In this three-part series, we’ve explored administrative issues with employed practitioners that may interfere with the smooth running of your practice. We discussed untimely processing of a clinician’s work in part 1 and in part 2, we looked at attendance and punctuality challenges. In this last installment, let’s examine scheduling concerns.
As much as some would like to debate it, medical practices are businesses and as such, they need to be profitable. Now, many factors go into achieving profitability, but let’s at least agree that your service schedule is the starting point. Most primary care practitioners see between three and four established patients per hour, and virtually all of our clients have some formula for scheduling appointments. Among the most important scheduling considerations is the time allocation for new patient appointments, routine follow-up appointments, annual wellness or preventive visits, pre-procedural visits and hospital follow-ups. Of course, your practice may have a few other visit types, but the most common choices are 15- and 30-minute slots.
We advise highly capitated practices to safeguard a few open slots for same-day/urgent or walk-in visits; these can vary from 10- to 15-minutes in length for which criteria exist to fill them. Some practices also build in some “breathing room” for providers, who might run late or who need a catch-up point for closing notes or reviewing documents, by allocating a certain number of open (non-bookable) spots.
The big issue many providers have is the composition of the schedule and a trusting relationship between administrators and clinicians goes a long way toward harmony. In practices where that trust has been damaged, or providers have developed bad habits, we see clinicians becoming testy with the staff (often within the earshot of patients – yikes!) or making scheduling demands as if they were self-employed. To avoid these behaviors and the confusion they stoke, we need to establish common ground by considering the following:
- As the manager, look at your provider visit schedules for last six months and note any patterns. How many new patients does your office see per day? How many inpatients do you traditionally manage or have within your panel (who will need timely follow-up)? How many walk-ins, urgent visits and no-shows do you generally see? These basic questions will reveal trends and guide you in planning any needed schedule overhaul. This info is also helpful when meeting with providers, who can snap about today’s or this week’s schedule without reflecting on the flow for a longer period of time. Of course, if your practice is significantly affected by seasonal variations, do consider them when identifying those patterns.
- When you’ve pinpointed your practice’s scheduling idiosyncrasies, draft a schematic. How many new patients is it feasible to see each day? If your practice is in growth mode, you don’t want a four-week (or longer) wait to see a new patient. When do you see these patients? The end of the day is usually the worst spot for new patients or any longer appointment type. Do you have a lot of urgent/sick calls and need to bring those patients in? A formula for open slots, like on the 45-minute mark (9:45, 10:45, 11:45), is a good idea; if you have multiple providers, stagger their open slots: PCP A gets the 15-min open spots (9:15, 10:15, 11:15), PCP B gets the 10-min spot (9:30, 10:30, 11:30) and PCP C has the 45-min ones we discussed above. The key is to review patterns and determine ahead of time how many of each appointment type you will see in a given day.
- A large number of no-shows- which you should be tracking anyway – can be frustrating because your staff may compensate by double-booking a slot. This frustrates providers who fear having to rush through visits because someone else is waiting. High no-shows should prompt an operational review: how frequent are your appt follow-ups? Patients may bristle at too frequent visits, or disregard them because they feel fine. Does your staff or EMR conduct reminder notifications? Do they contact patients one time and leave a message or make multiple attempts? How far in advance are your reminders? And lastly, do you charge for no-shows? That’s a dicey question because it’s a big patient dissatisfier, and you need to strike a balance between the longstanding patient who forgot her appointment for the first time ever and the habitual no-show-er. Charging for no-shows should be the absolute last resort after you’ve evaluated for – and fixed – any process issues in your practice.
- Meet with your providers. When they complain about the schedule, they may not be seeing the big picture of the practice. Fortunately, you’ve done your homework in numbers 1 to 3 above and can bolster your dialogue with facts. Successful scheduling requires give and take and also must be practice-wide. So, consider a preliminary meeting to hear their scheduling issues and where you communicate the results of your due diligence, and re-convene soon once everyone has had a chance to consider both sides.
- The last step is to memorialize the “formula” for your schedule. This will help you in training and refreshing staff and providers, and help you spot any subtle deviations from the norm that occur over time. Nothing undermines trust like accusations of, “We agreed on X and it’s not happening.”
It may be impossible for you to make everyone happy with the practice scheduling system, but make sure everyone feels heard, and when you can’t implement someone’s suggestion – say, 30-minute slots across the board – be ready to explain why.