The Appointment Schedule Can Make or Break a Practice

Abstract:

If you are repeatedly running behind schedule or have patients who are arriving late, canceling appointments, or not showing up, there’s a problem. The problem is a poorly managed schedule. An appointment schedule can make or break a practice in terms of efficiency, patient service, and profitability. When a practice overbooks or doesn’t manage the appointment schedule, everyone pays the price—the physician, patients, and staff. Missed appointments can compromise patient care and reduce your potential profits. Three missed appointments a day can add up to as much as $150,000 a year in lost revenue. Here are some tools to better manage the appointment schedule and improve patient service.

Analyze how much wait time there is for the patients and how much downtime there is for the physician. Start by examining patient flow. Many practice management systems provide a tracking system that follows patients from check-in to checkout. Print the report for a 10-day period, and analyze how much wait time there is for the patients and how much downtime there is for the physician. If your computer system does not have a patient time-tracking module, gather data the old-fashioned way. Create a simple form to put on the outside of the charts, and document the following information for each patient:

Scheduled appointment time and length of appointment;

Arrival time;

Time patient is roomed;

Time physician enters the exam room;

Time patient checks out;

Comments (an area to note any reasons for delay in treating the patient, such as “double booking” or a need to locate the patient’s x-rays or other diagnostic studies); and

If patient was a no-show (indicated on the form, along with the length of time blocked for the appointment and the reason the patient was coming in).

Collect the data, and analyze average wait times, late arrival times, no-shows, and length of time the physician spent with the patient versus the amount of time allotted on the schedule. This will reveal whether your schedule is realistic and will help identify ways to resolve problems that play havoc with the schedule. The problem may be something as simple as the physician allowing interruptions for phone calls that could be dealt with between patients or at the end of the day. If you are double booking, it is better to do so at the beginning of each clinic session: the physician can be seeing one patient while the other is getting prepped for the visit.

Next, examine the historic scheduling data for 10 days, and count the number of appointments of each type and calculate the average daily “work-in” appointments, cancellations, and no-shows. For example, the scheduling parameters may allow for only four half-hour appointments a day for new patients and 15 minutes for all other appointments. But in reality, the practice is seeing an average of six new patients a day. In this situation, you would need to open up the schedule for seven half-hour slots each day. Or you notice there is double booking for the end-of-day appointments. Perhaps scheduling one day a week to open late and work until 8 p.m. would provide needed relief.

It will be important to evaluate the cause of those missed appointments that result in costly downtime. Maybe patients don’t place importance on their scheduled appointment. If the physician habitually runs late, patients don’t think they’ll be missed if they don’t show up. In a busy practice, it might be the staff that doesn’t value the appointment and feels a missed appointment is just an opportunity to get caught up. This is not healthy for a practice. Patient satisfaction will decline, and productivity will suffer. Now it’s time to develop a template for each physician based on the information that has been gathered. By understanding practice scheduling patterns and patient needs, a realistic schedule can be created, and productivity will improve. Take into account whether time should be factored into the schedule to allow physicians to review charts and complete their documentation.

Before implementing the new scheduling templates, set a standard for wait times, and educate staff about emphasizing to patients the importance of keeping scheduled appointments. When established patients are seen on time and new patients do not have to wait three or four weeks to get into the office, they will appreciate and respect the appointment. Finally, once the new appointment templates are in place, monitor the results. Is wait time reduced? Are there fewer no-shows and last-minute cancellations? Are you actually improving physician and staff productivity? If not, why not? Another problem may emerge, such as the realization that the physical space is insufficient. Perhaps additional exam rooms are needed, or maybe it’s time to consider adding a midlevel provider to improve access and ease the demand. It’s important to look at the historical data from time to time to understand the practice scheduling performance and identify areas that need attention. Only then can you make informed decisions that benefit the entire practice.

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