Introduction to Appointment Scheduling The key concept to remember in all appointment scheduling is It is to create a schedule with minimal waiting for the patient and smooth function of the office. How can conflict arise between the needs of the office and the desire of the patient to be seen as soon as possible after arriving at the medical office? 1

Guidelines for Appointment Scheduling Maintain confidentiality of the patient Speak clearly and do not appear to be rushed Concentrate on the person to whom you are speaking Avoid external and internal distractions Obtain complete information Repeat information for accuracy Schedule the proper amount of time f Document all necessary information Why is it important for the medical assistant to concentrate fully when scheduling an appointment by telephone? In person? 2

Appointment Book Methods Each physician may have his own book, section, column or page in the book Choose a format that suits the practice Pages may be set up in 10 or 15 minute intervals Appointment books are usually written in pencil Changes can be made easily in the appointment book Daily schedule is typed and used for permanent record What factors might be considered when choosing an appointment book? If your practice had two physicians, would you prefer to use one appointment book for both physicians or a separate appointment book for each physician? Why? 3

Computer Scheduling Methods Appointment intervals can be adjusted easily Each physician has a screen or column for each day Easier to change appointments or set up repeating appointments Daily appointment schedules can be printed quickly Why is it important to set up the basic appointment interval in a computer scheduling program before beginning to make appointments? What are advantages and disadvantages of using a computer appointment scheduling program? 4

Daily Appointment Schedule Used to pull medical records for patients being seen that day Official schedule is a legal document Additions in black ink No-shows and cancellations on the day of the appointment marked in red ink Posted in area inaccessible to patients or covered with a sheet of paper To protect patient confidentiality What is the daily appointment schedule used for? When should the daily appointment schedule be created if using a manual appointment book? A computer scheduling program? What are the implications if the daily appointment schedule is a legal document? How is the daily appointment schedule posted so that staff have access to it but patient confidentiality is protected? 5

Pair & Share “The Schedule” Students pair up and share something that they learned from the presentation so far… What did you remember or think was important? What seemed a little confusing to you? Any questions?

Time Specific Stream Scheduling Most common way to schedule appointments Steady flow of patients (like a stream) The length of time scheduled for the appointment depends on the patient’s needs – for example 30-45 minutes for a new patient 10-20 minutes for an established patient 30-45 minutes for a physical examination Why do some offices schedule more time for individual appointments than other offices? What are the advantages and disadvantages of patients arriving in a steady stream for appointments? 7

Wave Scheduling Patients arrive in “waves” so that there is always a patient waiting Three or four patients are scheduled every half-hour Patients are seen in the order in which they arrive Sometimes ill patients are taken before those with routine appointments How do patients react if they realize that one or more other patients may have been given the same appointment time? If three patients have the same appointment time, which patient is seen first? What are the advantages and disadvantages of patients arriving in “waves” for appointments? 8

Modified Wave Scheduling Patients are given appointments at specific times during the first half of each hour (usually longer) Several appointments One long appointment, such as physical examination Second half-hour used for wave (usually shorter) Work in patients Finish appointments from the first half-hour Schedule several rechecks on the half-hour What are advantages of the modified wave appointment scheduling compared to wave scheduling? Why is it often very helpful to have two or three patients who may not need a long time for appointments scheduled for the same appointment time? 9

Double Booking Two patients are given the same appointment time One patient may be seen by physician while the other is having diagnostic tests performed It is a way to work in urgent patients Why do many offices double book patients? If the medical office uses double booking as a method to add patients with urgent problems to the schedule on the day of the appointment, how will this affect the flow of appointments? 10

Open Booking Patients told a range of hours for their visit Used in clinics Used for urgent care before or after office hours Works best where there is a constant stream of patients Patients seen in the order in which they arrive What experience have you had with open booking? Did it increase your waiting time? When is open booking usually used? 11

Clustering or Categorizing Scheduling patients with similar problems or conditions together Physical examinations Prenatal patients in an OB/GYN practice Patients having the same diagnostic procedure Can be an entire day or part of day Do physicians like to do several physical examinations or examine several new patients back to back? Why or why not? Why are pregnant patients often clustered at a different time from patients with infertility problems? How might a pediatric office cluster patients? 12

Pair & Share “Types of Scheduling” Students pair up and share something that they learned from this section of the presentation … What did you remember or think was important? What seemed a little confusing to you? Any questions?

Multiple Offices Physicians may see patients at different office locations Appointments may be booked through a central system or at each individual office If booking centrally, it is important to clarify with the patient which office they wish to visit Paper medical records may need to move from office to office What special concerns arise related to appointment scheduling if there is more than one office belonging to the same practice? Why might a medical practice schedule appointments for multiple offices from a central office? From each office independently? Why are patients encouraged to select one office if a practice has more than one location, and make most appointments at that office? 14

Setting Up the Appointment Matrix Appointment matrix is usually set up for 6 months in advance and shows available appointment times Times when a physician is not available to see patients are blocked In a computer system, blocked times are usually a different color from available appointments Several factors that influence the appointment matrix Scheduling system or format Physician preferences and needs Facilities and equipment Why is the appointment matrix usually only prepared six months in advance? What are typical reasons to block times from the physician’s appointment schedule? 15

Appointment Intervals Appointment interval is minimum time allotted for one appointment 10-minute interval 15-minute interval 20-minute interval Patient may be given more than one block of time depending on type of appointment All appointments are multiples of the basic appointment interval How does the time interval for a basic appointment affect the appointment matrix? Which type of appointments require the least time? The most time? Why? 16

Physician’s Preference and Needs Times are blocked from the schedule when the physician has other obligations or is not available Times are blocked for lunch, meetings, and catch-up Days are blocked for vacation, conferences, lectures, etc. Facilities and Equipment Requirements Physicians may have special needs for equipment or treatment rooms Schedules may have to be coordinated Physicians like to have at least two examination rooms available to see patients Improves efficiency and time management Which physician obligations are likely to be the same or similar every day? Which physician obligations are likely to occur regularly but not every day? Which physician obligations may change after the schedule has been established? 17

Pair & Share “Considerations” Students pair up and share something that they learned from this section of the presentation … What did you remember or think was important? What seemed a little confusing to you? Any questions?

Guidelines for Scheduling Established Patients Insurance billing defines an established patient as one seen in the medical office within the past 3 years or has a current medical record Record patient name, physician, date of birth, and telephone number If a return appointment, the interval or time needed was usually indicated by the physician at the previous visit Schedule as close as possible to date specified by the physician Ask patient for day of the week and time of day that is convenient, then offer open times If patient is in the office, write patient name, date, and time of appointment on an appointment reminder card for the patient Why do insurance companies differentiate between new patients and established patients when setting up reimbursement schedules? What are possible reasons that a patient who has not been seen for more than three years is treated as a new patient for billing purposes? If a computer system is used, how does the medical assistant identify that he or she has located the correct patient before making the appointment? 19

Guidelines for Scheduling Special Situations If patient must have diagnostic tests, be sure they are scheduled so that results have been received before the next appointment Office may only be making appointments 6 months ahead and patient may not need to return until after that time Ask patient to call later for appointment Place patient’s name on reminder list How should laboratory tests be scheduled related to follow-up appointments? Why does the medical assistant attempt to schedule fasting laboratory tests in the morning? What are examples of laboratory tests or diagnostic tests that require the patient to be fasting? How can the medical office remind patients to make appointments for intervals that are longer than the appointment matrix has been created? 20

Guidelines for Scheduling New patients and Referrals Obtain complete information about a new patient Obtain referral form if patient has a referral Set aside appointment time for new patient, usually 30-45 minutes Give patient directions to office Send information according to office policy Health history form New patient brochure Make appointments for referrals as soon as possible What information must be obtained from a new patient when making an appointment? What does the medical assistant need to find out if the patient is being seen for something other than primary care? 21

Guidelines for Scheduling non-patient appointments Pharmaceutical representatives Salespeople Usually given specific appointment times Often during lunch or another time period that has been blocked from the schedule When are physicians willing to make appointments to see pharmaceutical representatives? What types of equipment might the physician wish to consult with a salesperson about? What is the advantage to the physician of making a specific appointment with an individual who is not a patient? If the physician does not make appointments with pharmaceutical representatives, how is the respresentative handled? 22

Guidelines for Changing Appointments If using appointment book, erase original appointment and enter all information in new slot Some offices may require that the information be left in the book and a line placed through the cancelled appointment If using computer schedule, use “move appointment” feature Moves all information to new slot Deletes original appointment Appointments may be changed because of change in physician’s schedule Do you think it is faster to change an appointment in an appointment book or in a computer scheduling program? Why? Why is it important to be sure that all information is transferred when changing appointments? 23

Guidelines for No-Show Patients No-shows are patients who do not keep appointments and do not call to cancel or reschedule Marked in red on the appointment schedule Failure to keep the appointment documented in the medical record No-shows usually reviewed after three occurrences May be asked to find another physician because they do not adhere to treatment plan Why should all no-show appointments be documented in the medical record? Why do many office place a telephone call to patients who fail to keep an appointment? What are possible legal implications if patients frequently fail to keep appointments? 24

Managing Late Patients Offices usually have a policy regarding late patients If the patient telephones, he or she may be worked in on arrival Habitual latecomers may be given the last appointment of the day or told a time earlier than they are scheduled Why are late patients a problem for the smooth process of appointments? If a late patient is turned away, how might the patient respond? How late is really late? 25

Guidelines for Scheduling Walk-Ins or Same Day Patients who come into the office, without an appointment, and ask to be seen If need is urgent, physician may work patient into the schedule If need is routine, person may be offered an open appointment and told to return Why is it generally not recommended to see walk-in patients unless the physician intends to do so regularly? What factors should determine if a walk-in patient is seen or given an appointment for another day? 26

Guidelines only!!! These are only some of the common guidelines and may differ according to the procedures of a particular office. Best practices are to learn the protocol for the office you are working for all of the mentioned situations.

Pair & Share “Guidelines” Students pair up and share something that they learned from this section of the presentation … What did you remember or think was important? What seemed a little confusing to you? Any questions?