位於離Knoxville有一小時車程、鄉下偏遠的傑佛森市，有著傑佛森家庭醫療團隊（Jefferson Family Physicians）長期關照市民的健康。對這個充滿活力、由六位醫師所組成的基層醫療團隊而言，沒有任何地方是偏遠的鄉野。在今天瞬息萬變的醫療執業環境、不可預測的地域市場變動和全國大規模趨勢的衝擊之下，傑佛森醫療團隊一再地遭受挑戰；然而，也一再地茁壯成長、邁向成功。
The Best of WebMD Business of Medicine
Operational Flexibility, Efficiencies Pay Dividends for Rural Tennessee Group
Jefferson Family Physicians Stays Ahead of Change -- and On Top of Bottom Line
By Bonnie Darves
WebMD Business Writer
Nov. 14, 2000 -- Jefferson Family Physicians cares for the people of rural Jefferson City, Tenn., about an hour's drive from Knoxville. But there's nothing "backwoods" about this dynamic six-physician primary care group practice. In today's volatile medical practice environment, beset by unpredictable local-market changes and the impact of large-scale national trends, Jefferson has met every challenge -- and become stronger and more successful as a result.
"Our physicians and PAs are willing to learn and change with the medical environment -- and that makes all the difference [in the success of the practice]," says Betty Prescott, administrator of the practice, which was founded in 1985 by Dewayne Darby, MD. According to Prescott, the practice staff is constantly evaluating its processes and operations. The results of this shared evaluation process are assessed at highly productive all-staff monthly meetings where chart audits are conducted, in-service sessions on the newest coding issues are held -- and staff members are encouraged to make suggestions for efficiency improvements.
"We've made many changes as a result of those suggestions," Prescott notes, adding that the practice constantly seeks out education opportunities for staff members in the belief that "to keep good employees, you need to keep challenging them."
Of course, the biggest challenge to any practice is achieving and maintaining a strong revenue stream. At Jefferson, both charges and receipts were up nearly 17% in the first half of 2000, and the practice has an enviable collection rate of 85.6%.
A second key contributor to the group's financial success, Prescott says, is the physicians' procedure proficiency. All of the group's physicians are able to perform colonoscopies, vasectomies, and several other procedures that primary care groups typically refer out.
"This required a large investment in equipment, but it's paid off because we refer out fewer fees," Prescott says. Jefferson Family Physicians also operates an in-house moderate-complexity lab and X-ray facility, and recently purchased a DEXA scanner to conduct bone-density tests.
A surprising third leading factor: the hiring, 2 years ago, of a full-time compliance officer. Relatively few practices of the size of Jefferson Family Physicians have a designated compliance officer, much less a full-time one.
"It's really the smartest thing we've done," Prescott says of the staffing decision. "She's also a Certified Professional Coder, so she trains our staff in coding and conducts our chart audits." The end result, Prescott says, is cleaner claims and fewer denials.
What else has helped to place Jefferson Family Physicians in the upper echelons of physician productivity? Prescott cites the following:
Payor mix limits. The group constantly evaluates its payor mix to ensure that no single carrier accounts for more than 15% of the Jefferson's patient base. When a carrier begins to exceed 15%, the practice "closes" to that health plan or payor: "This gives us the flexibility of pulling out of a plan when they reduce their allowables," Prescott says.
Patient flow fine-tuning. Patient flow always is top-of-agenda for the group's monthly staff meetings, where the focus is on looking for bottlenecks and revising systems as necessary to improve flow. A small checklist at the top of patient encounter forms -- indicating when patients check in, when they enter the exam room, when they are seen by the physician, and when they check out -- has proved a simple and effective tool in identifying flow problems.
A call-light system and hallway dictation stations also help reduce physician wait times.
Exam room efficiencies. All exam rooms are set up exactly alike so that physicians and nurses always know the location of equipment and supplies. In addition, each room contains a file drawer with all patient education materials, so patients don't need to wait, for example, for a diabetes information handout or a tip sheet for managing cholesterol.
Electronic advantages. Jefferson Family Physicians commits to staying as far ahead of the technology curve as the budget will allow: When deciding whether to implement new software or systems, the group looks at both efficiency gains and customer service benefits.
"We do as much electronically as possible -- with our claims submission, monthly billing, appointment scheduling, and dictation," Prescott says. A voicemail system for prescription refill requests and nurse questions keeps phone call times to a minimum, and the practice recently implemented a dedicated lab line to allow patients to retrieve their results via a personally dictated message from their physician. The savings on staff time and postage, along with fewer concerns about lost results letters, are just two of the payoffs.
"The best part is that patients just love to hear their doctor give them the results," Prescott says.
For the Jefferson Family Physicians staff, perhaps the best part of the group's success is the knowledge that they all have a share in it.