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Opening Doors To Information


By Howard J. Anderson, Executive Editor April 30, 2008

Eight years in the restaurant business before medical school taught Tom Landholt, M.D. some valuable lessons that he now applies to his practice. A focus on excellence in customer service is essential to all businesses, including the practice of medicine, he stresses.

“Every industry is a service industry,” he says. “In medical school, they tried to disabuse me of that notion. I was taught in medical school to focus on making good medical decisions and that someone else would handle the business issues. I was told that wasn’t the task of a physician.”

But making the proper treatment decisions is just one aspect of running the business of a small practice, the physician argues. “It came as a shock to me that some of the best training I got was in the restaurant business, where I got my management training.”

Take The Lead

Landholt argues that physicians who own small group practices should take the lead in writing a detailed business plan that spells out “what services we provide, who provides them and how we can deliver them more efficiently by using technology.”

Vinson Hudson, president of Jewson Enterprises, an Austin, Texas-based consulting firm specializing in technology for group practices, strongly endorses Landholt’s viewpoint. “Doctors need to take the stethoscope out of their ears and start listening to the real world,” he says.

When physicians approach Hudson for advice on what software to acquire, he asks them, “Can you create a flow chart for the functions of your business?” Technology won’t help a practice improve efficiency if its fundamental business processes are inefficient to begin with, he stresses.

Landholt, a family practitioner, owns PatientCare Family Clinic in Springfield, Mo., where he practices with a physician’s assistant and four cross-trained medical assistants. The practice makes extensive use of automation, including electronic health records and practice management systems, speech recognition software and a patient portal with secure messaging.

Without the technology, the practice would likely need at least three more support staff members and its margins would be much slimmer, Landholt contends.

The physician estimates his total overhead cost is the equivalent of about 40% of what he collects. By comparison, Hudson, the consultant, says most practices spend the equivalent of 55% to 60%of revenue on expenses.

“Most practices’ expenses are too high because they’ve never done cost accounting,” Hudson says. “Doctors need to go through the practice and identify ways to cut costs. There’s plenty of money to save by eliminating lousy workflows.”

One significant component of Landholt’s business plan for serving the needs of young families is to offer “open access scheduling.” About 90% of his patients are seen within 24 hours of calling in, he says.

Because he treats many children of working mothers, he often bunches up appointments first thing in the morning and late in the afternoon to accommodate families’ needs. He averages more than 25 patients a day.

The Essential EHR

By relying on an electronic health record—Centricity from GE Healthcare, Waukesha, Wis. — the practice can handle a higher patient load, the physician contends. “My staff spends more time with patients than the average clinic because we’re not dealing with chasing paper,” he says. “The average doctor could probably see five more patients a day if they had access to all the right information.”

Because the practice’s four medical assistants are cross-trained, any of them can handle blood draws, X-rays, vaccinations, billing or scheduling. This enables the practice to handle large volumes of patients at peak times, Landholt says.

Gear Up

“During flu season, on Monday mornings we might have 25 patients show up before noon and we have to gear up to handle those peaks,” he says.

This approach to scheduling is extremely rare, says Hudson, the consultant. “Most physicians are afraid of open scheduling. They see it as giving power to their patients to determine when they come in instead of being able to tell patients when they should come in.”

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