Behind schedule with your patients? Here's how to get back on track

November 1, 2009

This article helps you identify the signs of poor scheduling and offers helpful tips to keep you on time.

This article helps you identify the signs of poor scheduling and offers helpful tips to keep you on time.

The cost of falling behind

These same patients are the ones who tend to miss appointments because they think they'll never be missed. They may not be missed, but the no-show patient costs you plenty. That hole in the schedule is lost revenue and results in inconsistent charge patterns from day to day. Think about what this does to profitability.

First, if the average revenue per patient is $105 and there are three missed appointments per day, that's more than $75,000 in lost revenue per year. Second, the costs to operate the practice and pay staff for 8 hours per day will be the same whether you maximize the number of patient encounters or end up with missed appointments. Finally, the missed appointment represents a noncompliant patient who requires follow-up.

Beyond the missed appointments, a host of other factors can lead to an unmanaged schedule, including double booking, not allowing enough time for new patients, and not being realistic about the start and end times on the daily schedule.

Double booking: Prime culprit

The most troublesome scheduling problem is double booking. Most practices do this to meet the demand of patients who call and need to see a physician quickly.

Double booking is a slippery slope because patients who walk into an already-crowded reception area begin to think their scheduled appointment isn't all that important. Down the road, these patients will begin to arrive late or won't show up at all. In addition, nurses struggle to keep patients moving at a steady pace when, in fact, there is little predictability in how the schedule will flow.

To gain a clear understanding of the demands double booking places on the schedule, start tracking the number of patients who call in to be seen the same day and end up requiring the scheduler to double book. At the end of 2 weeks, the picture will be clear.

If you typically have 10 people double booked, that means that 10 slots should be reserved on the schedule and not opened up for booking until late afternoon of the subsequent day. This will reduce the need to double book and will give you better control of the schedule.

In essence, you are predicting demand based on historical patterns. When this demand shifts, adjust the number of reserved slots accordingly. If the demand continues to increase, it's time to expand the schedule to a longer day and plan for the addition of another physician or a mid-level provider.

Getting on track: Consider patient type

Be realistic about your time needs for each type of patient. New patients take more time for everyone-receptionist, nurse, and physician-so don't schedule them back to back. When a patient's next visit will involve a procedure, mark the encounter form accordingly and let staff know whether more time needs to be allocated on the schedule.

Begin each scheduling session on time. Starting the schedule with a follow-up patient, rather than a new one, will give you an edge on managing this. This is the one spot on the schedule where double booking might make sense, as the new patient can be processed while the nurse is getting the follow-up patient ready to see the doctor.

Each patient should be doctor-ready when the physician enters the room. This means the nurse has the patient properly prepared, has documented the reason for the visit, and has the necessary equipment and supplies ready and easily accessible to the physician.

Finally, avoid exam room interruption. It may seem to take only a minute, but in reality, interruptions lead to ineffiency and compromise time and patient service.

Implementing these steps to improve scheduling patterns and efficiency will be a testimony to the practice's commitment to patients' valuable time. Go one step further to encourage patients' commitment to their scheduled appointments. Confirm patient appointments 48 hours in advance; automated systems can accomplish this without taking up staff time.

Incorporating these improved scheduling techniques into your practice will improve access, patient compliance, and patient satisfaction. At the same time, the practice will become more efficient and profitable.

Judy Capko is a health care consultant and the author of Take Back Time-Bringing Time Management to Medicine . She can be reached at 805-499-9203 or judy@capko.com
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