It’s the Catch-22 of a medical practice: How do you keep the patients flowing without compromising patient care? There are solutions to the problem, and they aren’t all high tech, but they do take a little planning.
Preventive care
“When patients wait a long time,” says Laurie Morgan, partner and senior consultant in San Francisco, California, medical consulting firm Capko & Morgan, “it’s usually not because zillions of people showed up with the flu; it’s because the allotted time in the schedule was not correct.”
Approaches to scheduling have become complex in recent years. “Lately, schedulers practically need a PhD,” says Elizabeth Woodcock, president of Woodcock and Associates, an Atlanta-based physician practice consulting firm. “I think we need to take a more simplistic approach to how much time a visit will take. I advocate using only three types of visits: new, established, and procedure.”
You also need to allow for your no-show rate. Woodcock recommends a simple formula here, too. “If you have a 20 percent no-show rate, and you want 20 patients, then book 23 patients,” she says.
Another way to get control of your workflow is to take care of some check-in routines before patients arrive. “Get as much information—address, phone number, insurance information—as you can over the phone when the patient schedules the appointment,” recommends Tammie Olson of Management Resource Group, a firm offering financial management and support services for the health care community.
For established patients, verify the information you have on file over the phone. You can also save time by mailing paperwork to new patients and asking them to fill it out at home and bring it to the visit. You can do some of your paperwork ahead of time, too. “Have your front desk verify the appointments and insurance and get the chart ready the day before the visit,” suggests Olson.
Back room deals
Often the bottleneck starts in the exam room. You can avoid some of these problems with a little front-end work as well. “Have all the exam rooms stocked and ready to go, and set up in the same way, so that doctors don’t waste time looking for things,” says Morgan.
She also recommends having patients document their issues before coming to the exam room. “If possible, have tablets in the waiting room where patients can check directly into the EHR,” Morgan says. But even if you don’t go that high tech, you can still have patients fill out forms with the reason for their visit and any special issues or questions they want the provider to address, before they go back.
You can get a bit ahead with testing, too. “If the provider wants certain tests done routinely, such as blood sugar checks for patients with diabetes, establish a protocol for nurses to do this before they take the patient back to the exam room,” says Olson.
What time did you say?
Late patients can wreak havoc with even the best systems.
“In order to avoid a chain reaction when a patient is late, take the patient who is on time first, and then work in the late patient,” advises Morgan. But don’t give patients the idea that working in late patients is standard operating procedure.
Woodcock suggests saying to the late patient, “‘We’ll have to check to see if our clinical team can see you.’ You want to signal them that being late is not OK.” Sometimes it can take some training to get your patients to realize the importance of being on time.
Late patients aren’t a huge problem for many practices, but some have a non-compliant patient base. If that’s you, Woodcock suggests changing the way you schedule your appointments, scheduling in “waves” or “blocks,” say every hour or half hour, and taking patients on a first-come, first-served basis within that block.
But sometimes, no matter how organized you are, you’re the one running late and holding up patients. Good business as well as good manners require that you deal with this as directly and honestly as possible.
“When a legitimate problem comes up, it’s best to let patients know as soon as possible that you are running behind. If you can, text them,” says Morgan.
Owning the problem can go a long way with your patients, too. “Running behind puts the receptionist in a bad situation,” says Woodcock. “It can help a lot if a doctor or nurse comes out to the waiting room and apologizes. If you want to train your patients to respect your time, then you have to demonstrate that you respect theirs, too.”
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