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Setups or Upsets? …. You Make the Difference!
By Wayne Care - printer version

Do you remember the days when the predominant colors used in the examination room were apple green, shades of orange, or the ever-popular bumblebee décor of black and bright yellow?

Yep, the 70s!  If you have physicians still hanging onto that exam room equipment, remind them that the “Brady Bunch” has been cancelled! Get over it! Color schemes have changed, but many of the basics of the exam rooms have remained the same. You are the expert that can help the physician have a functional and attractive office. You determine whether it is a successful setup or an upset.

You Are The Key

Many tools are available to help with a setup, but the key component is you! You are the customer’s source of reliable information.

You will deal with a wide range of experience among physicians, and this, to some degree, determines how much advice and consulting is required from you. Take Dr. Doe who is just out of residency and is opening a practice with two other physicians. Your experience could really help them avoid costly or embarrassing mistakes, such as having the door open the wrong way and exposing the patient to view.

Now, consider that Dr. Smith has six partners and two offices and is opening a satellite office. She will still benefit from your knowledge, but the amount of help she needs will certainly be less.

There is also another wrinkle. Dr. Jones hands you the list he needs for his new office and wants you and five others to submit bids.

Bidding

Everyone agrees that the best way to avoid the bid is to be there at the start and seal the deal early. But sometimes it just doesn’t happen that way. Even so, you can turn that situation around. This is where you knowledge becomes important. Consider these points:

·         Always consider the bid list a work in progress and not a final document. Look at this as a starting point for conversation and a chance to use your expertise.

·         Take notice of things that are missing from the bid list.

·         Ask questions about procedures to be done in the office. Many times you will find that the physician plans to do some procedures that he or she neglected to include on the bid list.

·         Suggest additional procedures that they doctor might want to perform, with complete information products, the CPT codes and reimbursement.

·         Inquire about factors such as patient flow and inventory storage, things that the physician may not have thought about yet.

·         Sell up! Watch for products that could be changed to a better alternative and sell the doctor on trusting your opinion.

Will you turn around every situation this way? No–but you will get some loyal customers that you might otherwise have missed.

Many years ago I had the privilege to work with John Stutz of Healthco, which later became Foster Medical. John was designing physician offices and buildings before I ever entered the industry. Sure, he had soup stains on his tie and wore a rumpled lime green leisure suit, but he was a genius at physician practices. He told doctors that he did not care whether he got their setup orders; that he was still available to give advice. When a doctor asked why he didn’t care about his setup order, John replied that he didn’t look at customers as one large order, but as 20 years of orders and loyalty.

I always wanted to get the setup, of course, but when I lost one I listened to John’s advice. I tried to develop a loyal customer for the future, no matter who got the initial setup.

Criteria

What determines the best way to go about setting up a new office? Let’s begin by listing some of the criteria:

·         Physician specialty

·         Number of physicians in the practice

·         Patient flow

·         Number of exam rooms

·         Procedures to be done

·         Laboratory procedures

·         Storage

Considering the expense of office space, you always need to weigh the best use of that space. Anything that can better utilize space for storage, etc. without hurting functionality is a bottom-line saving to the practice.

Patient Flow

Some other considerations:

·         Pediatric practices need two waiting rooms (or at least one divided by a partition): one for well checkups and one for sick children. They also need appropriate entertainment for children.

·         Practices that anticipate that their adult patients may have to bring children along with them may want to set up a small play area.

·         Some specialties–fertility and OB/GYN, for example–may set up an audio-visual room where patients can watch health videos to get answers to some of their questions.

It is getting more common for patients to bring along a family member or friend, particularly older patients, those with disabilities and those with language barriers who may need help in translation and understanding.           

Check-In

The area where patients sign in, fill out medical histories, etc., should, ideally, be separated from the area where they check out, both to protect confidentiality and to lessen logjams. 

Vital Signs

Taking vital signs becomes one of the first issues in patient flow. How will the staff get patients’ vitals, temperature, blood pressure and weight? Many practices do this in the exam room, but a number have one or more vital signs stations. Keep in mind that patients are sensitive about their weight. They want some privacy. Also, be aware that scales need to sit on a proper surface and be adjusted for accuracy, if necessary, when installed.

Seeing the Patient

This is the next component in how the office gets laid out. Some questions to consider:

·         Will blood be drawn in the exam rooms or in a central location?

·         Will there be a laboratory?

·         Will the doctor perform other diagnostics in the exam rooms (e.g., EKGs, spirometry, etc.), or will the physician have a special room for that?

·         If it is a walk-in clinic or an office where minor surgeries, suturing, etc will performed, will these procedures be done in a treatment/surgery/trauma room or in the exam room?

·         What other in-office procedures will the practice do that might require special consideration (e.g., x-ray, bone densitometry, sigmoidoscopy, etc.)?

·         Will the practice use a flag system by the door to identify either the physician who is to see the patient, or the patient status? 

Posters, Compliance, Registrations: Proving You Go the Extra Mile

Many physicians opening practice and already in practice lack the knowledge of the various laws and regulations they must comply with. Reps can be a tremendous resource. Consider the following:

·         Registration. Physicians who intend to see Medicare/Medicaid patients must register as Medicare providers. Refer them to this website for more information: http://www.hcfa.gov/medicare/enrollment/.

·         DME. Some physicians may want to register to be providers of durable medical equipment. This includes billing items, such as orthopedic soft goods. Refer these physicians to their state CMS (formerly HCFA) office or the following website: http://www.hcfa.gov/medicare/enrollment/forms/855-s.pdf.

·         Posters. Physician offices must display a variety of federally mandated (and sometimes state-mandated) posters. Usually, between five and seven posters are required. Some of these include information about OSHA, minimum wage and hours, etc. Help them get these posters so that they start off on the right foot.

·         CLIA’88. Even if your physician plans on doing only CLIA-waived testing, such as urine dipsticks and fecal occult blood tests, he or she MUST have a CLIA certificate. The required form, HCFA-116, can be obtained from CMS or the Centers for Medicare and Medicaid Services (formerly known as HCFA):

Centers for Medicare and Medicaid Services/HCFA

ATTN: CLIA Program

P.O. Box 26687

Baltimore, MD 21207-0487

410-402-8025

There are also state addresses available for HCFA and Medicare/Medicaid carriers. Currently, there are two websites for CMS/HCFA: www.hcfa.gov and http://cms.hhs.gov/siteinfo/. In the future, all information will be moved to the CMS website.

§         OSHA:  Every medical practice must have an OSHA Manual (Exposure Control Plan) that covers the three main regulations: Bloodborne Pathogens, Hazard Communication and TB. Physicians need to have a training program for their employees as they hire them. As you determine their initial stocking order for products help them get and create a centralized file for all of their MSDS. Copies of MSDS can be found at www.msdssearch.com.

Exam, Treatment and Procedure Rooms

The accompanying checklists include most of the common items that one would put in exam, treatment and procedure rooms. Additional items can be added, as well as deleting some items that may not be needed by your customer.

Keep a setup list by specialty that includes the common items. For example, an OB/GYN would have one or two Kevorkians, x-number of vaginal specula in each size, just as an orthopedic office would require a cast cutter and cast spreader. This is a good starting point.

Beyond this, as specialties order products from you, ask why they use them. If they seem essential add them to your lists. Setups are always a work in progress.

Examination Room

As in all areas of the physician office, space is at a premium in the examination room. While I specify wall- mounted diagnostic sets and blood pressure units, some physicians will prefer desk units or sets that perhaps they carry from room to room.

Exam Room Checklist

Treatment/Procedure Room

This room is very dependent upon what treatments or procedures the physician will perform. For example, in an orthopedic office this might be a casting room and the physician will most times prefer a wood or metal flat-top table.

Treatment/Procedure Room Checklist

Laboratory

Most physician offices will have a lab area, even if they are going to register as CLIA-waived (see the accompanying laboratory checklist). What testing will they want immediately? What may they want to add later? They may plan to increase testing as their patient load increases or perhaps they may increase testing based on the mix of patients between Medicare and private pay patients.

Suggest testing that may help to draw patients, such as cholesterol screening. This list shows options to discuss with the physician. It is by no means complete.

q     Draw blood

q     Spin down urine

q     Microscopic examination of urine

q     Urinalysis strips

q     Urine culture dip paddles

q     Rapid diagnostics, such as pregnancy, Strep A, mono, etc.

q     Cholesterol checks

q     Monitoring of patients on therapeutic drugs (such as blood thinners)

q     Monitoring of diabetic patients (How closely? Just glucose testing, or Hemoglobin A1c or Fructosamine?)

q     Other chemistry tests

q     CBCs - Do they want them on a real-time basis?

Faster, and in some cases better, diagnoses can be made when testing is done in the office. Office-based testing also improves patient convenience. Do not “oversell” them, but make sure they understand the possibilities and how easy it is to move from CLIA-waived to moderately-complex. This is also a good time to tell them what their competitors are doing. If most pediatricians in the area do Strep A and CBC's and mono testing, then tell them.

Basic Laboratory Checklist

Additional Diagnostic and Screening Equipment Checklist

Emergency Equipment and Supplies

The area of emergency equipment and supplies offers reps an opportunity to really help out new offices from the beginning. Don’t just help your customers order the items needed to keep on hand for an emergency. Rather, help them develop an inventory list of these items that they can use to review. Set up a review schedule for them, because if they never use some of these items, they will become outdated and need to be reordered.

Emergency and Safety Checklist

Disposables and Supplies

Not only does the practice need enough disposables and supplies for opening day, but it needs to establish the base inventory for a period of time. This is the time for you to do some real work, to create a partnership that will last for years.

Help the practice determine and label storage areas. If they have a storeroom, label it, use bins for small items, and develop an inventory control and re-ordering system. The levels they need to keep on hand will change as their patient load increases, but the system can already be in place. Will you do the inventory? Will they call or fax in orders? Will they use an electronic ordering system?

Some common inventory rules apply: Don’t let them run out, don’t overstock them, and make sure they spend less time on inexpensive items. You, the rep, are at the heart of planning with them now, so help them develop a system that works for them. Here are some things to consider:

·         Develop a pre-printed inventory list.

·         Stock at least a 2-3 week supply for the expected patient load.

·         Revise re-order points as necessary.

·         Be there the week after opening and help them review. Pay particular attention to the dating on dated products.

·         Be there again at two weeks and at one month after opening. Review and adjust the inventory levels. Don’t be afraid to take some returns– it is the long-term relationship that matters more than selling an extra box of tongue blades. Once they are on your routine call schedule continue to help them review their inventory levels as the patient load increases.

Wrapping It Up

Follow-up is critical. In fact, the rule is: Follow-up, Follow-up, and Follow-up!

Be there when the office equipment is installed (Oops, something is missing or broken). Add a personal touch; deliver a plant, flowers, or a coffeemaker when the practice opens. If you do the coffeemaker, make the first pot and have some mugs or cups available. It may cost you a few dollars, but it will earn you a relationship.

The key to a good setup and to developing the ongoing relationship with that customer is reliability. The devil is in the details–it’s always in the details–so get them right.

Ten Rules For Successful Setups Without An Upset

1.        Check and double-check the setup list. If you see that an item which is essential to that type of practice is not on the list, ask the physician more than once to be sure he or she does not want it.

2.        Give the physician a complete list of items for approval, including colors where necessary.

3.        Ensure there is adequate lead-time for decision making and ordering.

4.        Make sure the financing is arranged and approved in advance.

5.        Hand-hold the customer throughout the process. If there is doubt about items, confirm them.

6.        Follow up–make sure everything is on order and on schedule.

7.        Keep the customer informed of the progress and your follow-up procedures.

8.        If there are delays expected, tell the physician as soon as possible.

9.        Ensure that the means and times for delivery are set in advance.

10.     Be there on delivery day to ensure a smooth installation and to handle any last minute glitches.

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