When a local six-bed Sleep Disorders specialty practice found itself without a manager, they asked us to work with them as interim management and recruiters. They also wanted to correct workflow inefficiencies and expand the sleep beds by two.

Crystal Nolan, (principal) and Dee Collins, RN, stepped in as interim managers over a four-month period. In addition to daily operational oversight, the two helped recruit the new manager, plus performed an operational and financial assessment. Concurrently, fellow consultant Julie Titus conducted an in-depth coding analysis. After the assessments and analyses, the team recommended and helped implement several major process improvements.

Patient Schedules

• Decreased follow-up visits from 30 minutes to 20 minutes and patient consult visits from 45 to 40 minutes to help increase volume. The appointment time change alone resulted in over 100 more consults per year.
• Installed Murphy beds in two of the sleep rooms, allowing them to double as consult rooms, thereby negating space limitation concerns.

Front Office

• Instructed staff to fully use the internal e-mail system for communications, e.g. incoming messages for physicians were stored in an e-mail folder in the sleep clinic file, which also saved time and reduced errors.
• Recommended the use of an automated reminder call system, rather than individual confirmations, to alleviate individual appointment reminder calls, freeing up front desk to help with more administrative duties.

Workflows

• To speed up MA’s work, we transitioned several tasks to the Front Desk, as well as making process changes that allowed the MA sufficient time to complete room turnover.
• Reception would do the download while the MA roomed the patient. Additionally, reception would add the previous Weight and BMI (body mass indicator) to the chart form when doing chart prep work.
• Implemented the use of automated Blood Pressure, oxygen saturation, temperature and pulse machines, instead of using a manual BP, second device for oxygen saturation and pulse, and a third for temperature, saving MA’s time.
• Recommended physicians complete dictation immediately after patient visit. This gave the MA an additional five minutes to handle download handoff and complete rooming processes, ensuring the physician gets out on time.

Financial Analysis

• The internal coding audit undertaken based on results from a CMS peer review showed one physician in particular was default and under coding. Rather than base coding on time, we recommended it be based on examination elements to reflect the study and treatment more accurately.

Derry, Nolan and Associates worked in tandem with the leadership team to place the new manager. Crystal helped ease the transition, providing a comprehensive report to help the new manager decide how to focus her energy and best use staff resources. As the team continues its workflow improvement tasks under the guidance of the new manager, the Sleep Disorders Clinic is on the path to further its expansion goals, as well as positively affect its bottom line.

Client Testimonial
“Derry, Nolan & Associates performed an operational and financial assessment leading to coding opportunities, streamlining scheduling, improving workflow processes and assisting in the recruitment of a new sleep center manager. Also, the interim management they provided was exactly what we needed to help identify internal issues.” — Mitch Weinberg, MD PhD, Vice President, Medical Affairs, Evergreen Healthcare

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