They weren't the views you would expect of a managed care expert: That solo practices can thrive, that there are no economies of scale from grouping physicians and that cutting practice expenses makes offices less productive.
But that's what nationally known consultant and author, Greg Korneluk, told an intrigued Baptist Hospital audience of 50 physicians, spouses and office managers June 18.
Korneluk chairs the International Council for Quality Care in Boca Raton, a physician advisory company that takes a decidedly contrarian approach to managed care. His philosophy is backed by time motion studies of 5,000-10,000 physicians.
"I don't have a problem with managed care,' he says. "But it has forced doctors to focus on dollars. Physicians who focus on making money make less money. Doctors who focus on quality make more money."
The Council's main philosophy mimics that of other consulting groups: The most successful doctors improve quality and patient satisfaction while increasing volume and efficiency — though that often seems to physicians a contradiction in terms.
Korneluk takes an industrial engineer's approach to physician work. For 13 years, the chairman has shadowed physicians from dawn to dusk, equipped with a stopwatch and clipboard. He attached pedometers to labcoats to observe how much time is spent in wasted motion.
"High quality physicians that are highly productive are efficient in time management," he says. "Minimize motion and your day will have less stress."
A minute saved is a minute earned
The results of his research are dozens of physician-friendly, time-saving recommendations that run from shaving seconds by removing exam room doorknobs to hiring "documentation assistants," that is, transcriptionists, who sit alongside physicians in exam rooms and keep records. "Every chart needs to be finished by the next morning at 9 a.m. or you're at risk when patients call," Korneluk admonished.
The Council estimates primary care physicians' office time is valued at $3 to $4 per minute. 'Make every minute count" is the unofficial company motto.
Doctors spend lots of wasted time looking for their nurses. Korneluk's suggestion: install a $50 cordless doorbell chime available at do-it-yourself home stores. At least one audience member said she had carried out that idea with success.
Korneluk found an average physician walks four to six miles per week in the office. His suggestion: reduce time spent walking and productivity will increase. Merely taking off rubber gloves and putting them in a wastebasket three steps away costs two minutes a day, or the equivalent of $6.
That's $1,200 per year in one activity alone. Solution: move the basket to where the physician sits.
Tune out the negative
Korneluk's goal is to show physicians how to preserve quality in a system paying them less and less. Doctors who heard the talk called his ideas "profound" yet remained skeptical. 'I don't believe that managed care companies look for superior quality. They look for average," said Miami internist Mark Kutner. "Taking good care of people pays off but it costs more."
But Council research turned up the opposite results. "If you cut staff to save expenses, you see less patients, you are less efficient and less productive. You have to spend more to make more," says the Council chairman.
Another internist voiced reservations. "Even if you make yourself more efficient, the insurance companies continue to lower fees. I don't see managed care rewarding physicians for efficiency," says Miami internist Robert Friedman, MD.
Korneluk says the most successful doctors are good clinicians whose practices hum with happy staffers and satisfied patients.
Much of his advice for achieving such harmony hinges on delegation and personalization. For example, he believes that to build a successful practice, the doctor, his nurse and receptionist should randomly call three patients daily and ask them how they are doing. He suggested doctors take Polaroid pictures of patients and list their hobbies.
At times, Korneluk seemed a cheerleader for downhearted physicians fed up with managed care. 'There's a lot going on in medicine that's negative. Tune out the negative," he said. He told physicians the most successful doctors wake up in the morning, look forward to going to work and try to make each day a perfect day. "When you study successful people, they imagine being successful, they have that vision," he said.
For burned-out physicians, he suggested re-engineering practices to focus on what doctors truly enjoy. One Toronto physician he coached, for example, enjoyed treating body builders best. Another young doctor enjoyed treating seniors. Both changed their practices to specialize in those groups.
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