Mixin’ it up

 

What percentage of your office visits are a response to an acute complaint? What percentage are prescheduled well-child visits? And how many are follow-ups to manage chronic conditions and behavioral problems?

You probably have a sense of how you are spending your time in the office, but do you really have the numbers to support your guesstimate of the patient mix? Does anyone in your organization have that data? You probably could come up with some numbers in a few hours with a pencil and your office schedule for the last 2 months. However, learning how much of your income is generated by each category of visit would be more difficult.

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If you discover your patient mix is tilted toward acute visits, you may be making a mistake, according to one pediatric practice management consultant, Chip Hart, who claims that one of the five biggest mistakes independent pediatricians can make is failing to shift their focus toward preventive care and chronic disease management (“The 5 biggest business mistakes independent pediatricians make,” Contemporary Pediatrics, April 1, 2018). He argues that, “preventive care pays well; fills your schedule, is required by your payors; is a crucial part of being a patient-centered medical home; establishes your position as the trusted medical source for your families; and, most of all, is good for your patients.” He suggests that parents who take their children to quick-care walk-in clinics for earaches and sore throats are actually doing you a favor, at least as far as your bottom line is concerned.

Before you run out to the front desk and ask the receptionist to delete your same-day slots and replace them with a few preventive and chronic care visits, we should question a few of Mr. Hart’s assertions.

Of course, like you, I never spent the time to learn which categories of office visit were driving my income. However, I do know that I saw a stimulating mix of acute and chronic visits, and the most important number, the bottom line, was more than adequate for my needs. To achieve this profitable balance of visits meant that I needed to be as efficient as the patients’ complaints would allow. There is an often-repeated myth that there is a direct correlation between the length of time a physician spends with the patient and the quality of the visit. In my experience, patients are more impressed by the physician’s level of attention and concern than the amount of time he spends in the exam room.

What about Mr. Hart’s claim that preventive care visits represent “a crucial part of a patient-centered medical home?” Of course they are important, but suggesting that we distance ourselves from our patient’s acute complaints that they deem as emergent, he is ignoring a critical cornerstone of community pediatrics: accessibility. When you limped home from the playground with a scraped and bleeding knee, did you find a sign on the door suggesting you go next door to the neighbors because your parents were busy reading a book to your little sister? That strategy doesn’t fit with my image of a medical home. I think Mr. Hart seriously undervalues your patients’ acute concerns.

You might argue that you just don’t have the time to fit in all those acute visits. But have you had the courage to open up your schedule, maybe hire more staff, and give it a try? It takes a bit of shift in mindset and the acknowledgment that a large part of what we call preventive care has not proved effective. Immunizations? Yes, but the rest, not so much.

 

I know this is a heretical proposition but a mix of acute and chronic complaints keeps the practice of pediatrics stimulating and rewarding and is good for the patients. I found that I knew my patients better after seeing them when they were in need rather than in the less frequent but longer encounters of a health maintenance visit. It takes work, but there is room for both kinds of visit.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

 

What percentage of your office visits are a response to an acute complaint? What percentage are prescheduled well-child visits? And how many are follow-ups to manage chronic conditions and behavioral problems?

You probably have a sense of how you are spending your time in the office, but do you really have the numbers to support your guesstimate of the patient mix? Does anyone in your organization have that data? You probably could come up with some numbers in a few hours with a pencil and your office schedule for the last 2 months. However, learning how much of your income is generated by each category of visit would be more difficult.

iStock

If you discover your patient mix is tilted toward acute visits, you may be making a mistake, according to one pediatric practice management consultant, Chip Hart, who claims that one of the five biggest mistakes independent pediatricians can make is failing to shift their focus toward preventive care and chronic disease management (“The 5 biggest business mistakes independent pediatricians make,” Contemporary Pediatrics, April 1, 2018). He argues that, “preventive care pays well; fills your schedule, is required by your payors; is a crucial part of being a patient-centered medical home; establishes your position as the trusted medical source for your families; and, most of all, is good for your patients.” He suggests that parents who take their children to quick-care walk-in clinics for earaches and sore throats are actually doing you a favor, at least as far as your bottom line is concerned.

Before you run out to the front desk and ask the receptionist to delete your same-day slots and replace them with a few preventive and chronic care visits, we should question a few of Mr. Hart’s assertions.

Of course, like you, I never spent the time to learn which categories of office visit were driving my income. However, I do know that I saw a stimulating mix of acute and chronic visits, and the most important number, the bottom line, was more than adequate for my needs. To achieve this profitable balance of visits meant that I needed to be as efficient as the patients’ complaints would allow. There is an often-repeated myth that there is a direct correlation between the length of time a physician spends with the patient and the quality of the visit. In my experience, patients are more impressed by the physician’s level of attention and concern than the amount of time he spends in the exam room.

What about Mr. Hart’s claim that preventive care visits represent “a crucial part of a patient-centered medical home?” Of course they are important, but suggesting that we distance ourselves from our patient’s acute complaints that they deem as emergent, he is ignoring a critical cornerstone of community pediatrics: accessibility. When you limped home from the playground with a scraped and bleeding knee, did you find a sign on the door suggesting you go next door to the neighbors because your parents were busy reading a book to your little sister? That strategy doesn’t fit with my image of a medical home. I think Mr. Hart seriously undervalues your patients’ acute concerns.

You might argue that you just don’t have the time to fit in all those acute visits. But have you had the courage to open up your schedule, maybe hire more staff, and give it a try? It takes a bit of shift in mindset and the acknowledgment that a large part of what we call preventive care has not proved effective. Immunizations? Yes, but the rest, not so much.

 

I know this is a heretical proposition but a mix of acute and chronic complaints keeps the practice of pediatrics stimulating and rewarding and is good for the patients. I found that I knew my patients better after seeing them when they were in need rather than in the less frequent but longer encounters of a health maintenance visit. It takes work, but there is room for both kinds of visit.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

 

What percentage of your office visits are a response to an acute complaint? What percentage are prescheduled well-child visits? And how many are follow-ups to manage chronic conditions and behavioral problems?

You probably have a sense of how you are spending your time in the office, but do you really have the numbers to support your guesstimate of the patient mix? Does anyone in your organization have that data? You probably could come up with some numbers in a few hours with a pencil and your office schedule for the last 2 months. However, learning how much of your income is generated by each category of visit would be more difficult.

iStock

If you discover your patient mix is tilted toward acute visits, you may be making a mistake, according to one pediatric practice management consultant, Chip Hart, who claims that one of the five biggest mistakes independent pediatricians can make is failing to shift their focus toward preventive care and chronic disease management (“The 5 biggest business mistakes independent pediatricians make,” Contemporary Pediatrics, April 1, 2018). He argues that, “preventive care pays well; fills your schedule, is required by your payors; is a crucial part of being a patient-centered medical home; establishes your position as the trusted medical source for your families; and, most of all, is good for your patients.” He suggests that parents who take their children to quick-care walk-in clinics for earaches and sore throats are actually doing you a favor, at least as far as your bottom line is concerned.

Before you run out to the front desk and ask the receptionist to delete your same-day slots and replace them with a few preventive and chronic care visits, we should question a few of Mr. Hart’s assertions.

Of course, like you, I never spent the time to learn which categories of office visit were driving my income. However, I do know that I saw a stimulating mix of acute and chronic visits, and the most important number, the bottom line, was more than adequate for my needs. To achieve this profitable balance of visits meant that I needed to be as efficient as the patients’ complaints would allow. There is an often-repeated myth that there is a direct correlation between the length of time a physician spends with the patient and the quality of the visit. In my experience, patients are more impressed by the physician’s level of attention and concern than the amount of time he spends in the exam room.

What about Mr. Hart’s claim that preventive care visits represent “a crucial part of a patient-centered medical home?” Of course they are important, but suggesting that we distance ourselves from our patient’s acute complaints that they deem as emergent, he is ignoring a critical cornerstone of community pediatrics: accessibility. When you limped home from the playground with a scraped and bleeding knee, did you find a sign on the door suggesting you go next door to the neighbors because your parents were busy reading a book to your little sister? That strategy doesn’t fit with my image of a medical home. I think Mr. Hart seriously undervalues your patients’ acute concerns.

You might argue that you just don’t have the time to fit in all those acute visits. But have you had the courage to open up your schedule, maybe hire more staff, and give it a try? It takes a bit of shift in mindset and the acknowledgment that a large part of what we call preventive care has not proved effective. Immunizations? Yes, but the rest, not so much.

 

I know this is a heretical proposition but a mix of acute and chronic complaints keeps the practice of pediatrics stimulating and rewarding and is good for the patients. I found that I knew my patients better after seeing them when they were in need rather than in the less frequent but longer encounters of a health maintenance visit. It takes work, but there is room for both kinds of visit.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].