Managing Appointments Chapter 6: Managing Appointments

Chapter Objectives Cognitive Domain Note: AAMA/CAAHEP 2008 Standards are italicized. 1. Spell and define the key terms 2. Describe the pros and cons of various types of appointment management systems for scheduling patient office visits, including manual and computerized scheduling 3. Describe scheduling guidelines 4. Explain guidelines for scheduling appointments for new patients, return visits, inpatient admissions, and outpatient procedures 5. Recognize office policies and protocols for handling appointments

Chapter Objectives (cont’d) 6. Identify critical information required for scheduling patient admissions and/or procedures 7. Discuss referral process for patients in a managed care program 8. List three ways to remind patients about appointments 9. Describe how to triage patient emergencies, acutely ill patients, and walk-in patients 10. Describe how to handle late patients 11. Explain what to do if the physician is delayed 12. Describe how to handle patients who miss their appointments 13. Describe how to handle appointment cancellations made by the office or by the patient

Chapter Objectives (cont’d) Psychomotor Domain Note: AAMA/CAAHEP 2008 Standards are italicized. 1. Manage appointment schedule, using established priorities a. Schedule an appointment for a new patient b. Schedule an appointment for a return visit 2. Schedule patient admissions and/or procedures a. Schedule an appointment for a referral to an outpatient facility

Chapter Objectives (cont’d) b. Arrange for admission to an inpatient facility Verify eligibility for managed care services Obtain precertification, including documentation Apply third-party managed care policies and procedures Apply third-party guidelines 3. Use office hardware and software to maintain office systems

Chapter Objectives (cont’d) Affective Domain Note: AAMA/CAAHEP 2008 Standards are italicized. 1. Implement time management principles to maintain effective office functions 2. Demonstrate empathy in communicating with patients, family and staff 3. Demonstrate sensitivity in communicating with both providers and patients 4. Communicate in language the patient can understand regarding managed care and insurance plans 5. Demonstrate recognition of the patient’s level of understanding in communications

Chapter Objectives (cont’d) ABHES Competencies 1. Schedule and manage appointments 2. Schedule inpatient and outpatient admissions 3. Be impartial and show empathy when dealing with patients 4. Apply third party guidelines 5. Obtain managed care referrals and precertification

Chapter Objectives (cont’d) 6. Apply computer application skills using a variety of different electronic programs including both practice management software and EMR software 7. Communicate on the recipient’s level of comprehension 8. Serve as liaison between physician and others

Introduction Responsibility for scheduling and managing the flow of patient care in a medical office or clinic is one of the most important duties assigned to a medical assistant. As appointment manager, you make the first, last, and most durable impression on the patient and providers. providers: health care workers who deliver medical care Back to chapter objectives

Appointment Scheduling Systems Manual Appointment Scheduling The Appointment Book Should have enough space for all pertinent information (e.g., patient’s name, telephone number, reason for visit) Should be divided into time units appropriate for your practice (e.g., 10- or 15-minute intervals) Should open flat on the desk where it will be used Should fit easily into its storage place when not in use Figure 6-1 Sample page from manual appointment book. Back to chapter objectives

Appointment Scheduling Systems (cont’d.) Establishing a Matrix Cross out times physician is unavailable Include reason for unavailability Block off 15–30 minutes morning and afternoon to accommodate emergencies and delays Give copies to staff each day A legal document matrix: a system for blocking off unavailable patient appointment times Along with the notations in a patient’s chart, the pages of the appointment book provide documentation of a patient’s visits and any changes, such as cancellations and rescheduled appointments. Back to chapter objectives

Appointment Scheduling Systems (cont’d.) Computerized Appointment Scheduling Software varies Easy access to billing information Prints out schedule easily Figure 6-2 A computer-generated appointment schedule. Courtesy of Ingenix® CareTracker.TM Once the daily schedule is printed, this important document is referred to as the daily activity sheet or the daysheet and is the guide for everyone involved in the flow of patient care. Back to chapter objectives

Checkpoint Question What is the purpose of a matrix? Back to chapter objectives

Checkpoint Question Answer: A matrix is established to indicate times of each day that are not available for patient appointments. Back to chapter objectives

Types of Scheduling Structured Appointments 30 minutes at the beginning or end of the day is often used as a buffer Uses for buffer time: Returning phone calls Reviewing records Transcribing reports buffer: extra time to accommodate emergencies, walk-ins, and other demands on the provider’s daily time schedule that are not considered direct patient care Back to chapter objectives

Types of Scheduling Clustering Group patients with similar problems or needs Daily or weekly Allows good use of specialized equipment or staff clustering: grouping patients with similar problems or needs Back to chapter objectives

Types of Scheduling (cont’d.) Wave Schedule several patients in first half or each hour, second half left open for rechecks, emergencies, and other tasks Patients are seen in order of arrival Good for large, multidepartment facility Modification — full physicals on the hour, rechecks on the half-hour wave scheduling: a flexible scheduling method that allows time for procedures of varying lengths and the addition of unscheduled patients, as needed Back to chapter objectives

Types of Scheduling (cont’d.) Fixed Most common method Patients allotted time by complexity of problem Schedule disruptions affect entire day Schedule chronically late patients toward end of day Or, tell patients to arrive 30 minutes prior to their allotted time

Types of Scheduling (cont’d.) Streaming Standard time periods assigned to different needs streaming: a method of allotting time for appointments based on the needs of the individual patient to minimize gaps in time and backups.

Types of Scheduling (cont’d.) Double Booking Two patients scheduled for same time slot with same physician double booking: the practice of booking two patients for the same period with the same physician

Types of Scheduling (cont’d.) Flexible Hours Office hours vary throughout week Patients are scheduled during open times Greater range of possible appointment times allow patients with work or family schedule conflicts Back to chapter objectives

Types of Scheduling (cont’d.) Open Hours No scheduled appointments Patients come when they can during open hours Common in walk-in clinics Patient records must be pulled as patients arrive Clear disadvantages: Effective time management almost impossible Facilities may be overloaded or completely empty at times Charts must be pulled and prepared as each patient arrives Sign-in sheets are considered a breach of confidentiality, since patients signing the sheet can see the names and medical conditions of other patients. Back to chapter objectives

Checkpoint Question What are the three systems that can be used for scheduling patient office visits? Back to chapter objectives

Checkpoint Question Answer: The three systems that can be used for patient office visits include scheduled appointments, flexible hours, and open hours. Back to chapter objectives

Factors that Affect Scheduling Patients’ Needs Good communication critical — emotions can make slight miscommunication into negative experience for patient With a patient in an emotional state, even the slightest real or imagined miscommunication can lead to negative response from the patient. Back to chapter objectives

Factors that Affect Scheduling (cont’d.) Obtain appropriate patient information: Reason for visit Length of time of symptom Problem acute or chronic Time of day convenient for patient Special needs of patient Whether patient needs to see other office staff Third party payer constraints Documentation for referrals if required by third-party payer acute: abrupt in onset chronic: long-standing Back to chapter objectives

Factors that Affect Scheduling (cont’d.) Strive to accommodate patient’s requests but remember: You control the schedule—do not let it control you Entire medical office team depends on a well-managed schedule Back to chapter objectives

Factors that Affect Scheduling (cont’d.) Providers’ Preferences and Needs Become familiar with providers’ habits Punctual or often behind? Medical assistant clinical duties should be accommodated Possible provider scheduling needs: Nonmedical office visitors Telephone time Teaching duties Back to chapter objectives

Factors that Affect Scheduling (cont’d.) Physical Facilities Number of providers using facility Number of examination rooms Need to resterilize instruments between procedures Must thoroughly understand the requirements for procedures to be performed in the office You must thoroughly understand the requirements for procedures to be performed in the office to schedule appointments accurately. Back to chapter objectives

Checkpoint Question What are three factors that can affect appointment scheduling? Back to chapter objectives

Checkpoint Question Answer: The three factors that can affect scheduling are patients’ needs, physicians’ preferences, and the physical facilities. Back to chapter objectives

Scheduling Guidelines Be pleasant and helpful Always include patient phone number on schedule Include buffers each day Back to chapter objectives

Scheduling Guidelines (cont’d.) New Patients Allow adequate time Obtain full name and correct spelling Mailing address Day and evening phone numbers Reason for visit Name of referring physician or individual Responsible party and third party payer (insurance) Explain payment policy The information you exchange at this encounter is crucial, and entering the patient’s data accurately is imperative. Back to chapter objectives

Scheduling Guidelines (cont’d.) Request pertinent insurance information Ensure that patient knows office location and directions Ask patient if messages can be left at home or work — note in chart Reconfirm date and time of appointment before ending call Recheck that appointment is correctly entered in book Note if referral — obtain relevant patient information from source of referral Back to chapter objectives

Scheduling Guidelines (cont’d.) Established Patients Carefully check appointment book or screen before offering appointment time Offer patient specific date and time Enter information in appointment book (or enter in the appointment screen) If patient is present, fill out appointment card Figure 6-3 An appointment card will help the patient remember his or her appointment and reduce no shows. Back to chapter objectives

Scheduling Guidelines (cont’d.) Reconfirm date and time Recheck appointment book End with pleasant word and smile Back to chapter objectives

Preparing a Daily or Weekly Schedule Most offices—medical assistant responsible Make copy for staff—ensure corrections are made on all copies Place next day’s schedule on physicians desk before he or she leaves—next week’s on Friday Should include patient appointments and all other commitments Important to make manual changes to computer schedules as day progresses Back to chapter objectives

Patient Reminders Appointment Cards Give out one at a time Regular appointments should be scheduled at same day and time Telephone Reminders New and already-scheduled patients should receive phone call day before appointment Check chart to ensure that patient has agreed to allow messages to be left If patient must cancel, use move-up list to schedule another patient in slot All new patients and patients with appointments scheduled in advance should receive a telephone reminder the day before their appointment. Back to chapter objectives

Patient Reminders (cont’d.) Mailed Reminder Cards Alternative to phone calls Mail at least 1 week before appointment Can be used to remind patients to make appointments for regular examinations Keep a supply of preprinted postcards in the office Most medical management software packages can alert you that it’s time for patient reminders Figure 6-4 Sample reminder postcard. Back to chapter objectives

Checkpoint Question What are the three types of patient reminders? Back to chapter objectives

Checkpoint Question Answer: The three types of reminders are appointment cards, telephone reminders, and mailed reminder cards. Back to chapter objectives

Adapting the Schedule Emergencies Figure 6-5 When a patient calls from home with a possible heart attack, you will call 911. Emergencies Must determine if problem can be treated in office or whether to call EMS “STAT” = Latin statim, or immediately When a patient calls with an emergency, your first responsibility is to determine whether the problem can be treated in the office. Back to chapter objectives

Adapting the Schedule (cont’d.) Ask questions to elicit crucial information: Possible heart attack Possible poisoning Life-threatening bleeding Shock Burns Back to chapter objectives

Adapting the Schedule (cont’d.) Constellation of symptoms can indicate particular condition: Shortness of breath, chest pain, arm/neck pain, nausea/vomiting can indicate heart attack Severe right lower quadrant pain, nausea, and fever often points to appendicitis If life-threatening emergency: Keep patient on phone Call EMS for transport Do not advise patient to drive to hospital constellation of symptoms: a group of clinical signs indicating a particular disease process Back to chapter objectives

Adapting the Schedule (cont’d.) Patients Who Are Acutely Ill Severe but not life-threatening Obtain as much information as possible Place note on chart for physician review Tell patient you will call back as soon as physician makes decision Obtain as much information about the patient’s medical problem as you can so your message to the physician will allow him or her to decide how soon the patient should be seen. Back to chapter objectives

Adapting the Schedule (cont’d.) Walk-in Patients Office policy should be in place Emergencies must be handled immediately Ask patient to wait — work in to schedule as possible Late Patients Explain to patient that they are late and must wait until physician is available Chronically late patients can be told that lateness of more than 15 minutes mandates rescheduling Schedule chronically late patients in afternoon/evening to avoid schedule disruption Back to chapter objectives

Adapting the Schedule (cont’d.) Physician Delays Call patients with appointments later in the day to alert them and allow the option of rescheduling Patients in waiting room should be notified immediately Allow to wait or reschedule If rescheduling, note reason in patient record Continue to offer updates Always keep patients informed Most will understand if they know they are not ignored or forgotten If patients are waiting in the office, inform them immediately if the physician will be delayed. Back to chapter objectives

Adapting the Schedule (cont’d.) Missed Appointments No-show = patient fails to show up for appointment and does not call to notify Call patient to determine reason and to reschedule If unable to reach by phone, sent reminder card — place copy in patient’s chart Note missed appointment and follow-up steps in chart Continued failure to keep appointments should be handled by physician May decide to terminate relationship Continued failure to keep appointments should be brought to the attention of the physician, who may want to call the patient personally (particularly if the patient is seriously ill) or send a letter expressing concern for the patient’s welfare. Back to chapter objectives

Cancellations Cancellations by the Office If physician is ill or has emergency Call patients to reschedule — don’t tell exact reason Note in medical record If physician will be out for an extended period, a locum tenens should be arranged On-call physicians can stand in These cancellations should be noted in the patient’s medical record. Back to chapter objectives

Cancellations (cont’d.) Cancellations by the Patient Note in record Offer to reschedule If patient has ongoing problem, emphasize importance of regular care Notify physician of frequent cancellations Can schedule move-up list patients if schedule is light Back to chapter objectives

Making Appointments for Patients in Other Facilities Figure 6-6 Sample referral form. Referrals and Consultations Must make sure referral meets requirements of third-party payers. HMO’s have strict requirements for precertification Must complete referral form with approval number from insurance company Give patients choice of specialist Be sure the physician you are calling is on the preferred provider list for the patient’s insurance company. Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) referral: instruction to transfer a patient’s care to a specialist consultation: request for assistance from one physician to another precertification: request for assistance from one physician to another Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) When calling another physician’s office for patient appointment provide the following: Physicians name and telephone number Patients name, address, and telephone number Reason for referral Degree of urgency Whether patient is being sent for consultation or referral Record in patients chart: Time and date of call Who received your call Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) Inform person that you wish to be notified if patient does not keep appointment (if this occurs—enter in to the patients record) Can write name, address, telephone number of referral doctor on office stationery and include the date and time of appointment Give or mail to patient Patient may call referring physician and make appointment—ask patient to notify you with date—document Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) Diagnostic Testing Patient sent to another facility for laboratory test, radiology, computed tomography, Magnetic resonance imaging etc. Appointments usually made with patient still in office Prior to scheduling, must determine exact test or test: How soon results are needed—STAT? Ask patient about time restrictions Provide patient’s name, address, telephone number, exact test or test required and other special instructions Give patient referral slip with name, address, telephone number of facility Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) Some laboratory studies or x-ray test require advanced preparation Give patient written and verbal explanation Ensure he or she understands Document in chart and put reminder in tickler file to ensure test results are received. Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) Surgery Determine precertification—call number on back of insurance card Call facility chosen by patient and specify time and date physician has requested Operating facility needs to know Exact procedure Amount of time needed Anesthesia required Back to chapter objectives

Making Appointments for Patients in Other Facilities (cont’d.) Other instructions Also need all pertinent patient information Give patient copy of preadmission forms—if available Follow policies of surgical facility regarding preadmission testing (laboratory studies, autologous blood donation) Write down all for patients—ensure he or she understands Note—may need to also arrange for hospital admission with hospital admitting department Back to chapter objectives

Checkpoint Question What information should be readily available when calling to schedule a patient for surgery in another facility? Back to chapter objectives

Checkpoint Question Answer: When scheduling a patient for surgery, the following information is needed: demographic and insurance information; the patient’s name, age, address, telephone number, precertification number (if required), and diagnosis; surgery planned; and any special instructions. Back to chapter objectives

When the Appointment Schedule Does Not Work Regular schedule disruptions require determining cause Evaluate the schedule over 2 to 3 months by listing: All patients seen Arrival times Amount of time spent with physician Departure times Amount of time needed to perform each examination or treatment Office meetings are ideal way to identify scheduling problems Adjust schedule to avoid causing frustration for both patients and office personnel Since the workflow of the office affects every staff member, involve all employees in your study. Back to chapter objectives