© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-1 Scheduling Appointments and Maintaining the Physician’s Schedule PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Explain the importance of the appointment book in maintaining the schedule in the medical office Identify common scheduling abbreviations Identify different types of appointment scheduling systems Discuss ways to arrange appointments for patients. Learning Outcomes

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Explain how to handle special scheduling situations Explain how to properly document no-shows and late patients Describe how to schedule appointments that are outside the medical office Discuss ways to keep an accurate and efficient physician schedule. Learning Outcomes (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-4 Introduction Scheduling systems Types How each is used Scheduling situations Appointment book Legal aspects documentation

© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-5 The Appointment Book A well-managed appointment book Creates an efficient patient flow Shows respect for everyone’s time by preventing excessive wait time Unexpected events that occur Early and late arrivals No-show patients Emergencies Physicians spend extra time with patients

© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-6 The Appointment Book (cont.) Preparing the appointment book Create the matrix, or basic format Block off times the doctor is unavailable Examples of when time should be blocked off Hospital rounds Surgery Vacation and holidays Scheduled meetings

© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-7 The Appointment Book (cont.) Computer or traditional paper appointment book Obtain patient information Patient’s full name Home and work telephone numbers Purpose of the visit

© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-8 The Appointment Book: Commonly Used Abbreviations AbbreviationMeaning BPblood pressure check cancancellation c/ocomplains of consconsultation CPchest pain CPEcomplete physical exam ECGelectrocardiogram

© 2009 The McGraw-Hill Companies, Inc. All rights reserved 12-9 AbbreviationMeaning FUfollow-up appointment GIgastrointestinal I & Dincision and drainage injinjection lablaboratory studies N & Vnausea and vomiting NPnew patient NSno-show patient The Appointment Book: Commonly Used Abbreviations (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved AbbreviationMeaning P & PPap smear and pelvic exam PapPap smear PMSpremenstrual syndrome ptpatient PTphysical therapy rerecheck refreferral RSreschedule The Appointment Book: Commonly Used Abbreviations (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved AbbreviationMeaning Rxprescription sigsigmoidoscopy SOBshortness of breath S/Rsuture removal surgsurgery USultrasound URIupper respiratory infection UTIurinary tract infection The Appointment Book: Commonly Used Abbreviations (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved The Appointment Book: Determining Standard Procedure Times Create a standard list of procedure times Indicate how much time to allow for the tests Use only as a guide Helps identify appointment openings appropriate for the patient visit

© 2009 The McGraw-Hill Companies, Inc. All rights reserved min or > 30–60 min 5 – 10 min 15 – 20 min 15 min 15 – 30 min 10 – 20 min 30 min 5-10 min min 15 min min min 30 min 30 min or > min The Appointment Book: Determining Standard Procedure Times (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Keep appointment books for at least 3 years Entries must be clear and easy to read  Never erase a name or use liquid paper  Use blue ink and never pencil  Draw a single line through the name  Write the date, time, and reason for cancellations  Document cancellations and no-shows in patient’s record The Appointment Book: A Legal Record

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Use your knowledge of abbreviations and scheduling to order these from least time required to most time required. (1= least time required and 5= most time required) Apply Your Knowledge S/R CPE FU CAN P&P suture removal 10 – 20 min complete physical examination 30 – 60 min. follow-up appointment 5 – 10 min. cancellation 0 min. Pap smear and pelvic examination 15 – 30 min. ANSWER: GOOD JOB !

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Appointment Scheduling Systems Goals Smooth flow of patients Minimal waiting time Open-hours scheduling No appointments Patients arrive at their own convenience Seen on a first-come, first-served basis Rural practices and urgent care centers

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Appointment Scheduling Systems (cont.) Time-specified scheduling Stream scheduling Patients are scheduled for specific times At regular intervals Time based on reason for the appointment

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Wave scheduling Large offices See several patients at the same time Seen in the order of their actual arrival Flexibility for appointments that run longer than planned Uses an hourly target Number of patients to be seen hourly determined by dividing 60 minutes by the average estimated length of visits Multiple patients at the same time can result in Patient dissatisfaction Annoyance Appointment Scheduling Systems (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Modified-wave scheduling Options Patients scheduled in 15-minute increments Four patients scheduled during the first half hour and the second half hour is left free for catch-up Double booking Two or more patients scheduled for the same time Both patients will see the doctor within the scheduled period One may be seen by NP or PA Used when patient with no appointment needs to be seen Appointment Scheduling Systems (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Cluster scheduling (categorization) Groups similar appointments together Useful if specialized equipment has limited availability Advance scheduling Scheduling patients weeks or months in advance, such as with annual exams Leave a few slots open for patients with unexpected problems Appointment Scheduling Systems (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Combination scheduling Using two scheduling methods Computerized scheduling Affords the following advantages Can “lock out” selected appointment times Information can be accessed from all terminals in the office Help identify patients who are late, miss appointments, cancel, or require more time with the physician Reports to help improve efficiency Appointment Scheduling Systems (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge A large pediatrician office commonly must “squeeze in” patients in that have become ill, so this new office plans to offer immunizations only twice per week. Which scheduling system(s) would you recommend for this medical practice? ANSWER: Combination scheduling consisting of cluster and a form of wave scheduling would be recommended to allow for the needed flexibility.

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Arranging Appointments Offer choices Dates Times Accommodate patient’s needs whenever possible Confirm choice with patient

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Arranging Appointments (cont.) New patients Those not established at the medical office Obtain all necessary information Name Address and phone number Date of birth Insurance information Have patient arrive 15–30 minutes early to fill out forms Return appointments Ask patients if they need another appointment before they leave

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Appointment Reminders Appointment cards  After appointment time is entered in the book, it is recorded and given to the patient Reminder calls  1–2 days before the scheduled appointment the office calls the patient Reminder mailings  A postcard addressed to the patient that is mailed one week before the appointment Recall notices  Form letter sent to remind patients to call for an appointment Arranging Appointments (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge The doctor wants Mr. Lincoln to return to the office for a follow-up appointment in two weeks. What should the medical assistant do? ANSWER: The medical assistant should offer Mr. Lincoln a choice of dates and times available to accommodate Mr. Lincoln’s needs. After entering the appointment in the book or into the computer, confirm the date and time with the patient and give him a appointment card. TERRIFIC!

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Emergencies Seen immediately upon arrival at the office Explain to waiting patients without details Provide opportunity to reschedule Referrals Referred patients should be seen as soon as possible When arranging referrals for a patient Provide choices Be sure the facility accepts the patient’s insurance Document in patient record Special Scheduling Situations: Patient

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Fasting patients Fast Refrain from eating or drinking Usually beginning the night before the appointment Schedule as early as possible Instruct patient about the need to fast and when to start Special Scheduling Situations: Patient (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Patients with diabetes Require regular meals and snacks to regulate blood glucose Consider avoiding late morning slots that are close to lunchtime Keep appropriate snacks on hand in the event a patient develops a low blood sugar Special Scheduling Situations: Patient (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Repeat visits Schedule regular appointments on same day and time Late arrivals Schedule chronically late patients toward the end of the day Prevents disruption in the office schedule Document late arrivals or missed appointments in patient record Special Scheduling Situations: Patient (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Walk-ins If it is an emergency, handle as such If no openings, offer to schedule an appointment Post a sign in the office if no walk-ins are allowed Special Scheduling Situations: Patient (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Cancellations Thank patient for calling to cancel Appropriately mark appointment as canceled Attempt to reschedule while the patient is on the phone Document cancellation in the patient’s medical record J.Jones cancelled S Smith R Hansen M Fitz Special Scheduling Situations: Patient (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Missed appointments Document no-shows in the appointment book and patient medical record Inform the physician of no-shows Wrong day Reschedule if patient lives locally Attempt to accommodate if patient required special transportation or traveled far H Plummer P. Lexar No show Special Scheduling Situations: Patient (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Physicians may throw the schedule off by Arriving late to the office Returning late from lunch or meetings Being called away for emergencies Being delayed at the hospital If a physician is late repeatedly, you may want to add some buffer time to the schedule and slot patients accordingly. Special Scheduling Situations: Physician

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge Mr. Washington needs a follow-up appointment in a week for a fasting blood sugar after the physician changed his medicine for diabetes. How should you handle this appointment? ANSWER: The appointment should be made for the first or second appointment for that day. Mr. Washington should be reminded he should not eat or drink after midnight, and that he should not take his diabetes medicine prior to the appointment but should bring it with him.

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Scheduling Outside Appointments Common outside appointments include Consults with other physicians Laboratory work X-rays and other diagnostic tests Hospitalizations and surgeries Be sure to have a doctor’s order specifying Procedure When results are needed

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Scheduling Outside Appointments (cont.) Validate the patient’s insurance prior to selecting the outside physician or facility HMOs often arrange referral and notify office when approved Discuss possible appointment times with patient or give patient information to make appointment Give pre-appointment instructions if necessary

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge Mr. Anderson calls at 0830 and cancels his 0900 but calls the office again at 1230 c/o redness and discomfort at his surgical site. What should the medical assistant do? ANSWER: The medical assistants should tell the patient to come right in due his complaints of incision redness and discomfort. However, Mr. Anderson should also be told that he will be “worked in” around other patients’ appointments.

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Maintaining the Physician’s Schedule

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Maintaining the Physician’s Schedule (cont.) Overbooking Scheduling too many patients Office schedule falls behind Stressful for staff Underbooking Gaps in schedule Try to schedule another appointment in cancelled time slot

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Maintaining the Physician’s Schedule (cont.) Emergencies or delays Apologize to waiting patients Offer choice Estimated waiting time Leave to run errands and return at agreed-upon time Reschedule appointment for another day

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Reserving operating rooms Reserve the facility, staff, supplies, and equipment needed Give preferred days and times, types and length of surgeries Stocking the medical bag Some physicians see patients in nursing home facilities Block this time in the office schedule The medical assistant may be responsible for stocking the physician’s medical bag Check expiration dates Supplies must not be taken from the bag in the office Maintaining the Physician’s Schedule (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Scheduling pharmaceutical sales representatives Called detail persons Some physicians meet with them Block time for this purpose New representatives Request a business card Check with the physician before scheduling an appointment Maintaining the Physician’s Schedule (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Making travel arrangements Out-of-town meetings or events Medical assistant may be responsible for Airline arrangements (get itinerary) Car rentals and lodging Get confirmations for all reservations A locum tenens or substitute physician may cover practice while regular physician is away Maintaining the Physician’s Schedule (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Planning meetings Find out number of people, length and purpose of meeting Secure location with adequate room and parking Prepare an agenda if requested Secure equipment such as podium and microphones Take minutes as needed Maintaining the Physician’s Schedule (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Scheduling time with the physician Meet regularly with the physician Review schedule Other items State medical license Drug Enforcement Agency registration Documentation of continuing medical education (CME) requirements Maintaining the Physician’s Schedule (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge When making travel arrangements for the physician, which of the following would be the responsibility of the medical assistant? a) Locum tenens b) Itinerary c) Agenda ANSWER: Right!

© 2009 The McGraw-Hill Companies, Inc. All rights reserved In Summary Proper scheduling = efficiency Most medical offices select one or two scheduling systems that fit its practice Special scheduling situations involve both patients and physicians Maintaining a physician’s schedule may include making travel arrangements and planning meetings

© 2009 The McGraw-Hill Companies, Inc. All rights reserved Taking a few extra minutes, going that extra mile, and giving that added special touch can make a world of difference in a very difficult situation. ~ Lisa Lockhart (From A Daybook for Nurses: Making a Difference Each Day)