Physiatry Practice Management Resources

Today's patients expect a level of service similar to what they experience in an upscale department store. One important way to achieve this is to perfect the art of scheduling patient visits, so that your practice is busy, but is not overbooked.

For most practices, this requires some self-evaluation. While most appointments are scheduled in a standardized manner, some staggered hours should be available to accommodate patients who require early morning or late-evening appointments. For example, one day of the week a practice could see a patient as early as 7 a.m. but end appointments by 3 p.m., or start at noon and end at 8 p.m.

Staff should also be trained to be respectful of both the physicians' and patients' time. Neither physicians nor patients like to be kept waiting. It is very expensive for the practice to have a physician available with no patients to see. It can be just as costly to the practice when patients, faced with unreasonably long times to see the physician, decide to find a new doctor.

Staff should avoid large gaps in the physicians' schedules and, when necessary, apprise the physician of any sudden cancellations by patients. In some cases, that time can be filled from a waiting list, same-day appointments, emergencies or walk-ins. If that's not feasible, the physician should be given adequate notice so he or she can catch up on dictation, follow-up calls or other tasks normally completed after patient appointments.

Efficient Scheduling Creates Efficient Practices
To avoid "holes" during a typical day, staff should schedule morning appointments from noon backward and afternoon appointments from noon forward, thereby filling in late morning and early afternoon appointments first and gradually booking early and late slots. This way, if a day is not fully booked, early morning hours can be used productively for a staff meeting or permit the doctor to come in later. An empty slot in the middle of the day is generally wasted time.
Efficient practices typically allot an appropriate block of time depending on the type of visit, such as a follow-up appointment or a specific procedure. Different time blocks should also be created when new or established patients make appointments. With 85% or more of a typical medical practice's expenses fixed, completely booking the physicians' day is vital to increasing revenue.

When the doctor is faced with emergencies or is running significantly behind schedule, take the opportunity to partner with the patient. Patients already in the office as well as those scheduled for later in the day should be told of the approximate wait time and offered options. If the physician appears unable to see all of the scheduled patients, start calling immediately to reschedule those who likely have not yet left for their appointment.

Typically, patients should be offered the option of rescheduling or coming in an hour or two later than the scheduled appointment. Most patients will appreciate the call and understand the need to reschedule. For those patients already in the reception room who do not wish to reschedule even if the wait will be long or of unknown duration, some practices provide beepers which will allow the patient to run an errand, visit a museum, or have a quick lunch.

To ensure a practice's day is fully booked; staff should follow these procedures:

Confirm appointments: Practices that remind their patients of their upcoming appointment will generally have fewer no-shows and have less need to overbook. Each patient should be contacted by phone a day or two in advance of the appointment. Mail reminders should arrive a few days before the appointment. Part of your patient registration information should indicate whether your office could leave a reminder message on their voicemail.
If your practice cannot call every patient, make a point to contact those who are scheduled for a large block of time, such as patients undergoing a complete physical exam. Consider an automated telephony product if you do not have staff to make the calls. From an efficiency standpoint, it is far better to have a patient with a follow-up visit for an ear infection forget an appointment than a new patient scheduled for a complete physical.

Practices with a history of no shows will need to double-book to assure there is a patient in every time slot. Generally, however, Monday morning is not a good time to overbook for any practice.

Triage emergency appointments: Your receptionist should be trained to ask specific questions to determine the patient's status and, when uncertain, quickly refer the call to a nurse or the doctor. Patients with serious complaints such as chest pain should be instructed to go to the hospital emergency room immediately.
Practices that routinely handle emergencies (or situations that the patient perceives as such) should set a specific period of time aside each day, such as 30 minutes before lunch. Those patients should be told that the doctor will treat only the urgent problem and do what is necessary to relieve the immediate discomfort; additional procedures or follow-up treatment would be scheduled for a later date.

Discourage walk-ins: Do not encourage patients to walk in without an appointment. However, for those who do, indicate the doctor will see them as soon as possible and try to fit the patient into a no-show or late arrival slot.

Allow same-day appointments: Depending on the nature of the practice, leave some time open for visits from sick patients. Pediatricians, in particular, may want to provide the answering service with a list of "open slots" for the next day in which sick children can be booked by the service.

Open-access appointments: Practices that typically book months in advance should leave some appointment slots open until the week prior that can be filled by patients requiring a return visit or referrals who need to be seen within a week.
This will ensure that there is a slot available when the doctor wants to see a patient again in a week or 10 days. In the same manner, it is always advisable to accommodate a referring doctor's request that a patient be seen as soon as possible. Any remaining open slots can be filled with walk-ins, emergencies, and last-minute appointments as well as by calls to the patients on the practice's waiting list.

Reschedule canceled visits: Reschedule canceled appointments as soon as possible. Depending on how much notification you were given, use walk-ins, follow-ups, waiting lists, and last-minute appointments to fill the slot.

Reduce no-shows: Payer mix and/or the patient-practice relationship can be major factors in the no-show rate. Practices with a high transient population, long wait times between appointments, and patients with transportation problems all contribute to a high no-show ratio. Reminding patients of appointments and generally improving the practice's relationship with patients can help in reducing no-shows.

Making the Wait Less Burdensome
Most practices will experience occasional delays in adhering to the schedule, especially when patients are late or require more attention than expected. And, despite the best efforts of the scheduling staff, there are times when patients are tripping over one another in the reception area. In certain specialties, such as ob/gyn, the physician can be called away for an emergency, wreaking havoc with a fully booked schedule.
To make the wait less onerous for patients, many practices are implementing innovative amenities. In addition to the reception room staple of magazines (current, please!) consider adding these:

• Library of relevant medical information
• Health-related videos
• Internet access
• A telephone for local calls to a patient's office, baby-sitter, etc.
• Recipe bin featuring health-conscious or patient favorites
• Coffee, tea, water
• Television
• Piped-in music
• Children's play area

If you find your practice is consistently over- or under-booked, call your staff together to discuss the issue. Gather data and analyze the situation. Develop a spreadsheet for each physician to track his or her appointment activity for a month. Pay attention to fluctuations in days of the week.
Share and analyze the information you have received at the next staff meetings. All staff should be involved in discussions about scheduling since problems in this area affect all aspects of the practice -- patient flow, customer service, and accounts receivables. Suggestions from the staff should be implemented and monitored so everyone feels responsible for the success.

Written by: Debra C. Cascardo