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Medical Practice Scheduling Issues

FOR DOCTORS AND PATIENTS, ALIKE

By Dr. David E. Marcinko MBA

Doctor Scheduling Issues

Nothing creates more distress for a new medical practice administrator than “holes”, or empty slots, in a physician’s appointment schedule. While doctors may complain about too much work and not enough time with patients, a corollary is the lack of production that accompanies such downtime.

This scenario is common in January-February [patient insurance deductibles not paid] and August-September [new doctors join existing practices]. An increase in new doctor days, and marginal native practice growth, usually mean space in the daily schedule.

Now, the natural tendency is to try and fill the day. And, it is best if the day is filled by increasing patient services acuity levels. However, a common, but ill-advised approach is to add time to existing patient appointments. So, when a practice accepts a new medical provider, creation of a checklist similar to the one below may be helpful.

LIST:

  1. List appointment types and expected length.
    2. Use booking or scheduling secretarial templates.
    3. Review the templates with booking secretary then make sure they’re followed.
    4. Allow for walk-in or ‘urgent’ visits.
  2. Rather than having a policy of scheduling days or weeks ahead, ask patients if they’d like to come in the same day.
  3. Some physicians have moved to open-access appointments that eliminate traditional time slots altogether. This should be tested short-term before instituting since it is not effective in all markets.
  4. Know your area and know your patient base. If you have a high “no show” rate, you may want to pad in additional access by double-booking on the hour. Certain payers also have members with historically high “no show” rates that should be taken into consideration.
  5. Give yourself at least 60 days to credential the new provider (if they will be billing under your TIN). Otherwise, they may be seeing patients free of charge for some payers where credentialing is not yet completed. Limiting them to self-pay, work comp, non-covered services or patients whose payers have issued a provider number may pose some scheduling obstacles.

The danger of open appointment slots is adding inefficiencies to a schedule by the pressure to fill time. Instead, look at organic practice growth [5-8% annually for a mature practice], the change in provider time and have realistic expectations for open time-slots in the first few years of new practitioner availability [see http://waittimes.blogspot.com, Wait Time & Delayed Care; a blog devoted to helping healthcare providers shorten wait times and improve patient flow].

Patuient Scheduling Issues

Most mature doctors follow a linear (series-singular) time allocation strategy for scheduling patients (i.e., every 15 or 20 minutes).  This can create bottlenecks because of emergencies, late patients, traffic jams, absent office personal, paperwork delays, etc.  Therefore, as proposed by Dr. Neal Baum, a practicing urologist in New Orleans, one of these three newer scheduling approaches might prove more useful. 

 1. Customized Scheduling

The bottleneck problem may be reduced by trying to customize, estimate or project the time needed for the patient’s next office visit. For example:  CPT #99211 (5 minutes), #99212 (10 minutes), #99213 (15 minutes), #99214 (25 minutes), or #99215 (40 minutes). Occasionally, extra time is need, and can be accommodated, if the allocated times are not too tightly scheduled.   

2. Wave Scheduling

Some patient populations do not mind a brief 20-30 minute wait prior to seeing the doctor.  Wave scheduling assumes that no patient will wait longer than this time period, and that for every three patients; two will be on time and one will be late. This model begins by scheduling the three patients on the hour; and works like this. The first patient is seen on schedule, while the second and third wait for a few minutes.  The later two patients are booked at 20 minutes past the hour and one or both may wait a brief time. One patient is scheduled for 40 minutes past the hour. The doctor then has 20 minutes to finish with the last three patients and may then get back on schedule before the end of the hour. 

 3. Bundle Scheduling

Bundling involves scheduling like-patient activities in blocks of time to increase efficiency.  For example, schedule minor surgical checkups on Monday morning, immunizations on Tuesday afternoon, and routine physical examinations on Wednesday evening, or make Thursday kid’s day and Friday senior citizens day. Do not be too rigid, but by scheduling similar activities together, assembly-line efficiency is achieved without assembly line mentality, and allows you to develop the most economically profitable operational flow process possible for the office. 

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 Patient Self Scheduling (Internet Based Access Management) 

The traditional linear patient scheduling system is slowly being abandoned by modern medical practitioners; an all venues (medical practices, clinics, hospitals and various other healthcare entireties). New software programs, and internet cloud applications, allow patients to schedule their own appointments over the internet. The software allows solo or individual group physicians with a practice to set their own parameters of time, availability and even insurance plans. Through a series of interrogatories, the program confirms each appointment. When the patient arrives, a software tracker communicates with office staff and follows the patients from check-in, to procedures, to checkout. Today, many hospitals have even abandoned the check-in or admissions, department. It has been replaced by access management systems.

Automated Medical Office Access Management Systems [Patient Check-In Kiosks]

According to a McLean report published in InfoTech,

“Today’s patients demand the same level of self-service convenience in healthcare that they do in other industries. Medical kiosks save money, reduce wait times, and significantly enhance the patient experience. The payback period for medical kiosks is often as short as 180 days”

Automated medical office access management [AM] or patient self check-in solutions provide a wide range of functionality including patient registration, insurance verification, and demographic-validation, electronically consent form completion, back-end scheduling, financial systems integration, real-time appointment re-scheduling, direction text mapping and way finding; and more.  Often, solutions can be individualized and integrated with HIT systems using HL7, XML, web and other standard data exchange protocols.

Open Access Patient Scheduling

A sub variant of the above is open-access patient self-scheduling, either in full or part. Benefits include reduced patient appointment wait times, matching and scheduling patients with physician, improved continuity of care, increased productivity per patient visits, higher physician compensation and higher net gains for medical offices and clinics.

Real Time Claim Adjudication

Real Time Claim Adjudication [RTCA] or expecting payment at the time of service is becoming the rule, not the exception, in the modern AM era. RTCA makes a medical practice more like other businesses.

Benefit of Automated Medical Office Access Management

  • Streamlines patient flow with focus on improved patient care
  • Real-time insurance verification
  • Capture credit/debit card information with funds verification
  • Improves office cash flow and collections
  • Provides patient payment receipts
  • Decrease accounts receivable [ARs]
  • Save time and office staff resources
  • Increases office return on investment [ROI]
  • Demographic capture and validation improve marketing
  • Continually improve office operations.

Vendors for the above AM processes include: Phreesia.com, KioHealth.com, MediSolve.Ca; VecnaMedical.com; MeridianKiosks.com; AppointmentDesk.com; and KioskMarketPlace.com; etc.

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Five people are sitting in the waiting room of a doctor’s office. Some of the people look tense or upset, and others look completely relaxed.

More: Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance

LINK: http://store.hin.com/Simple-Steps-to-a-Patient-Registry-Ticket-to-Care-Coordination-Quality-Reporting-and-Pay-for-Performance_p_0-3855.html#

Assessment: Your thoughts are appreciated.

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