Neil H. Baum, MD

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.

In the second part of this two-part series, Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, gives suggestions on how urologists who have already successfully attracted patients by removing barriers to entry can then keep those patients in their practice by building barriers to exit. He explains that the goal is for each patient to have a stellar experience and then share their feedback with others. Dr. Baum emphasizes the importance of a robust, regularly updated website and active social media pages. He also highlights the importance of practice accessibility, from having online scheduling and communication via email and text, to having same-day appointments available, keeping office wait times as short as possible, and supplying accessible, validated parking. He suggests that doctors call patients at home after they have had a procedure, both to demonstrate care and to reduce incoming calls from patients. Dr. Baum also notes the importance of having transparent pricing and insurance assistance, and of providing translators for patients who do not speak English. He concludes by encouraging urologists to make their USP (unique service proposition) visible and obvious to patients, by noting that there are riches in the niches, and by reiterating the importance of eliminating negative barriers and fortifying positive ones in a medical practice.