Does the Solo Doc = "Lean" Doc?


WSJ Article: Faltering Family M.D.s Get Technology Lifeline

While I was skeptical of Intel's planned tablet PC for nurses, I'm much more positive in my first reaction to this WSJ article about small (or single MD) physician practices using technology (and process changes) to improve service and to reduce waste.

Hearing about stories like this, being an MD with a group practice owned by a large corporate health system, makes me think that being a doctor really wouldn't be that great of a job:

“To increase revenue, the hospital pressured him to see more than 30 patients a day, usually for 15 minutes each. Many patients couldn't get appointments for weeks. Dr. Moore determined it took 19 separate actions and 253 feet of corridor-walking to order a prescription refill. He says he was so rushed he often failed to provide the best medical care, and once mistakenly prescribed a blood-pressure drug for a toddler.”

30 patients a day.That's really cracking the whip.With the doctor's capacity being that highly utilized, from a queuing theory perspective, it's no wonder that it takes a long time to get an appointment.I'm dreading calling my doctor's office on Monday (if I'm still not recovering from this flu) in case I can't get an appointment.Am I supposed to plan my illnesses in advance?

Look at the illustration of waste in the process – 19 separate steps and 253 week of walking to get a prescription ordered.Being so rushed also helped contribute to a near medical mistake.In any environment, whether its building cars of treating patients, any “worker” who is pushed to do too much too quickly is bound to make errors.

Dr. Moore took a risk to go out on his own to form what is often called a “micropractice,” literally a small office that's staffed by only the doctor. That's right, no receptionist, no assistants, no medical staff other than the doctor.

So in early 2001, Dr. Moore took a risky step. He borrowed about $15,000 to start a solo medical practice in a tiny space with no nurse, receptionist or waiting room. He bought computer software to help him track patients' appointments, illnesses and medications, and to process insurance claims.

Patients at his “micropractice” can call or email to get appointments the same day. Visits last 30 minutes. Dr. Moore can be reached day or night on his cellphone. To refill a prescription, he walks “zero feet,” he says, and taps a few keys on his laptop.

Less patient waiting, longer visits, and less waste in the process.Not bad, eh?

There are some tradeoffs.Many of the MD's end up making less money, but they enjoy the quality of life and the freedom to do a better job taking care of their patients.

There are many technological tools that help a physician manage their own practice without an office staff or direct administrative support.

Initially, [Dr. Moore] didn't want to handle his own billing and insurance paperwork, because it would reduce time with patients. But he decided to pay $250 a month for five years to use software that combines electronic health records, patient scheduling, and electronic billing.

He also bought off-the-shelf “disease management” software, called DocSite, to track how well his patients are doing on key measures, such as cholesterol, blood pressure and blood sugar levels. For example, the software easily generates a list of patients who failed to follow through on a blood-pressure checkup, alerting Dr. Moore to call or email those patients to come in.

One other practice mentioned that reminds me of lean is the call to not overspend on equipment.More from Dr. Moore:

His most expensive purchases for medical equipment were a new exam table for $750, and an electronic thermometer for $250. He paid $100 to buy used furniture. While many doctors spend hundreds of dollars on wall-mounted eye- and ear-examining equipment, Dr. Moore says he pulled out hand-held versions that he used in medical school. His total outlay in that area was $20, for a rechargeable battery. “I advise other doctors to buy the minimum of what they need,” he says.

Dr. Moore has reduced overhead costs AND increased patient satisfaction:

Dr. Moore estimates that his overhead costs make up 35% of his revenue. That compares with a figure of about 60% for other small primary-care group practices, according to Medical Group Management Association, an Englewood, Colo.-based professional association for doctors' practices.

I know if I have trouble getting an appointment the next time I'm sick, I'm going to seek out a “micropractice” physician (if I can find one in my area).

Websites about Micropractices:

Solo Doc Blog

The Solo Practitioner Blog

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.



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