Set-ups or Upsets?
Edition: November 2001 - Vol 9 Number 11
Author: Wayne Care
Do you remember the days when the predominant colors used in the examination room were apple green, orange, or the ever-popular bumblebee décor of black and bright yellow? Yep, the seventies! If you have physicians still hanging onto that exam room equipment, remind them that the ''Brady Bunch'' has been cancelled! Get over it! Color schemes have changed, but many of the basics of the exam rooms have remained the same. You are the expert who can help the physician have a functional and attractive office. You determine whether it is a successful setup or an upset.
You Are the Key
Many tools are available to help with a set-up, but the key component is you! You are the customer's source of reliable information.
You will deal with a wide range of experience among physicians, and this, to some degree, determines how much advice and consulting you must give. Take Dr. Doe, who is just out of his residency and opening a practice with two other physicians. With the benefit of your experience, they can avoid costly mistakes or embarrassing ones, such as having the door open the wrong way and exposing the patient to view.
Now consider Dr. Smith, who has six partners and two offices and is opening a satellite office. He will still benefit from your knowledge, but the amount of help he needs will certainly be less. There is also another wrinkle. Dr. Jones hands you the list he needs for his new office and wants you and five others to submit bids.
Everyone will agree that the best way to avoid the bid is to be there at the start and seal the deal early. But sometimes it just doesn't happen that way. Even so, you can turn that situation around. This is where your knowledge becomes important. Consider these points:
Always consider the bid list a work in progress and not a final document. Look at this as a starting point for conversation and a chance to use your expertise.
Take notice of things that are missing from the bid list.
Ask questions about the procedures that will be done in the office. Many times you will find out that the physician plans to do some procedures that he or she neglected to include on the bid list.
Suggest additional procedures that the doctor might want to perform, with complete information of products, CPT codes and reimbursement.
Inquire about such factors as patient flow and inventory storage, things that the physician may not have thought about yet.
Sell up! Watch for products that could be changed to a better alternative and sell the doctor on why he should trust your opinion.
Will you turn around every situation this way? No. But will you get some loyal customers whom you might otherwise have missed? Yes.
What determines the best way to go about setting up a new office? Let's begin by listing some of the criteria:
Number of physicians in the practice.
Number of exam rooms.
Procedures to be done.
Considering the expense of office space, you always need to weigh the best use of that space. Anything that can make better use of space for storage, etc. without hurting functionality is a bottom-line saving to the practice.
In the past, physicians designed their offices to suit their own needs, but things have changed. Now they must also think about patient satisfaction. More and more health plans conduct patient satisfaction surveys. Physicians get rated on wait times, ease of access and many other parameters. If you are part of the early-stage planning, you can help the practice as they decide how patients will move through the office.
Think of the office as a horseshoe. The patient travels the following route: greeting and sign-in, exam, testing or treatment, payment and rescheduling the next appointment. The patient enters one side of the ''U'' and exits the other.
Hopefully the wait will not be interminable a common complaint in many practices. Waiting rooms should be comfortable. Ensure there is adequate seating for the number of patients and family members they expect to have at one time.
Some other considerations are:
Pediatric practices will need two waiting rooms, at least divided by a partition: one for well check-ups and one for sick children. They will also need appropriate entertainment for children.
Practices that anticipate that their adult patients may have to bring children along with them may set up a small play area.
Some specialties fertility and OB/GYN, for example may set up an audio-visual room where patients can watch health videos to get answers to some of their questions.
It is getting more common for patients to bring along a family member or friend, particularly older patients, those with disabilities and those with language barriers who may need help in translation and understanding.
The area where patients sign in, fill out medical histories, etc., should, ideally, be separated from the area where they check out, both to protect confidentiality and to lessen logjams.
Taking vital signs becomes one of the first issues in patient flow. How will the staff get patients' vitals, temperature, blood pressure and weight? Many practices do this in the exam room, but a number have one or more vital signs stations. Keep in mind that patients are sensitive about their weight. They want some privacy. Also, be aware that scales need to sit on a proper surface and be adjusted for accuracy, if necessary, when installed.
Seeing the Patient
This is the next component in how the office gets laid out. Some questions to consider:
Will blood be drawn in the exam rooms or in a central location?
Will there be a laboratory?
Will the doctor perform other diagnostics (i.e. EKGs, spirometry, etc.) in the exam rooms, or will the physician have a special room for that?
If it is a walk-in clinic, or an office where minor surgeries, suturing, etc., will be performed, will these procedures be done in a treatment/surgery/trauma room, or in the exam room?
What other in-office procedures (for example, X-ray, bone densitometry, sigmoidoscopy, etc.) will be performed that might require special consideration?
Will the practice use a flag system by the door to identify either the physician who is to see the patient, or the patient status?
Following the Law
Many physicians opening practices and already in practice lack knowledge of the various laws and regulations with which they must comply. Reps can be a tremendous resource. Consider the following:
Registration. Physicians who intend to see Medicare/Medicaid patients must register as Medicare providers. Refer them to this website for more information: http://www.hcfa.gov/medicare/enrollment/.
DME. Some physicians may want to register to be providers of durable medical equipment. This includes billing items, such as orthopedic soft goods. Refer these physicians to their state CMS (formerly HCFA) office or the following website: http://www.hcfa.gov/medicare/enrollment/forms/855-s.pdf.
Posters. Physician offices must display a variety of federally mandated (and sometimes state-mandated) posters. Usually between five and seven posters are required. Some of these include information about OSHA, minimum wage and hours, etc. Help them get these posters so that they start off on the right foot.
CLIA'88. Even if your physician plans on doing only CLIA-waived testing, such as urine dipsticks and fecal occult blood tests, he or she MUST have a CLIA certificate. The address to obtain the required form (Form HCFA-116) is:
Centers for Medicare and Medicaid Services (formerly HCFA)
ATTN: CLIA ProgramP.O. Box 26687 Baltimore, MD 21207-0487(410) 402-8025
There are also state addresses available for HCFA and Medicare/Medicaid carriers. There are two websites for HCFA/CMS presently http://www.hcfa.gov and http://cms.hhs.gov/siteinfo/. In the future, all information will be moved to the CMS website.
OSHA. Every medical practice must have an OSHA Manual (Exposure Control Plan), which covers the three main regulations: Bloodborne Pathogens, Hazard Communication and TB. They need to have a training program for their employees as they hire them. And as you determine the initial stocking order for products, help the practice create a centralized file for all necessary material safety data sheets. Copies of MSDS can be found at www.msdssearch.com.
Exam, Treatment and Procedure Rooms
The accompanying checklists include most of the common items that one would put in exam, treatment and procedure rooms. Additional items can always be added, and those not needed by your customer can be deleted.
Keep a set-up list by specialty, including the most common items. For example, an OB/GYN has one or two Kevorkians and ''x'' number of vaginal specula in each size, while an orthopedic office requires a cast cutter and cast spreader. Such lists are good starting points.
Beyond this, as specialties order products from you, ask why they use them. If they seem essential, add them to your lists. Set-ups are always a work in progress.
Most physician offices will have a lab, even if they are going to register as CLIA-waived. (See the accompanying laboratory checklist.) What testing will they want immediately? What may they wish to add later? They may plan to increase testing as their patient load increases, or they may vary the amount of testing they do based on the mix of Medicare and private pay patients. Suggest that some testing, such as cholesterol screening, may help draw patients. The following list shows options to discuss with the physician and is by no means complete:
Spin down urine
Microscopic examination of urine
Urine culture dip paddles
Rapid diagnostics, such as pregnancy, Strep A, Mono, etc
Monitoring of patients on therapeutic drugs (such as blood thinners)
Monitoring of diabetic patients (simple glucose testing, Hemoglobin A1c or Fructosamine)
Other chemistry tests
CBCs on a real time basis
Emergency Equipment and Supplies
The area of emergency equipment and supplies offers reps an opportunity to really help out new offices from the beginning. Don't just help your customers order the items needed to keep on hand for an emergency. Rather, help them develop an inventory list of these items that they can use to review. Set up a review schedule for them, because if they never use some of these items, they will become outdated and need to be reordered.
Disposables and Supplies
Not only does the practice need enough disposables and supplies for opening day, but it needs to establish the base inventory for a period of time. This is the time for you to do some real work, to create a partnership that will last for years.
Help the practice determine and label storage areas. If they have a storeroom, label it, use bins for small items, and develop an inventory control and re-ordering system. The levels they need to keep on hand will change as their patient load increases, but the system can already be in place. Will you do the inventory? Will they call or fax in orders? Will they use an electronic ordering system?
Some common inventory rules apply: Don't let them run out, don't overstock them, and make sure they spend less time on inexpensive items. You, the rep, are at the heart of planning with them now, so help them develop a system that works for them. Consider the following:
Develop a pre-printed inventory list.
Stock at least a 2-3 week supply for the expected patient load.
Revise re-order points as necessary.
Be there the week after opening and help them review. Pay particular attention to the dating on dated products.
Be onsite two weeks and one month after opening, in order to review and adjust inventory levels. Don't be afraid to take some returns; the long-term relationship matters more than selling an extra box of tongue blades. Once the practice is on your routine call schedule, continue to help them review their inventory levels as the patient load increases.
Wrapping It Up
Follow-up is critical. In fact, the rule is follow up, follow up, and follow up! Be there when the office equipment is installed. (Oops, something is missing or broken!) Add a personal touch; deliver a plant, flowers, or a coffee maker when the practice opens. (If you do the coffee maker, make the first pot and have some mugs or cups available. It may cost you a few dollars, but it will earn you a relationship.)
Reliability is the key to a good set-up and a strong ongoing relationship. The devil is in the details. It's always in the details. So, get them right!
Great selling! Do a set-up without the upsets!