Can office layout improve a
provider's success under capitation?
"In capitation, where income is fixed,
the issue is to hold down expenses," says
Richard C. Haines, Jr., president of
Productivity by Design, Tucker, Ga.
"You need to make sure the physicianthe
high-cost item in care deliveryspreads
his salary over the largest number
of patients."

The "four S's" of physician productivity
are systems, space, style and staff,
Haines stresses.  The key is to sub-divide
each patient encounter into its component
tasks-diagnostic, educational,
work-up, etc.-and determine which
can only be or are best performed by
physicians, and which can be accomplished
more cost efficiently by limitedlicense
practitioners.

A detailed examination of patient
encounter patterns can help a practice
decide what type of space and staff it
needs, as well as how to make the best
use of current resources.
"The ideal is to have enough space, and
staff, so a doctor always has a patient to
go to," Haines says.
Haines has developed a database of average
patient-per-hour rates for a number
of physician specialties, as well as bestcase
scenarios, to use as a benchmark of
individual physician efficiencies (see
table).

When Catherine Harrison joined a
four-physician OB/GYN practice in
Boca Raton, Fla., as administrator in the
late 1980s, she implemented such efficiency
techniques for each physician.
Dividing each appointment into 10-
minute unit values and analyzing the
resulting data allowed Harrison

to add three appointment slots per day to three
of the four physicians in the practice.

"Efficiency increased, and we cut patient
waiting time, so customer satisfaction
increased," she recalls. "It can work for
both fee-for-service and capitation."
Now, as clinical systems coordinator
for Presbyterian Healthcare Associates
Corp., a Charlotte, N.C., physician
hospital organization, Harrison intends
to institute the same efficiency testing
as part of physician profiling. "It will
serve to educate physicians about how
they spend their time," she explains.
Richard C. Haines, Jr., Medical Design International, (770) 409-8123

Catherine Harrison, Presbyterian
Health Services Corporation; (704)
384-4975