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Monday, August 31, 2009

What is your donut?

I was talking to my father-in-law the other day about a client of his who is a baker. This baker used to make lots of fancy and expensive items, such as cakes and tortes, but now he makes mostly donuts. He did not always do this. He began to do it out of neccessity. Donuts, you see, are high profit margin products.

Dunkin Donuts only makes donuts and coffee and guarentee them to be fresh anytime. Dunkin Donuts can do this because donuts are so cheap to make and they have such a high profit margin, that the store can afford to throw away items that have gone stale.

Urology has high profit margin procedures. Vasectomies and cystoscopies are 2 examples. Larger, maga-groups have radiation therapy for prostate cancer, which for now has a high margin. Laboratory work is low margin. Major surgery in the hospital is low margin.

In your practice, what has a high margin?

Sunday, August 30, 2009

A great use for an EMR

Everyone has no-shows. It is just a way of life in medical practice. Effective no show management can add to your bottom line. An EMR can help here.
Set your EMR to automatically run a no show list or even better, a no show letter, once per month, at least. Then you and staff get these patients back into the office.
One, you'll recoup income. Two, you'll practice good medicine.
Win, win.
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Tuesday, August 25, 2009

It's a tough life

Tennis is a very rough way to make a living. Only about 100 of the world's best make a decent living solely through winning matches. Of those, only about 50 make what a cardiologist makes with the top 25 making wall street figures.
What amazes me, year after year, is how much the draw changes. Only 2 to 3 players from last year have returned this year. Maybe one made the big show, but the rest have done worse.
At my urology meeting, I saw all my old colleagues and everyone was successful. My dad was right. Play as an amateur, be a professional.
Good advice..
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That time of year again

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Saturday, August 22, 2009

Who's your role model?

I was watching tv the other day, flicking through the channels. I came across Bill O'Reilly first and listened to him and Dennis Miller. Entertaining? A bit, Angry? Very. Inspiring? Not at all.
Then I flipped to C-Span and a speech by Muhummud Yunnis, the Nobel Peace Prize winner for microfinance. Microfinance is a great concept; lend a woman 100 dollars so she can start a business, grow it, and eventually take herself and her family out of poverty. His concept has taken 40 million people in Bangledesh out of poverty. Here in New York, his microfinance program, which is not welfare, has allowed thousands in Jackson Heights Queens to ascend out of poverty.
Muhummud Yunnis: truly inspiring.
Who inspires you?

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Thursday, August 20, 2009

Information Flow

One of the best aspects of a good and integrated EMR and PM system is the rapidity with which information can flow through your practice. A patient phone call can result in action within minutes, even seconds, after the phone call is made. The same with the doctor's orders or a staff member's questions. Processes just get done with speed and efficiency.

Information at the speed of thought, to paraphrase Bill Gates. Truly amazing.

Wednesday, August 19, 2009

Automation and the demise of doctoring

Doctors will always be needed. So will carpenters and iron workers and all skilled laborers. However, as technology advances, it allows for high labor intensive jobs to shift down the labor intensity curve. While we still need carpenters for custom jobs, the vast majority of carpentry is done by machine, not man. Very few carpenters, as a result, can command high incomes.
Medicine is going in this direction as well. Information management and science will enable thought leaders to produce efficient and accurate algorithms that automate the very process of patient care. As a result, most medicine will be delivered by non-doctor entities, perhaps even machines.
The need for doctors will diminish, as will income levels. This may take 20, 30, or even more years, but it will happen.
What will you tell your kids to do when they grow up?
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Monday, August 17, 2009

Long day

Good day

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Sunday, August 16, 2009

To consult or not to consult

The definition of a consult by CMS is unclear. At a conference yesterday, about 300 of us spent almost an hour parsing this one word.
In the US, medicine is easy. Coding is challenging.
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Saturday, August 15, 2009

How to use free in your office to make money

Free can make the good business person a lot of money. Here are some ways to convert free into dollars in your own practice:
Blogging
Seminars
Consults
Courses
Volunteering
The path might not be direct, but it will get there just the same.
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Friday, August 14, 2009

Who is driving?

I sometimes wonder who is driving all this lunacy in health reform.
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Saturday, August 08, 2009

Want to find in-efficiencies? Make a flow chart.

I serve on my hospital's performance improvement commitee. I enjoy it and I learn from it. Here is something I learned from my hospital's PI committee.

If you want to find sources of error, flow-chart your processes. It can go something like this for a small office like mine.



Let's say you want to find a weak spot in your diagnostic test ordering and resulting process; FLOW IT OUT
  1. Patient needs "blood test."
  2. Complete requisition (paper for sake of argument)
  3. Give requisition to MA to facilitate

  4. She draws the blood, processes it, ie centrifuge, and places it in the pick-up box with requisition attached

  5. Lab recieves, runs the lab

  6. Results are faxed and mailed to office (partials first, then finals)

  7. Result placed on doctors desk for review and signature
  8. Result then given back to staff for placement in chart, unless doctor needs chart pulled to interpret test
  9. Patient informed
  10. Chart re-filed

If you go through this simple list of steps, you can see lot's of inefficies. For example;

  • Step 2: WARNING: MAJOR SOURCE OF ERROR HERE: handwriting issues and duplication of data: an electronic ordering system can correct this. Contact your labas they may be able to install one for you at no charge, even.
  • Step 6: Duplication of results, wasted time and effort as doctor needs to sign-off on the same lab multiple times. Plus cost of tonor, printer/fax usage, staff time,and doctor frustration factor, there is a better way. Simply ask the lab to only send complete reports and better yet, ask them to automatically download those results from their server to yours and to notify you when done. Most good labs can do this easily and at no charge to you.
  • Step 7: Automating step 6 makes steps 7, 8, and 9 obsolete.
  • Step 9: Normals can be mailed to patients using a form letter.
  • Step 10: Electronic records obviously elliminates this step plus step 8 as well.

You can do this for almost, if not every, process that takes place in your office.

Try it.


Sunday, August 02, 2009

I aced my lab inspection

My information management system, www.ilabtqm.com to the rescue.

My COLA CLIA inspection went very well.

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