Healthcare Practice Strategies - Winter 2013 - Scheduling Matters: Why Waits Are Bad for Patients — and Your Practice

It's a truism of good practice management: The money comes in only when providers see patients. Yet scheduling is often the weak link in the revenue cycle. Whether it's no-shows and walkouts or simply time spent trying to decipher the chart of a colleague's patients, all of this lost productivity can hit your practice's revenue hard.

Creating the "Perfect" Schedule 

While there may be no such thing as a "perfect" schedule, you can come up with one that works best for your practice. The key is to first understand what each person impacted by the schedule really wants.

  • For patients, the perfect schedule allows them to get in when they want to be seen.
  • For providers, the perfect schedule is one that allows them to see their own patients and is consistent throughout the day, avoiding gaps and unplanned down time.
  • For nurses and medical assistants, the perfect schedule starts on time and flows smoothly without having to squeeze patients into an already full day.

Opening Up 

One possible solution to scheduling challenges is to try "open access" scheduling. Also known as "advanced access" scheduling, this straightforward approach has been gaining adherents since it was conceived back in the early 1990s by practitioners at Kaiser Permanente. Applying the axiom, "Do today's work today," providers simply strive to see patients the same day they call, regardless of the reason. Proponents note that patients with immediate concerns are more likely
to show up on time and stay focused on the primary reason for their visit.

Theoretically, then, all patients who want to see their doctor that day can do so — without being double-booked. To accomplish this, a practice leaves a large portion of the schedule open for same-day appointments. In fact, the American Academy of Family Physicians suggests that primary-care groups open up as much as 70 percent of their daily schedules for this type of appointment.

The rest of the day's slots are committed to appointments already scheduled in advance — typically for follow-ups or appointments for patients who could not make it in on the day they called. Here, practices can gauge demand by first keeping a phone log that tracks the number of calls and types of appointments requested.

Making It Work 

Of course, open access scheduling may not work for every provider or every practice. Primary care practices are typically well-suited to open access scheduling, while specialties with a heavy referral base (e.g., a doctor who does a lot of surgical consults) may find it's not a good fit.

It can take time to work out the kinks and find the right mix of prescheduled and open access appointments. Ultimately, your practice may need to follow a modified approach, such as one of these:

  • Hybrid approach Some practices combine both open-access and traditional scheduling in a hybrid approach. Patients can request same-day or next-day appointments, but can also utilize a limited number of slots to schedule appointments further out. So, on Monday morning, the front desk begins scheduling for Monday and Tuesday, but not Wednesday, which is already full with pre-scheduled visits for known purposes. On that day, established patients may be coming in for their regular diabetes check-ups, follow-ups or for monitoring of other chronic conditions.
  • "Carve out" approach This model entails traditional scheduling with some open access slots included (or carved out). Here, the practice splits open-access and scheduled appointments, with the majority of appointment slots not reserved for same-day calls. Pre-scheduled appointments are generally reserved for patients with chronic conditions and for follow-ups. The practice then uses the remaining slots to see all the people it can who call in requesting same-day appointments.

Schedule a Win-Win 

A scheduling makeover can result in a true win-win. By switching to a schedule that better matches supply with demand, providers can bring some order to the day while potentially increasing the intensity of each patient encounter. 

Considering a scheduling makeover? Our experienced professionals can help you design a scheduling system that maximizes productivity while minimizing aggravation. 

Healthcare Practice Strategies – Winter 2013 Issue

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