Key performance analysis of self-pay services: What they fail at and what GPs and specialists would need to change

Facts and Figures from the German Health Care System

What it’s all about

GPs and specialists use the offer of self-pay services to secure or expand their entrepreneurial freedom and to increase the attractiveness of their practice offer. In practice, however, only two out of ten practice owners who enthusiastically start with self-payer work are also economically successful with this form of offer after the introductory phase.

The practice management comparison identifies the problems

Although some patients decide to use the services, the offers often fail to really catch on, so that the planned turnover is not achievable either. An examination of self-pay work with the help of practice comparisons makes it clear that a number of important aspects are not taken into account or are insufficiently taken into account:

• An essential prerequisite for success is the commitment of the female employees. However, this is often significantly limited by team conflicts resulting from an inadequate distribution of tasks.
• Team meetings, which take place only sporadically and in which experiences of self-pay work could have been exchanged and problems discussed, also inhibit motivation.
• Although the staff receive instructions on how to work with self-pay patients, they often feel insecure in their arguments because they lack support or examples. For this reason, they avoid addressing self-pay offers with many patients.
• Furthermore, there is often no incentive for staff to offer self-pay services, so the offer is seen as an additional burden.
• The associated information material describes the services in full, but its content is usually not sufficiently geared to patient needs (comprehensibility and benefits).
• General organisational practice problems such as excessively long waiting times or low waiting comfort (old newspapers, dark waiting room, uncomfortable chairs), but also unfriendliness and short contacts lead to considerable dissatisfaction, incidentally not only among self-pay patients.

The statement of the Self-Payer Management Quality Score

Overall, practice owners do not take enough account of the causal chain of successful self-pay work: only on the basis of professional practice management, committed staff and professional patient satisfaction monitoring can self-pay work be realised that simultaneously meets the demands of clients and ensures success.

This statement is also reflected in the key performance indicator „Self-Payer Management Quality Score (SMQS)“. The score results from the ratio of self-payer management implemented in a practice in relation to best practice standards. The best practices comprise the tools, regulations and behaviours necessary for successful self-payer work. For general practitioners and specialists, it currently amounts to an average of just under 36% (optimum: 100%).

What do best practice practices do differently?

A look at the self-payer management of practices with above-average success clarifies what is meant by this in concrete terms:

• The teams of these practices see their self-payer offerings as a central ambition and not as a mere additional service,
• all work is carefully planned and regularly reviewed for improvement opportunities,
• the offer is aimed at clearly defined target groups in each case,
• the initial approach to individual patients is linked to patient-specific aspects,
• The core of the self-pay offer is the development, implementation and continuous review of a comprehensive information concept (short description, detailed brochure, internet presence, poster and video in the waiting room).
• annual work analyses ensure a smooth workflow organisation that dovetails normal practice operations with the self-payer work,
• the planning and activities associated with the self-pay services are anchored in target agreements for each individual staff member and are subject to regular monitoring by means of management meetings,
• Staff satisfaction and team spirit are promoted through joint leisure activities, as the offer only works well if staff are committed to „their“ practice; profit-sharing schemes supplement motivation,
• regular training (internal and external) of the staff ensures qualified patient consultations, an institutionalised suggestion scheme ensures the continuous development of skills, techniques and instruments,
• the services are presented to interested parties with the help of clear examples and catchy benefit arguments,
• staff and doctors work hand in hand by coordinating exactly what preliminary information patients come to the doctor with.

Concrete support

The basis of any consideration of the review and development of self-payer work, but an instrument of basic and regular control, is the implementation of a self-payer patient survey.

The Valetudo Check-up© „Patient Satisfaction IGeL „ offers practising doctors and their teams an importance-satisfaction view of the performance quality of their self-payer work from the perspective of practice visitors in a double benchmarking comparison:

• once in relation to the patients‘ requirements and
• additionally in a comparison with representative values from practices in the same specialist group.

The practice expertise resulting from the survey describes the strengths and weaknesses of the activity and identifies as yet unused optimisation opportunities.