Chapter 9: Appointment Scheduling Lesson 1: Scheduling Systems

Chapter Objectives Lesson Objectives Upon completion of this chapter, students should be able to … Define, spell and use key terms List and describe four pieces of equipment used in scheduling process. Name and describe six scheduling systems. Identify ten conditions that qualify as emergencies. 2

Objectives Explain the importance of correct documentation when a patient does not keep an appointment. Describe the appointment scheduling process. Describe and arrange the process for scheduling a hospital admission and surgery. Summarize the ethical implications related to scheduling. 3

Key Terms Acuity New pt Matrix Specific Time Acute Exacerbation Chronic Remission Urgent Emergency Advance booking Archived Cycle Time Time patterns Catch-up time Double booking Established pt New pt Matrix Specific Time Wave, Modified wave Open-ended questions Close-ended questions Real time Referral Scheduling system Surgery scheduler Privacy screen Screen Saver Subpoena Tickler file

Critical Thinking Question What factors do you think need to be considered when selecting scheduling system for medical office?

Factors to Selecting Scheduling System Physician’s preference Type and size of practice Availability of equipment Staff availability Amount of required flexibility Insurance coverage Pt needs 6

Two Basic Appointment Scheduling Systems Scheduled appointments Open office hours 7

Purpose of Scheduling System Assists in flow of office Provides time management Increases efficiency Helps to ensure quality of pt care 8

Variations of Appointment Schedules Specified time scheduling Wave scheduling Modified wave scheduling Scheduling by grouping procedures Double booking pts Open office hours system Lets take closer look at each one of these! 9

Specified Time Scheduling Length of appointment determined by pt need Up to each staff member to reduce cycle time Problems in scheduling occur when pt does not indicate full extent of problem and not enough time provided on schedule Important for office to build in time patterns, allow for “Catch up” time Unscheduled emergencies 10

Wave Scheduling Provides flexibility for unforeseen events Purpose to begin and end each hour on time Each hour is divided into equal parts of time Three 20-minute or four 15-minute appointments could be seen in 1 hr 3-4 pts told to come in all together at beginning of ea. hr Pts seen in order in which they arrive Actual time used by pts averages out over hr 11

Modified Wave Scheduling Built on hr as base of each block of time Many variations One example: Have 3-4 pts scheduled at 10 min intervals during 1st half hr with none scheduled for 2nd half hr All pts seen during entire hr, but not waiting for late arriving pt Physician can still spend 20 min with each pt without having to wait for any pts to arrive

Comparison

Scheduling by Grouping Procedures Scheduling similar procedures and examinations during block of time Examples: Well-baby checkups, sports physicals New pts Vaccines

Example of scheduling by grouping Example of scheduling by grouping. All immunizations scheduled for morning appointments.

Example of Manual Appointment book

Appointment Schedule with Completed Matrix

Example of Computerized Scheduling Format

Table 9-2 Time Estimates

Acuity Need to know, ask open-ended questions! Acute Chronic Sudden unexpected, severe; usually short term, Chronic Long term illness, longer than 6 months Exacerbation Sudden flare-up or severe worsening of chronic condition Remission Stable period in condition; period of decrease or subsidence of manifestations of disease (temporary vs. permanent)

Double Booking Pts Practice of scheduling two pts during same time slot without allowing for any additional time in schedule Not efficient type of scheduling system Same as overbooking Disadvantage: If each pt needs 20-minute appointment, and both are scheduled from 1:00 to 1:20, then entire afternoon’s schedule will be at least 20 minutes late

Open Office Hours System Least structured of all systems Pts may arrive at any time during business hours Pts seen in order they arrive Due to disruption of missed appointments, this method preferred by some Disadvantages to this system include: Too many pts arriving at same time producing longer pt cycle time Overworked physician and staff members during peak times 25

Reminder card completed and handed to pt after appointment scheduled.

Critical Thinking Question Why might office choose to stay with manual scheduling system rather than invest in computerized system?

Computerized Scheduling Systems Advantages: Completed in real-time environment Provides ability to view appointment information with ease Maximizes office process flow and pt cycle time Provides ability to track patterns of medical practice Disadvantages: Privacy and security issues Technological factors 28

Manual Scheduling Systems Still used in some small practices and specialties Consists of hard-copy schedule book Schedule books come in various styles, sizes, and features Book selected based on practice needs and preferences As with computerized system, use of manual system must be in compliance with HIPAA 29

Requirements for both Computerized and Manual Systems Appointment book legal document that can be subpoenaed by court Record of physician’s day and time spent in contact with pts Appointment books should be archived for future reference Kept for several years in event of court case that may subpoena information

Requirements for both Computerized and Manual Systems Files archived by placing appointment book or back-up disks in storage container or facility and keeping then for predetermined number of years If any changes from scheduled pts in appointment book, noted both in appointment book and in pt’s medical record If appointment rescheduled, should be appropriately documented as well NS or Cx

Scheduling Pts For video on scheduling pts go to MyHealthProfessionsKit.com, or insert DVD-ROM at back of your book. 32

Chapter 9 Appt Scheduling Lesson 2: Pt Scheduling Process

Critical Thinking Question When scheduling pt, what is critical for success? Being organized and efficient! TIME MANAGEMENT

Steps to Scheduling Pt Step 4: Use office criteria requirements Step 2: Gather all information (pt name, tel#, DOB, cc, MD, office location). Step 1: Ensure appt book has been matrixed. Step 3: Listen to pt’s information and requests to determine type of appt that is actually needed. Step 4: Use office criteria requirements checklist to help determine type of and time needed for appt. 35

Steps to Scheduling Pt Step 8: Repeat back to pt date and Step 5: Determine facility, equipment, and staff availability to meet pt’s needs. Step 6: Discuss available dates and times with pt. Try to schedule first available that meets pt needs. Step 7: Enter agreed upon date and time into computer or manual schedule book. Step 8: Repeat back to pt date and time of appt. 36

Critical Thinking Question Why is it important to understand difference between definition of established pt vs. new pt?

Established Pt One who has previously seen physician within past three years Existing medical record/chart that accessed each time pt contacts physician for appt

Steps to Manually Scheduling Established Pts Set up matrix by blocking out all time periods when physician not available for appts DEMO Use pencil so that appts can be erased to make changes as needed Begin with 1st Available appt. in morning or early in afternoon that meets pt needs, and then fill in day whenever possible Print pt’s full first and last name next to appropriate time on schedule, reason for appt, phone # and DOB Add Jr. or Sr. if two pts with same name in family

Steps to Manually Scheduling Established Pts Block off required amount of time for appt Once appt recorded, repeat date and time along with any special instructions back to pt and provide reminder card if pt is in office Reminder Email or phone call 24-48 hr prior Document appt in pt chart

Additional Steps Related to Scheduling Pts Electronically Be sure scheduling system open Search for correct pt – this sometimes done by using pt’s Social Security number or chart number Verify telephone numbers, emails, address, insurance, correct; if incorrect, take time to update

Definition of New Pt Has been more than 3 years since physician within practice has seen pt OR They have never been seen by physician in practice

Steps to Scheduling New Pts Assemble necessary appt scheduling equipment Obtain pt’s full legal name and correct spelling, birth date, full address, telephone contacts (home, office, cell), and e-mail address, DOB Record pt’s cc and symptoms, ask questions to determine acuity Request name of pt’s insurance carrier and policy number, verify if accepted

Steps to Scheduling New Pts Ask how pt was referred to medical office Ask pt if they have preference for morning or afternoon appts Attempt to accommodate new pt’s request for preferred appt time Inform new pt of all materials to bring with him/her for first visit Insurance card, id, medication list Confirm day, date, and time of appt Have new pt repeat information for verification Provide new pt with directions to office

Steps to Scheduling New pt Welcome and thank new pt by name for selecting your medical office May send registration forms ahead by mail or email Email, call for appt reminder If enough time available prior to appt, send all information as discussed with new pt via mail Document new pt information in new medical record (must create)

Addressing Missed appts and No-Shows Charge pt according to office policy Contact pt and reschedule Document missed appt and rescheduled date Write NS or Cx on appt schedule and in pt chart Make every attempt to fill void in schedule caused by cancellation 46

Advance Bookings and Follow-up Done for regularly scheduled appts Ensure pt receives appt card 47

Advance Bookings and Follow-up Tickler file used to remind pts of appts Information should include day, date, and time of appt Follow-ups can be made in writing, by telephone, or e-mail 48

Referrals When physician sends patient to specialist or other facility for treatment Requires paperwork be sent to referred physician Referral recommendation must be in writing Documentation must be placed in patient’s chart Preauthorization from insurance carrier must be obtained 49

Regular Referrals When primary care physician requests specialist Authorization can take up to week to obtain Preauthorization can be obtained by sending information to carrier by fax or e-mail, or by calling company 50

Urgent and STAT Referrals Urgent referrals: Granted for non-life threatening situations Authorization can take up to 48 hours STAT referrals: Approval obtained immediately for life-threatening situation 51

Arranging Referral appt Schedule referral appt as soon as possible Information required for outgoing or incoming referral includes pt’s name, contact number, insurance, and referral needs Referral physician’s name, address, and contact number Depending on insurance, preauthorization/precertification may be necessary before scheduling appt

Steps to Arranging Referral appt Gather supplies Open pt chart for insurance information and physician request for referral Place call to physician’s office to which pt being referred Identify yourself and physician for whom you are calling Let office know calling to schedule referral appt

Steps to Arranging Referral appt Before providing pt’s name and other information, verify that practice accepts pt’s medical insurance Provide pt’s name, address, telephone number, and reason for referral Record referral appt information in pt’s chart as well as on appt reminder card for pt

Steps to Arranging Referral appt Record name of individual with whom you spoke in chart and on reminder card Notify pt of date and time of appt and provide reminder card Verify that pt knows location of office Forward any pertinent information such as lab tests or X-rays to physician’s office and record them in pt’s chart

Steps to Arranging Referral appt If precertification required, contact pt’s insurance company and request authorization If completing by telephone, document precertification number, name and telephone of individual who provides number Provide precertification number and pertinent information to physician’s office where pt being referred

Considerations for Scheduling Direct Admit to Hospital Contact pt’s insurance company for pre-admissions approval Verify spelling of pt’s first and last name Verify DOB, SS#, address, phone Find out if pt has hosp, room preference and if covered by pt’s insurance Give physician’s statement from pt record as to reason for admission Ask pt for last admission date in any hospital (if known) Document person’s name at insurance company who gave pre-approval and precert#

Critical Thinking Question What type of considerations should be given for nonscheduled pts who contact office and want immediate appt?

Considerations for Handling Nonscheduled Pts Determine seriousness (acuity) of pt’s condition Ask pt for telephone number from where he/she calling and determine if pt alone Follow office policy and protocol regarding handling emergency situations Inform physician immediately regarding potential emergency

Considerations for Handling Nonscheduled Pts If physician not available, follow office protocol May require referring pt to nearest emergency center Call 911 for pt, stay on the line

Questions? Paper scheduling Manual Weekly Matrix Dr. Cho Applied Practice Ch9 #1 & 2 Dr. Cho/Jackon Wed./Thurs Schedule Competencies P9-1 to P9-5 61