Cutting Wait Times in Doctors Offices and Patient Service Centers Using Modern Industrial Techniques

General practice clinics and laboratory patient service centers share an age-old customer service problem: patients cannot get an appointment when they need one for urgent care, and, when they can get an appointment, they end up waiting for hours to see a physician for a few minutes. For patient service centers, it’s the problem of surges in patients showing up for blood draws, causing long waits.

For general practice clinics, the problem, according to Dartmouth Medical School professor and practice redesign expert John Wasson, is “The office practice hasn’t changed much in 50 years.” By contrast, industry and business continually do analysis and make incremental improvements in their business and manufacturing design, whereas doctor’s offices have stayed the same and cannot properly cope with patients whose expectations for quality service continually increase.

Numerous solutions to the problem of cutting patient wait times have been proposed. They range from common-sense ideas such as leaving afternoon appointments open for urgent visits and having patients fill out paperwork they download off the Internet ahead of time, to more radical ideas, such as using email in lieu of follow-up appointments and reducing office staff to almost nothing.

The “Ideal Micro Practice” idea calls for a sharp reduction in office staff and reliance on electronic health records and practice-management software to quickly dispense with administrative tasks. When properly implemented, doctors can see just 12 patients a day and earn 130% of the salary they would earn in a large practice seeing 25 or 30 patients a day. The reduction in overhead allows the doctor to earn more money from a smaller number of appointments. The most efficient way to run this type of practice, according to Dr. Wasson, is to offer same-day appointments by leaving 60 to 70% of slots open all day. This is because, typically, only 30 to 40% of patients call in wanting to set a future appointment and those that do schedule an appointment in advance are more likely to fail to show up for it.

Clinical Laboratories should consider the strategic insights of the Ideal Micro Practice model and the potential to save money by implementing electronic solutions and reducing administrative staff. Because patient service centers (PSCs) are the public face of the laboratory for most patients, anything that improves the customer’s experience at your PSC is a win-win outcome. Thus, use of sophisticated software systems that can evaluate work processes and identify ways to improve outcomes could pay major dividends in the management and operations of patient service centers.

Clinical laboratories should also consider Six Sigma principles for analyzing workflow and reorganizing their laboratory accordingly. The Dark Report has interviewed numerous laboratories that have successfully implemented Six Sigma principles to increase efficiency and workflow.

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Cutting Waits at the Doctor’s Office (PDF)

New AP Company Buys Five Pathology Group Practices

It may be a good news/bad news development for the anatomic pathology profession. This week a new anatomic pathology company made itself official and announced that it had already signed letters of intent to purchase five pathology laboratories. Aurora Diagnostics, Inc. is the new firm. Based in Palm Beach, Gardens, Florida, it was launched by four lab industry veterans.

Aurora Diagnostics represents good news in anatomic pathology because it wants to buy anatomic pathology groups and laboratories that meet certain criteria. It has $300 million in funding to execute those acquisitions. For pathologists looking to realize cash from their practice, as well as tap a new source of growth capital and management resources, the newly-formed Aurora Diagnostics may be an interested acquirer.

Aurora Diagnostics represents bad news in anatomic pathology because it means a new competitor will soon be putting sales reps on the street to compete for referrals from office-based physicians. For pathologists already facing sustained competition from national AP companies in the market, Aurora Diagnostics may soon be a competitive threat in their market.

The executive line-up at Aurora Diagnostics is comprised of familiar names. Founders of Aurora Diagnostics are James New, Chairman and CEO; Martin Stefanelli, Chief Operating Officer; Chris Jahnle, Business Development; and Kirk Rebane, Business Development. Aurora launched operations in July 2006 and has lined up $300 million of funding from Summit Partners and GSO Capital Partners, LP.

All four individuals are well-known to the laboratory profession. New is the former Chairman and CEO of AmeriPath. In that role, he built the company into a $500 million enterprise before it was sold to Welsh Carson Anderson & Stowe in early 2003. Stefanelli was COO at AmeriPath. Jahnle and Rebane are principals with Haverford Healthcare Advisors in Paoli, Pennsylvania. For more than a decade, Haverford has done business valuations and helped laboratories and pathology group practices in merger and acquisition negotiations.

There are several intriguing aspects to the business plan of Aurora Diagnostics. Expect a more detailed assessment on this nascent company in upcoming issues of The Dark Report. Should you have information or questions about Aurora Diagnostics, e-mail Robert at