This article is more than 5 years old. Information may no longer be current.
Deconstructing the office: The business office
During our series on the medical office, we have touched on the patients’ needs, the physicians’ needs and the staff’s needs, looking at what is required for each of these stakeholders to have a positive interaction with the practice. Sooner or later, however, the business aspect has to come into play, as well. So, this article will look at the business office of the typical ophthalmology practice.
First, it is helpful to understand the various zones that exist in any business office in a medical practice, regardless of size. Medical Design International considers these zones to reflect the degree of access workers in a particular zone need to have to patients. We shall break this down into three zones.
Public zone
In this zone are business staff members who need to have direct, public access to the patient flow routes in the office. Typically, these are the check-in and check-out staff. Years ago, George Conomikes, a noted management consultant to physicians, coined the term “hello staff” for the receptionists and “goodbye staff” for the check-out clerks. To this day, the terms still convey the primary expectation of patients for those roles. These staff members need to respond to patient demand based on the hourly flow of patients across their workstations.
The hello staff needs to be accessible to all patients upon entry to the suite. Their primary function is to greet the patient and welcome them to the practice, so they should be immediately visible to the arriving patient. Because this is a very public function, these staff members should not be doing tasks that require privacy. In most offices this means that they should not handle the telephones. In an earlier article in this series, we recommended that one staff person not have two “stat” functions to perform simultaneously. In this case, greeting the patient and answering the telephone are both stat functions; if expected to perform both, staff will succeed at one and fail at the other.
It should be expected that some patients will approach the hello staff with an issue that needs to be handled privately. We recommend that there be a private alcove in close proximity to the hello desk where patients needing privacy can be taken to discuss their issues.
While the goodbye staff is typically located on the clinical side of the practice and the hello staff is on the waiting room side of the practice, they have similar requirements. The goodbye staff needs to be highly visible and accessible to patients exiting the clinic. Some of these patients will also require private counseling — for instance, if they are upset with the practice and quite vocal. So, a private office near the goodbye counter is needed so that patients can be taken aside for private discussion.
Semi-public zone
There are business staff who need a degree of privacy and yet still need access to patients in the office, such as those who handle surgery scheduling or surgical, financial or insurance counseling. Although there is much less patient traffic to these positions than to the hello or goodbye positions, the staff members still need to be easily accessible.
These staff members often have private offices so they can have confidential conversations with patients. Typically, the number of staff needed for these positions is determined by the half-day flow of patients requiring their services. It should be expected that patients will arrive for that staff member while he or she is already busy with another patient; therefore, it is a good idea to provide some sub-waiting seating near his or her office.
Private zone
Finally, there are staff members, such as those in accounts receivable, accounts payable, human resources and administration, who have very little to no face-to-face contact with patients. They can be remotely located, be it away from the patient, on another floor or even in another building. Some business offices have reported to us that all their insurance clerks interact with patients face-to-face. Trying to get all of those clerks near patient flow can be a substantial spatial burden. However, if the job descriptions are juggled a bit, perhaps all of the patient interaction regarding insurance can be consolidated to one individual. In that case, that person’s office can more easily be located near the patient track.
There are several questions that practices often ask us about the business office.
1. Who needs private offices?
We recommend that any staff member who counsels patients have a private office. In addition, staff such as managers who counsel other staff members also need either a private office or access to a private conference room. Finally, staff members such as bookkeepers need private offices because of the sensitivity of their work. If these individuals are provided with a private office, they can simply lock the door when it is time for lunch rather than having to put away all the sensitive documents before leaving.
2. Won’t getting rid of medical records save space?
This is always an attractive opportunity because medical record storage can take up a lot of square footage in the business office. However, consider whether all records will disappear overnight. Oftentimes it is necessary to have some medical record storage space to transition from hard copies to digital records, and a place for managing the electronic medical records and associated scanning is still needed.
It always seems that the number of business office staff grows each year. Having the old medical records space available can provide a great place in the middle of the business office for this expansion. For instance, right now we are converting a medical records space in one of our ophthalmology clients’ business offices into a new exam module for an additional provider because the practice is growing. So, while not having hard-copy medical records may not save actual square footage, it may offer you options for meeting future needs.
3. Should we locate non-patient business staff in another building?
With the high cost of medical practice space, this is not an infrequent question. Putting an insurance clerk in a space that costs $18 per square foot per year seems very attractive compared to one that costs $30 per square foot. However, you must evaluate the inefficiencies associated with having part of your practice remote from the main office. The issue of office cohesiveness must also be addressed; it is easy for the people in the remote location to not feel part of the practice. Although many of our client practices have considered this issue, only one (a very large practice) resorted to it, and in retrospect the client was not sure it was a wise decision.
It is difficult in today’s medical practice environment to plan the business office for the distant future. The government keeps coming up with new requirements that entail more staff. The insurance companies want more accounting to generate reimbursement. The business office of 10 years ago always seems too small for the practice today. So, when you are planning your office, keep in mind that the business office, like many other parts of the practice, may have to expand.
Richard C. Haines Jr. can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662; email: haines@mdiatlanta.com.
Kurtis Grant can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662; email: grant@mdiatlanta.com.