Breaking with Tradition Can Improve a Practice's Bottom Line

In “Fiddler on the Roof,” Tevye sings about the importance of tradition—that it identifies who we are.

Perhaps, but in healthcare, and where medical practice hours are concerned, there’s a lot to be said about going non-traditional. According to Chris Zaenger, president of Z Management Group, Ltd., and a member of the National Society of Certified Healthcare Business Consultants, the benefits are 4-fold.

Zaenger cites increased patient satisfaction through improved access to care; increased revenue for the practice; increased utilization of mid-levels; and, anecdotally, an overall improvement in the quality of healthcare for the practice’s patient population.

“My argument has always been: you’re paying rent for 24 hours a day and only using it for 8,” Zaenger says. “Does that make sense?”

Dollars saved and earned

Zaenger explains that, especially from a billing perspective, every dollar saved is a dollar earned. Making better use of medical practice costs can result in a better return on investment. And that approach, he says, begins by knowing your patient population and addressing their needs.

For example, Zaenger works with several practices located in neighborhoods heavily populated by Hasidic Jews. Those practices have instituted hours on Sunday to accommodate a population that observes the Sabbath from sundown Friday to sundown Saturday. In some Hispanic neighborhoods, practices have office hours on Sunday afternoons following church. And in pediatric practices, the hours begin as early as 6 am to accommodate parents before they put their children on school buses.

“I have a primary care practice that has been doing early morning hours for the working class population for almost a decade now,” Zaenger says. “It was a 5-doctor practice, so each doctor took one morning, and it has worked out really well.”

Convincing staff, gauging the population

Zaenger says that, depending on the demographics of a practice’s staff, obtaining buy-in to non-traditional hours might be a bit challenging. For example, if the practice employs many single parents with school-age children, early mornings can be a problem. In that case, Zaenger suggests either hiring a couple of part-timers just for the early morning shifts, or alternate hours with those in the practice who welcome starting early because they can leave early as well.

“That can be a big plus for some people,” he explains.

Where your patient population is concerned, Zaenger says that if you’re not certain about their preferences for non-traditional hours—early mornings versus weekends or evenings—conducting a survey can be beneficial. However, he cautions that you could also be opening Pandora’s Box.

“The devil’s in the details,” Zaenger says. “If your patients want [non-traditional hours] and, after surveying them, you decide not to do it, you’ve disappointed your patient population—and that’s not a good thing. So, you’d better be prepared to move forward if you get a positive response from your patients.”

Proper implementation

Zaenger reiterates that implementing non-traditional office hours can have a positive impact on medical practice revenue—if done properly. The first wrong move, he says, would be opening your doors at 7 am but not showing up until 7:30 am.

“You can’t have patients waiting to see you, and you’re not at the front door,” he says. “You have to be cognizant that timing is important. Sometimes, evening hours might work better if you’re already in the office on those days.”

Another factor, Zaenger says, is to consider what patients you might be seeing. For example, if you’re implementing non-traditional hours but seeing patients who have complex medical conditions, have you blocked out enough time for them? Blocking out a Saturday or Sunday morning, when you don’t normally do those days, just to see and focus on patients with complex issues, makes a lot of sense.

“Maybe you’re a rheumatologist, or maybe you’re some other specialty, but you really haven’t had the time to focus on those patients that you would like,” Zaenger says. “By blocking out a Saturday morning just to see those patients, you can do things, like extra testing, that you don’t normally have the time for.”

Most important, Zaenger says, is a commitment to the plan, and buy-in from the practice office manager. Their willingness to commit at least one or 2 days a week to non-traditional hours is critical to its success—as is the willingness of practice staff in general.

“Get a timeline of who’s available, when they’re available, and when they’re willing to work non-traditional hours,” he says. “And do it before you move on to any other plans.”