants say these are some common mistakes that get lost in the shuffle, they also add that many more are beneath the surface. Change means that something always slips through the cracks. They said a practice needs to recognize a problem quickly, and take care of it as soon as possible to make sure patients are satisfied, and doctors and staff aren’t overwhelmed.

“No matter how well you have prepared, you are going to have forgotten something,” Elliott said. “You just need to understand that.”