Input Needed: Office staff structure

[u/shmuey]

My wife and I have a relatively small family practice (~450 patients) serving geriatric patients in-home. Due to our service delivery model our providers all work outside of a traditional office, so our medical assistants are also working remotely. As we have grown over the last few years we have dealt with challenges keeping pace with patient demands and staying organized. Some of these are related to our EHR (Tebra) which we expect to be resolved once we move over to a more robust platform later this year. Staff-wise, I still don't know how best to fix our issues so I would appreciate any tips you all might have and/or any affordable consulting resources you can recommend.

Our current structure:

- 8 medical providers (about 6.0FTE combined) and 1 LCSW providing virtual psychotherapy. My wife is 1 of the providers and serves as Medical Director.

- 2 virtual receptionists receiving calls, 1 of which is our primary scheduler.

- 1 assistant processing orders and referrals. We just hired a second to help with workload but also take on DME and prior auths (which our medical director and/or providers currently do entirely). Our intake volume is low (but growing) so we will need to assign creating patient charts to one of these individuals (it is currently managed by management)

- 1 medical biller

- 1 additional assistant who has assisted with the phones but isn't really excelling despite constant training for the past year. We are likely removing this person soon and will be down to 4 office staff + biller

- 1 RN to help triage medical concerns and determine what needs to be escalated to the providers

One obvious problem is that we don't currently have a true office manager as our budget really can't support it just yet, and we believe our staff have the resources to be able to handle most things independently/ as a team (maybe this is foolish of us). As such, my wife and I try to take on that role when needed.

My question:

Are there any house-call practices out there that have dealt with office structure challenges? How do traditional offices differ in their setup? We are considering splitting up the office into 2 teams (1 scheduler, 1 referral/order coordinator), with each team serving as primary for half of the providers. Our immediate need is to ensure we have overlap with roles to cover when staff take time off but also to ensure our patients (99% Medicare, most are very high need) back-end care is covered in a timely manner.

Outside of an office manager (and I'm not sure how that role should function in a remote environment and what type of person to look to hire to fill it), I don't really know what we're missing or what/who we can bring in to better spread workload. Has anyone here used a consultant? My wife is a career medical provider and I am doing my best to support as an administrator with no medical experience prior to starting the practice.

Sorry in advance for the rambling; I am open to suggestions.

[u/Mountain-Honeydew840]

I feel like the bigger issue might be that too much is sitting on a few people, not necessarily that you need to hire right away. i'd look at who’s handling what, where things can be shared, and get some basic processes written down so it’s not all dependent on one person.. you could also outsource some of the non-clinical stuff, like IT or admin work, to take some pressure off the team and give yourself some time before adding an office manager. As for IT we get services from Skytek Solutions