Case Study

You have been hired to manage a portfolio of several specialty clinics in a large multi-physician group practice in an academic medical center. The clinics reside in a multi-clinic facility that houses primary care and specialty practices, as well as satellite laboratory, radiology and pharmacy services. The practice provides the following centralized services for each of its clinics:

• Registration
• Payer Interface (e.g., authorization)
• Billing

The CEO of the practice has asked you to initially devote your attention to Clinic A to improve its efficiency and patient satisfaction.

Access Process

A primary care provider (or member of the office staff), patient, or family member call the receptionist at Clinic A to request an appointment. If the receptionist is in the middle of helping an in person patient, the caller is asked to hold. The receptionist then asks the caller, How may I help you? If the caller is requesting an appointment within the next month, the appointment date and time are made and given verbally to the caller. If the caller asks additional questions, the receptionist provides answers. The caller is then given the toll-free reregistration phone number and asked to preregister before the date of the scheduled appointment. IF the requested appointment is beyond a 30-day period, the callers name and address are put in a future file because provider availability is given only one month in advance. Every month, the receptionist reviews the future file and schedules an appointment for each person on the list, and a confirmation is automatically mailed to the caller.

When a patient preregisters, the financial office is automatically notified and performs the necessary insurance checks and authorizations for the appropriate insurance plan. If the patient does not reregister, when the patient arrives at the clinic on the day of the appointment and checks in with the specialty clinic receptionist, the patient is asked to first go the central registration area to register. Any obvious problems with authorization are corrected before the patient returns to the specialty clinic waiting room.

Points of View

Receptionist point of view	The receptionist has determined that the best way to not inconvenience the caller is to keep them on the phone for the shortest period possible. The receptionist is frustrated that there are too many tasks in the office to do at once.
Provider point of view	The provider thinks too much of her time is spent on paperwork and chasing down authorizations. The provider senses that appointment are always running behind and that the patients are frustrated, no matter how nice she is to them.
Patient point of view	Patients are frustrated when they are asked to wait in a long line to register, which makes them late for their appointments. They are frustrated when future appointments are scheduled without their input. As a result of this latter factor and work or childcare conflicts, patient often do not show up for these scheduled appointments.
Office Nurse point of view	The office nurse feels that he is playing catch up all day long an explaining delays. He also wishes there is more time for teaching.
Billing Office point of view	The billing office thinks that providers are giving some care that is not reimbursed because of inaccurate or incomplete insurance or demographic information, and observes that some care is denied authorization after the fact.

Patient Satisfaction Measures

All clinics in the multi-physician group contract with a customer satisfaction measurement firm that administers customer surveys. This survey is sent to a random sample of patients at each clinic to determine their satisfaction ratings for eight dimensions of outpatient and inpatient care for adults and children.

• Respect for patients values, preferences and expressed needs
• Coordination and integration of care
• Information and Education
• Physical comfort
• Emotional support and alleviation of fear and anxiety
• Involvement of family and friends
• Transition and continuity
• Access to care

Performance Data

Below is the last quarters worth of performance data for Clinic A.

Overall satisfaction with visit rated as very good or excellent.	82%
Staff courtesy and helpfulness rated as very good or excellent	90%
Waiting room time for patients is less than 15 minutes	64%
Examination room waiting time is less than 15 minutes	63%
Patient no-show rate	20%
Patient appointment cancellation rate	11%
Provider appointment cancellation rate	10%
Rate of initial insurance claim rejections because of inaccurate of incomplete patient record documentation.	4%
Patient preregistration rate	16%
Average number of patient visits per day	16
Range of patient visits per day	10-23

1. After reviewing the case study, determine which problem you want to focus on as your first priority for Clinic A. ( 10 points)
   1. Fully describe the problem
   2. Describe your rationale for choosing this problem.