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Coding Corner

Create a Better Patient Experience

Put yourself in the patient's shoes

Over the past 20 years, I have found several great tricks to improve the patient experience at a practice. The key is to put yourself in the patient's shoes.

Walk into your practice as though it were your first time coming through the door. Notice the atmosphere and ask yourself some particular questions:

• What's on the walls?
• What signage is present?
• How clear are the directions to the front office?
• Is there clutter?
• Is the patient's privacy fully protected?

Go through the same process that each patient experiences at every visit, and perform a workflow analysis. Take this as far as actually sitting in each exam room, as though you were waiting for the physician.

• What do you see?
• What do you hear?
• How varied are the periodicals that are available to help pass the time? 
    o What condition are they in? 
    o How recent are they?
• How much is the practice using recent technology?
• How comfortable are the chairs?
• Is anything hindering the high traffic areas?

Ultimately, you should ask yourself if the patients are getting a professional image of the practice and providers.

Using this method of observing what the patients undergo, I've noted several areas that often need improvement:
• Signage 
    o Typos 
    o Ambiguous directions
• Forms given to patients: 
    o Poor quality copies (e.g., black spots, runs, illegible type) 
    o Outdated or conflicting information
• Office flow 
    o Confusing or easy to get lost
• Waiting area and exam rooms 
    o Congested walls 
    o Outdated magazines 
    o Cluttered 
    o Disorganized check-in process
All of the above challenges can be fairly easily and inexpensively remedied - often generating many compliments from the patients.

For example, we recently updated the waiting area where I work. I asked my team to take all the clutter off the walls. I then rearranged the chairs and had an accent wall painted. These small changes ended up costing less than $1,000; however, the return on investment was priceless. One returning patient, coming in for her annual physical, actually thought for a moment that she might be in the wrong office! She was pleasantly surprised with our various changes.

Patients Play a Role, Too

Of course, part of the patient experience is dependent on the patient's personal accountability. Non-compliant patients cause risk to your healthcare practice and providers. If you have a patient who has breached his or her pain medication contract, follow the appropriate dismissal procedure for your state, and terminate the physician/patient relationship. If you have a patient who is currently taking medication for a chronic condition and keeps missing appointments, make sure to explain to him or her that the prescription is one that requires continuous follow up. In such circumstances, do not allow the patient to chastise or blame the office.

Grow Your Practice Through Mutual Respect

Patients gravitate towards, and stick with, practices that treat their patients with respect. These kinds of practices work patients into the schedule and not only treat their ailments, but also take the time to explain what's wrong. Patients want to be seen as a person, not a number. It's up to the practice manager to ensure that this happens.

On way to accomplish this mutual respect is by monitoring the patient schedules and performing a workflow analysis of the practice to provide an organizational culture that is cohesive and promotes a caring atmosphere.

Front desk procedures should be regularly monitored and evaluated by management. For example, how do you handle late patients? Provide appropriate scripting to your front desk personnel on how to deal with patients who are late for their appointments. The scripting should be straightforward, but still empathetic to the patient (everybody's late sometimes). Front desk staff should also know that there could be exceptions to the rules, and it may not be within the scope of his or her position to make those decisions.

Example scenario:
A 57-year-old female shows up 20 minutes late for her appointment with Dr. Smith. She apologizes extensively and says that she was just in a car accident, showing the police report. She explains that she came as soon as she could because she needs a refill on her blood pressure medicine.

Possible unscripted front desk employee response:
"I'm sorry, but Dr. Smith does not see patients who are more than 15 minutes late for an appointment; I'll have to reschedule you. Oh, sorry, I can't until you pay your $25 no-show fee. Can you pay that now?"

Possible scripted employee response:
"I'm so sorry that happened to you. Dr. Smith has a full schedule today, I'm afraid. Let me call my manager and see what we can do for you though. Would you have a seat for a few moments?" The employee checks with the manager and calls the patient back to the window. "My manager spoke with Dr. Smith; he understands and said that he feels bad this happened to you. He is going to call in a five-day supply of your blood pressure medication, and he's asked me to reschedule your appointment. We will also waive the usual no-show fee."

I have personally spoken with a patient who left a practice, explaining that the physician was fantastic, but she "just couldn't stand the girl at the front desk." All the support staff, especially the front desk, can make or break a practice. As long as management observes the process and stays connected to the patient experience, these kinds of unfortunate outcomes can be avoided.

With all this being said, none of it should preclude you from asking a patient to pay an overdue balance at the front window. Patients have rights, but they also have responsibilities. The practice's cash flow relies heavily on patients promptly paying their outstanding balances and co-pays. It is also important to remember that we have the responsibility of making the patient feel we have earned payment for the services we provided. Being concerned about and constantly improving the patient experience will result in more prompt payments and additional patient referrals.

Michelle Richards is director of practice management for EMH Professional Services, Inc. in Elyria, Ohio. She has over 20 years of practice management experience and has a bachelor's degree in health care administration. She also works as a consultant for AAPC Client Services.

Coding Corner Archives

It is very important to reason with a patient, I know sometimes some patient make up stories but according to the senerio this patient had a good reason for being late and that handling the situation by re-scheduling and giving her enough medicine to last her until the next appt.. the patient is happy and so is the staff.As a student in HIM is there a way that I can prep with handling difficult patients?

Michelo Tate,  CNA,  Porter HillsJanuary 16, 2014
Grand Rapids, MI


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