December 09, 2013
2 min read

BLOG: The cash flow benefits of continuity of care, part 1

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Read more from John B. Pinto.

Influenced, perhaps, by the now-rampant business mantra of efficiency at any cost, we live in an era of cutting corners. “Can we do without that test? Can we skip that last step of documentation?”

I’m all for efficiency, especially in practices larded with rules and routines that drag down profits and don’t add value to patients. But taken to extremes in your practice, cutting corners can have an unintended and remarkably large adverse effect on practice growth.

This is no more evident than in the area of patient recall systems, a dusty, unexciting corner of practice management often left to the oversight of the most junior staff members of the office.

It starts innocently enough. A front desk clerk who has been mailing out recalls leaves the practice and is not replaced as a cost-cutting measure. Then the office manager forgets to keep recall alive. Or a new scribe is brought on board with inadequate training, so the return-to-clinic order is left off the routing slips. Or a new doctor (one with capitated HMO experience) is hired into a private practice setting with largely fee-for-service Medicare patients, and she “PRNs” too many patients.

 I’ve just returned from two new client site visits, both in major urban markets. Both practices provide superior surgical care. Both practices have a high regard for their patients. But both practices — one an old-line, academically oriented center, and the other driven by consumer advertising — have stalled out in revenue and patient visit terms. Why? A review of the charts in both settings showed that only about half of all patients seen were subsequently followed with any degree of appropriate diligence.

These practices both work extremely hard to get new patients in the door. Watching these two organizations in action was like seeing a man scooping up water in a sieve instead of a bucket. The patients have no staying power. In one practice, most patients received a recall order from the provider, but this order was often stated diffusely in terms of “return in 2 to 3 years.” For other patients, a return-to-clinic order was made, but the staff didn’t post this in the computer. And critically, even when a recall notice was generated and mailed out, there was no follow-up with nonresponders in either practice.

Check back for my next blog when we’ll discuss the economic cost of this kind of negligence.