Many private practitioners leave the hospital or educational sector with a desire to escape the endless paperwork required to keep order in their work lives. They spend the first few years in private practice creating only that which is absolutely necessary. At first patients might have an evaluation report and treatment notes, possibly even on yellow legal pads. For the first time, duplicate copies are not required. Time cards and attendance sheets are unnecessary.
As a private practitioner's caseload increases, however, so does the use of paper. Many patient folders, evaluation reports, and treatment notes begin to accumulate in the file drawers. Patients need receipts to submit for insurance reimbursement. The private practitioner will want to make a copy of the receipt for the files.
Eventually a private practitioner may hire other clinicians and will need to track their schedules, hours of treatment, billing, and receipts, as well as pertinent information on each patient. The file becomes only one place to keep some information. What about the schedule? Where is it? Is it only with the clinician or is it available in the office at all times in case a change needs to be made? How many schedule books are necessary to keep the information available for all involved parties?
Files become crucial to keep a practice on track. As an example, a patient's insurance company might request a letter of medical necessity written by a speech-language pathologist who then filed a copy in the records. Months later a similar letter is needed, but the SLP cannot recall where the previous letter is filed, prompting the clinician to begin a new file for sample medical-necessity letters.
When a patient needs to be called for any reason, is the phone number handy or do office staff need to interrupt an SLP to look at the file? Obviously the latter is inefficient—a file is needed with all the contact information about each patient. What if the SLP calls in from a remote location and needs that contact information?
Clearly, running a private practice involves many non-clinical aspects. Without belaboring the need to be highly organized, one can imagine the many additional sources of paper collection in private practice—including insurance correspondence, future treatment ideas, correspondence with other professions, other professional reports, printed articles of interest, and behavioral observations.
After several years in practice, a practitioner will likely need to choose between increasing the office size or renting off-site storage space to store paperwork. From a business perspective, it makes more sense to increase office space only if that increase in feet and inches will increase a practice's revenue. Storage space can cost several hundreds of dollars a year.
"The worst part of having off-site storage space comes when you need a file that is a few years old and you don't have access to it in the office so you have to make a trip to the storage space," complained Anita Werner, director of Pediatric Speech & Language Specialists in Scottsdale, Ariz., at a recent meeting of the American Academy of Private Practice in Speech Pathology and Audiology (AAPPSPA). This discussion accompanied a demonstration of a practice management software system used by many AAPPSPA members and private practitioners.
A Paperless Practice
Although many business disciplines have been paperless for some years, the trend has been slower to reach the clinical professions. The last few years, however, have seen increased movement toward establishing paperless practices. The first commercial management software systems were generally adapted from medical software programs that allow scheduling, insurance claims, receipts, and medical records. Systems designed specifically for SLPs but applicable for multidisciplinary practices are now on the market.
At last the private practitioner can "go paperless." Practice management systems make it possible to schedule recurring appointments, revise the schedule, and make changes in one occurrence or a series of appointments with the click of a computer mouse. Billing can be done in advance from the schedule or from each patient's file. Patient files can hold all necessary billing information and identifying data including addresses, multiple phone numbers, responsible parties, insurance identifiers and authorizations, personal notes, and chart notes. Electronic billing is another option.
A paperless office offers many benefits. With all information in searchable practice management software, financial information—such as receivables, payments, and patients categorized by diagnosis—is easily retrievable, as are previously written letters of medical necessity. Data also can be used to predict trends. Determining SLP productivity is simple, because information is available regarding the number of patients seen during a given time period.
Networking all the computers in an office gives access to the management program to several users simultaneously, allowing changes to be made and posted. Claudia Goswitz, AAPPSPA board member and executive director of Stone Oak Therapy and Learning Institute in San Antonio, Texas, added that network access allows her as a manager to "do quality assurance from my desk" rather than working from paper charts that everyone is trying to use.
Hierarchies of access to different aspects of a program can also be arranged. For example, SLPs may have access to all patient files but be restricted from management aspects such as productivity or invoice deletion. This safeguard protects against the potential for falsifying records; it also prevents acts of sabotage (such as shredding records) by former or disgruntled employees. Although electronic sabotage is possible, some management systems allow an administrator to deny access to other users with the touch of a button or, if necessary, to render passwords invalid. In addition, the network can be made available remotely, allowing users to access the network and program from home or other locations.
The most recent systems can interface with standard office software programs. Information can be inserted into or exported from the management program to assist in record-keeping. Having all the information about a patient in one place can be convenient, but it also can be lost if the data are not backed up regularly. Most networked systems will save information on a server, or on a main computer set up to hold data and run the network. The server should have more than one backup in use. Many users prefer to have alternating portable external hard drives that back up data and are removed daily or weekly. With this method, the available data are never more than a few days behind if it is necessary to restore lost data from a computer crash or failure. Some management systems allow backup to servers through the Internet. There are advantages and disadvantages to each kind of backup; choose the one that best meets your needs.
Tax, employment, and other health care laws specify that records be kept for a specified number of years, further adding to the accumulation of paper files. Such paper files can easily fill a storage room. The hope is that in the near future the private practitioner will be able to give up costly storage space as technology improves and clinicians use less paper. By going paperless, SLPs and audiologists can contribute to creating a cleaner environment for generations to come.