By Jennifer Swinnich, PAMED Associate Director of Practice Support
With the practice of medicine evolving from volume- to value-based care and a greater emphasis placed on quality metrics, the result is new benefits for wellness and care management.
In the winter 2016 issue of Pennsylvania Physician magazine, we identified the reimbursement opportunities Medicare wellness visits present. Care plan oversight, chronic care and transitional care management, and advance care planning round out additional covered services that focus on overall health, wellness, and care coordination.
The components required of these visits are considerably different than typical medical exams, however. While physicians are often expected to simply start performing such services, little consideration is given to whether a practice has the resources to carry them out successfully.
In surveys of medical practices, workflow issues are often cited as the greatest barriers to offering new services or implementing new processes. Interruptions to workflows are costly, and bottlenecks and duplications exacerbate the inefficiencies. When the process is not running well, it can cause frustration — especially if you are attempting to provide a new service. It may cause you to abandon the process completely, negating any benefits related to bringing new services to your patients or increasing your reimbursements.
Addressing the functions of a new process prior to implementation will help anticipate pitfalls and improve your chances of success. If you are just getting started on providing a new service, become familiar with its requirements. You will need to make sure you meet the requirements within your workflows, and don't miss out on potential reimbursements.
If you are looking to add new services, change how your practice functions, or improve efficiency, consider doing a workflow analysis to get and keep your practice running smoothly. A workflow analysis is the study and organization of tasks within a process to achieve an intended result. For example, patient registration is a process; checking insurance eligibility is a task within that process.
Many different processes within an organization can be studied. Practices can use studies' results to streamline that process, and consequently improve the process, saving time and money.
What are the steps in a workflow analysis?
Select the process to be analyzed. For example, you might select the patient process during a wellness visit, or the documentation requirements of chronic care management for your study.
Create a preliminary process map. This is a flowchart that identifies the start and end of the process, and the major steps and activities in-between.
Observe and document the details. Walk through the process three to five times and document what really happens — not what is supposed to happen.
- Include who, what, how, and where the task is performed.
- Be aware of actions that trigger other actions and document them.
- Identify influential factors.
- Interview those who contribute to, and are affected by, the tasks.
Don't overlook any details. What may seem inconsequential now may have real influence on the actual progression of the tasks.
Update the original flowchart to add detail. It will provide a clear visual of the steps that make up the process. Define the roles within the process.
Isolate gaps, bottlenecks, and duplications. Look for ways to streamline tasks. Take the practice's limitations into account, whether they lie in facilities, personnel, or policies. Brainstorm with involved staff for possible solutions.
- Modify tasks and update your flowcharts to reflect the modifications; re-analyze.
- Look for inefficiencies and improve; re-analyze. Test and retest all new workflows using your updated flowchart as a guide.
- Once you have refined the process, the workflow analysis is complete.
REALIZING THE BENEFITS
Although a workflow analysis can seem complicated, time-consuming, and detailed, its benefits are long-lasting. It usually results in greater efficiency, increased productivity, and higher revenue. You also may realize better communication among providers, staff, and departments, as well as higher staff satisfaction. Participation from staff promotes buy-in, and encourages widespread acceptance and adoption of the changes in the process. In addition to saving time and money, it can also enhance the patient experience.
The updated flowchart communicates changes in workflows effectively to staff, minimizing variations and misunderstandings. It also adds accountability, aids in training new hires, and helps refine job descriptions.
There are no special skills required to perform a workflow analysis. You may have someone in your organization who can complete one easily. Qualities to look for are a strong sense of organization, attention to detail, and the ability to facilitate collaboration with others.
If your organization is committed to introducing a new service or improving current workflows, the workflow analysis is a valuable asset to consider — and the entire practice can benefit.
Pennsylvania Medical Society (PAMED) members with questions can contact our Knowledge Center at 855-PAMED4U (855-726-3348).
A version of this article appeared in the spring 2016 issue of Pennsylvania Physician Magazine and was reprinted with permission.