Neil H. Baum, MD

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, touts the benefits of offering same-day appointments. He notes a recent downward trend in reimbursement rate, explains the need to increase volume of patients, and offers an implementation plan. Dr. Baum highlights two key components needed to manage same- or next-day appointments: a timely urologist and a willing staff. Front desk staff can increase appointment efficiency by preparing patients for their visit, reminding them to complete paperwork in advance, collecting fees prior to the visit, and explaining estimated costs and copays. It helps to keep a list of conditions requiring immediate care at the front desk, such as acute scrotal pain, urinary retention, and gross hematuria. Advantages of same-day appointments include improved patient satisfaction, reduction in no-shows, increased productivity, and great marketing for the practice. Dr. Baum adds that if the current appointment wait-time is two weeks or longer, creating openings in the schedule, in addition to a waitlist for earlier time slots, will allow the doctor to accommodate new patients and those in need of immediate care. While same-day appointments can initially disrupt the workflow and create stress for staff, doctors can overcome these challenges by seeking feedback, clarifying the purpose of same-day appointments, and offering monetary or verbal rewards for their staff’s flexibility.

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, offers advice on maintaining standards in a medical practice. He provides common examples from physician lateness to addressing after-hours patient calls for routine medication refills. Instead of “widening the plate” as the baseball metaphor goes, Dr. Baum insists that doctors must hold themselves accountable to the same standards as those they serve. For example, if a doctor is consistently late, thereby requiring staff to make excuses for them, they should consider whether they would accept such behavior from a patient. Or if a payor denies a request for a procedure or medication based on a prior authorization requirement, should the doctor continue to accept this payor knowing that they may create additional work and future delays? Dr. Baum proposes physicians maintain their standards instead of modifying their protocols or behavior to accommodate others.

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses the importance of creating a positive first impression for new patients. He outlines several examples that establish a welcoming environment beginning with the patient’s first call to the practice. Dr. Baum emphasizes that when a patient has a positive experience, it will serve as effective marketing for the practice. The receptionist has the initial opportunity to make an impression by preparing patients for their upcoming visit, directing them to educational materials online, and reminding them to both fill out demographic information in advance and to hydrate appropriately to facilitate the collection of a urine sample during their visit. When patients arrive for their appointment, it is important to be respectful of the patient’s time by minimizing their wait time. Lastly, Dr. Baum shares a unique tip to impress patients by creating a personalized introduction video for each new patient welcoming them to the practice and reminding them of any pre-appointment information.

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses the shifting paradigm in healthcare from the volume of services provided to the value of services. He describes outcome management, how to get started, and challenges to this approach. This client-centric approach to healthcare delivery redefines value to equal health outcomes that matter to the patient divided by cost. To implement this approach, Dr. Baum advises starting with conditions that have quantifiable measures such as radical prostatectomy, BPH, or ureteral stones. Outcomes have historically been measured by mortality, morbidity, readmission rate, and length of stay, but the new standard will consider patient satisfaction, which can be measured by looking at the length of time it took to for the patient to make an appointment, time spent waiting in the exam room, whether their questions were answered, and if they received a follow-up on test results. He notes that AUA guidelines can also provide a rubric for outcomes that are important to both the physician and the patient. Dr. Baum underscores that patients who have a positive experience have better clinical outcomes and improved quality of life. Similarly, outcome management is proactive and promotes innovation with the goal of improving care.

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses how to manage inappropriate patient requests. He provides examples of common requests, reasons for saying ‘no,’ and how to maintain a positive doctor/patient relationship while doing so. Example scenarios include requests to add on extra days to a work exemption, inappropriate prescription medication, unnecessary procedures, requests for the medical records of an aging parent, and asking to remain in the office after an appointment has ended. Dr. Baum recommends proposing alternative solutions to the request and offering to reassess later if necessary. He advises doctors to gain their patients’ buy-in by involving them in the solution and asking them to agree to the plan. Additionally, reminding patients of a doctor’s ethical obligation against lying, violating HIPAA, or providing unsuitable care can help them understand the decision. It is important to document such requests in the patient’s file along with an explanation of the steps taken to address the reasons for the request.