A Day in the Life of the Doctor’s Front Desk

The phone is ringing. There are three people standing in line waiting to register. The last patient has a new insurance card, and while you’re sure it’s valid, the fax machine isn’t working and you can’t get a confirmation. You have someone on hold that insists she must see the doctor this afternoon, even though the doctor is already overbooked. It’s only 9:30 am and you still have seven hours left to your day. You pick up the phone, ask for them to hold, and with a smile on your face, ask the first person in line: how can I help you?

Welcome to the front desk, where the staff needs thick skin, calm tones, and the ability to bite their tongue for the greater good. These are the women and men who set the tone of the medical practice, who are the first faces patients see, and the voice that other doctors and physicians hear on the phone. These are the people responsible for not just greeting patients and answering phones, but for scheduling appointments, booking tests, arranging referrals, preparing charts, requesting records, handling claims, and maybe even rooming patients.

They are the both the face of the office and the force behind it, ensuring everyone gets what he or she needs as soon as humanly possible.

Streamlining the Patient Experience

Whether a doctor’s office’s front desk has one person or seven, there are certain roles that are indispensible. This is the office manager, who handles billing, a receptionist to greet patients and answer phones, and the medical assistant, who acts as a communicator between the office, doctor, and patient. Regardless if it’s one person in multiple roles or multiple people fulfilling one role, one of the main components of the front desk is to anticipate both the doctor’s and the patients’ needs and streamline the whole experience.

MediSolutions has been conducting original research with doctors and their care staff in order to get a sense of what some of the real challenges that are experienced by all members of the care delivery team are. One of the things that we have heard many times is how crucial all of these ancillary team members are. On speaking about his nurse practitioner one doctor said

“I used to have to spend like 10, 15 minutes tops with a patient, so I made a decision and invested in a nurse practitioner. So now, I get to spend maybe 20, 30 minutes depending on the situation, sometimes more, sometimes less. I’ll see less patients but I’ll be able to spend more time with them, because I have her backing me up.”

The doctor’s office is chaotic now; much of the time is spent fielding phone calls from the hospital, patients and insurance companies. As another doctor put it

“Oh you forgot to get this signed or you forgot to pre-cert this and you forgot to do that – now I gotta stop what I’m doing in the middle of seeing a patient, I gotta refocus and try to come back to neutral position.”

It’s the office managers, nurses and receptionists that help doctors manage the difficulties of running a practice. But as we learned from an orthopedic surgeon we spoke to:

“that’s all uncompensated. All these calls that you make trying to find the doctor, all these calls that you do to the insurance company, that’s all uncompensated, either to your office, or to you.”

With shrinking reimbursements and more requirements many doctors have to settle for less money and hire more staff or shrink their team to continue to operate. In one office, there were only two full time employees with benefits – The doctor and his office manager.

More and more we are seeing more practices have to deal with more work, with less staff. As this doctor from New Jersey put it:

“I have a very good administrator. She has a masters. She’s very good, whatever assignments we give to her, she’s good at tackling. It’s just that you can’t do everything at once.”

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Technology to save the day … or not

Many groups are trying to develop solutions to ease some of the burden on the front desk and the support staff as a whole. In addition to individualized solutions, there has been a large push for implementing an Electronic Health Record (EHR), which allows for doctors, nurses, and front office staff to view the same patient’s file and make necessary changes, which will be instantly visible to the others.

This is crucial for an office that has multiple doctors and multiple teams that support patients. Many doctors and their staff start off the day looking through communications from other team members. Doctors look at labs that came in, notes a referring physician left, what happened overnight to patients that that are in the hospital. One doctor told us: “there’s one day I had fifty messages by the time I made it to the office by 9:30.”

With that kind of volume and with that many people being responsible for a patient’s care, it’s critical to be able to coordinate and keep track of a patient’s health record. EHR’s are the critical tool to be able to do all of this.

But for all the help that they do provide, many doctors and their staff feel like the benefits will be later, and in the future. In the present, they are mostly slowing them down. “Now, when my day finishes at 5:15, I’m here till 7:30 writing notes and I still only get through half of them.” Other doctors hired scribes simply to “spend time with the patient and not go in with a laptop.”

The MA’s, nurses and front office staff are the ones spending the most amount of time in these EHR’s as they record patient visits, vitals, order tests. This day in the life of Klinic Health Services puts it well :

“While observing our MA’s and nurses it is clear the huge impact EMR has had on workflow for health care. It is mostly a blessing but sometimes a little bit of a curse too. Tracking tasks and creating referrals creates a great deal of efficiencies and improves checks and balances to prevent missed steps. Everything is carefully monitored; using EChart we can easily access tests and results to ensure that we have the most current information. The downside is that when something happens to the computer system, it is catastrophic to the day and seemingly small glitches like labels that don’t print or stalling of screens creates havoc and redundancy.”

The Front Office of the Future

As technology advances, so will the doctor’s office and its front desk. Instead of checking in with the receptionist, there may be a touch screen that asks for demographic or insurance changes. This computer system could monitor for documents that need to be signed or updated, like medical releases or HIPAA forms, taking some of the mundane responsibilities away from the front desk and automating them.

Regardless of where technology takes us, however, the friendly faces and helpful nature of the front desk personnel will always have a place in the doctor’s office.