This is the time of year, in the northern parts of the country, at least, when you begin to notice all the cracks that suck heat from your home. So it seems fitting that this issue offers to help you plug various leaks in your practice – leaks that lose more than heat.

First, Robert K. Jarve, MD, and David W. Dool lay out a way to revise referral management in your practice to stop the loss of efficiency, time and patient satisfaction that a poorly engineered process can cause. Their advice, and the tools that accompany their article, are products of their own gap analysis and quality improvement (QI) process and so may save you even more time – at least some of the time you would otherwise have to spend in your own QI effort.

Next, Peter Teichman, MD, MPA, and Anne Teichman, PharmD, describe how to stop losing time, money and clinical quality on managing “refills” – actually prescription renewals that occur without the opportunity for clinical reassessment and without compensation – by treating each prescription as a new prescription and reclaiming prescribing as a clinical event.

Third, Carolyn L. Hartwell, PhD, CPA, Susan S. Lightle, PhD, CPA (inactive), and Randall K. Domigan, CPA, CFE, help you plug what can be the biggest leak of all: the loss of money to fraud. Whether you own your practice or just work there, financial fraud will hurt you. Hartwell and her coauthors explain why most medical practices are at risk, and they outline steps you can take to reduce the opening for skimming, check tampering, outright theft and the many other schemes that someone with incentive, means and the ability to rationalize fraud can come up with.

If these three articles could be said to share a moral, it's that process improvement is crucial to successful practice. In a way, that's the core lesson of Family Practice Management. After all, you pretty much know the medicine you need to know; you had it hammered into you in medical school and residency, and you keep up with CME. Now the key to practicing better medicine is practicing better. Work to optimize every process, and you'll deliver better care to more satisfied patients in a vital, rewarding practice. You'll become a better doctor.