Model healthy behavior for your patients

I've found that the most effective way to promote healthy behavior in my patients is to model it myself. I sold my vehicle and now bike everywhere, even to the hospital to do my rounds. Quite unexpectedly, I've discovered that my example has instilled a desire for improved health in my patients. I give small gifts as incentives to patients who bike, walk, in-line skate, etc., to their office visits. I also display unusual vegetables, such as watermelon radishes or golden beets, on my desk. When patients ask about them, I offer them a bite and a prescription that they can take to the grocery store.

Reduce returned mail

I used to be very frustrated by the amount of returned mail we received when trying to send lab results and other important information to patients. Now I have my patients address an envelope while they're waiting for me to come into the exam room. We almost never have returned mail now that they address it themselves. Now, if only they would bring their own stamp!

Create a simple drug reference for patients

I've found that many of my older adult patients have trouble taking their medications correctly. I created a master template in Microsoft Word that I use to produce customized medication lists that patients can take home. Each patient's list includes his or her medicines, doses, how often and how they are taken (e.g., orally or as a patch) and the reasons for the medicines described in lay terms (e.g., for your blood pressure). In creating the lists, I consult a simple reference file that I keep on my computer. I save the list with the patient's name and the date. Creating these takes some time, but they are easily updated. I make copies for caregivers and family members when needed. I also fax the list to other physicians the patient sees so that they can reconcile their lists with mine.

Use a date stamp

I use a small date stamp to prepare the date on about a dozen prescriptions before the day begins. I also keep the stamp available for forms throughout the day.

Code detailed history with 4,3,2,1

The requirements for documenting a detailed history under the 1997 version of Medicare's Documentation Guidelines for Evaluation and Management Services can be remembered using the mnemonic device 4, 3, 2, 1:

• 4 elements of the history of the present illness (e.g., location, quality, severity) or the status of 3 chronic conditions;

• The review of 2 systems;

• 1 of the following: past history, family history or social history. With moderate-complexity decision making and clear medical necessity, a detailed history satisfies the requirements for coding 99214.

Remember that the guidelines allow ancillary staff to record the review of systems and past, family or social history as long as the physician notes his review and confirmation of this information.

Let your staff do their jobs

It's a physician's job to give advice to patients, but try to restrain yourself when it comes to telling your staff how to do their jobs. Hire quality people, give them the tools and training they need and then get out of their way. Without your constant direction, your staff will take ownership of their work. Be receptive to their suggestions and needs and, if reasonable, accommodate them. A healthy, happy office staff makes for a healthy, happy environment, which is something patients feel the minute they walk through your office door.

Remember prescription preferences

At the bottom of each patient's problem list, I write the patient's pharmacy information and whether they prefer their prescription for a 30-day supply, 90-day supply, etc.