1. Scheduling Appointments
Chapter 10
This chapter deals with the techniques and methods of appointment scheduling.

2. Introduction
Scheduling keeps the office functioning smoothly throughout the business day.
If scheduling is not done efficiently, the entire office does not function efficiently.
If the office is not on schedule, it is rarely the physician’s fault. A good scheduler knows the physician and his or her habits, and schedules patients and events accordingly.

3. This chapter will examine:
Three methods of appointment scheduling
How to recover from schedule interruptions
Setting up a scheduling matrix
Dealing with consistently late patients
Reasons for failed appointments
Provide this overview for the chapter content.
Assign the study guide that corresponds with this chapter if not assigned in advance, as well as any additional assignments that are associated with this chapter.

4. Guidelines for Appointment Scheduling
Some offices stick to a strict schedule.
Some are more flexible.
Some are never on schedule, no matter what day or time an appointment is made.
Scheduling appointments should never fall to the least capable medical assistant. The scheduler must learn the physician’s intricate patterns and occasionally, those of other staff members, so that each day is productive and runs smoothly.

5. Guidelines for Appointment Scheduling (cont’d)
Most physicians prefer to stay busy, with very little, if any, idle time. Discuss why this is true.

6. Guidelines for Appointment Scheduling
One of the most important tips for successful appointment scheduling is to know the physician.
Know his or her habits.
Know his or her preferences.
Observing and listening will help the medical assistant to understand and know the physician’s habits, preferences, and needs.

7. Guidelines for Appointment Scheduling
The person assigned to schedule appointments in the physician’s office must be proficient and organized and must know the physician and others in the office for whom appointments are booked.
Discuss the other qualities that the appointment scheduler needs to be successful.

8. Guidelines for Appointment Scheduling
Appointment scheduling systems must be individualized to each specific practice.
When scheduling, consider three things:
Patient need
Physician preference and habits
Available facilities
Discuss the needs of the patients. What type of priority is the patient’s needs? Talk about how the available facilities affect the appointment scheduling.

9. Patient Needs Determining Office Hours and Appointment Times:
Is the office located in a busy metropolitan area or a rural area?
What are the average ages of the patients?
Is the area more industrial or residential?
What types of patients are seen?
Are evening and weekend appointments essential for most of the patients served?
Talk about how office hours and appointment times are determined. Discuss influences outside the office that will be taken into consideration when office hours and appointment times are planned.

10. Assessing Patient Needs
What is the purpose of the visit?
Will the patient require the physician’s time, or will other staff members perform all or part of the service?
What is the age of the patient?
The medical assistant will ask the patient several questions before scheduling the appointment. Discuss more questions that may be necessary when deciding the right appointment slot for patients.

11. Assessing Patient Needs
Does the patient need an after-school appointment?
Does the patient object to traveling after dark?
Will the patient have problems taking off work for appointments?
Talk about the reason that each bulleted item is important to the scheduler.

12. Physician Preferences and Habits
Does the physician become restless if the reception room is not packed with waiting patients?
Does the physician worry if even one patient is kept waiting?
Is the physician methodic and careful about being in the facility when patient appointments are scheduled to begin?
Talk about the reason that each bulleted item is important to the scheduler.

13. Physician Preferences and Habits
Is the physician habitually late?
Does the physician move easily from one patient to another?
Does the physician require a break time after a few patients?
Would the physician rather see fewer patients and spend more time with them or more patients throughout the day?
Talk about the reason that each bulleted item is important to the scheduler.

14. Available Facilities
Make certain that the facilities needed for each patient will be available when scheduling appointments.
Talk about the typical medical office layout. Discuss what rooms are available and how the layout changes in specialty offices.

15. Methods of Appointment Scheduling
The two most common methods of appointment scheduling are:
Computer-based
Appointment book
Discuss the pros and cons for each type of appointment scheduling system.

16. Appointment Books
Consider the following features when choosing an appointment book.
The size should conform to the desk space available.
The book should be large enough to accommodate the practice.
Appointment books are available in numerous sizes and layouts. One of the first requirements to deciding on a book is to measure the space where it will be kept to make certain it can be manipulated easily.

17. Appointment Books
The book should open flat for easy writing and reference.
The book should allow space for writing when the appointment will be, who the patient is, and why the patient is being seen.
Talk about why the appointment book should lay flat. Discuss the idea line size and why the lines must be big enough, in relation to the legibility of the appointment book.

18. Appointment Books
Color-coded books are easy to use and are helpful when the patient is to be seen a certain number of weeks later.
Color coding can distinguish days and/or physicians.

19. Computer Scheduling
Computers can select the best appointment time based on the information entered about the patient.
The length of time needed for various procedures can be entered in advance, and when that procedure is scheduled, the correct time will be automatically allotted.
Discuss advantages of using a computer based appointment system.

20. Computer Scheduling
Computers can search by patient name and find all scheduled appointments.
More than one person can use the scheduling program at one time.
Printouts can be produced for all of the employees who need that information.

21. Self-Scheduling
Patients can log on and schedule their own appointments.
Allows for patient confidentiality by showing only available appointment times.
Reduces calls to the office.
Available to patients 24 hours a day.
Computer-illiterate individuals will object to such a system, so phone scheduling should still be made available.

22. Advance Preparation Establishing a Matrix
Block off time slots when the physicians are not available:
Holidays
Days off
Lunch, dinner, and other breaks
Time for hospital rounds
Meeting times
Vacations
Talk about the times that a family practitioner would block off when matrixing the appointment book. Discuss what differences would apply to speciality offices.

23. Types of Appointment Scheduling
Open Office Hours
Also called tidal wave scheduling.
Patients are seen in the order of their arrival.
Often used in rural practices.
Can result in long wait times.
Can overburden office staff members.
Discuss the types of practices that would benefit from open office hours.

24. Types of Appointment Scheduling
Scheduled Appointments
Practitioners can see more patients with less pressure.
Scheduling appointments takes skill, organization, and efficiency.
The scheduler must know the length of time involved with various procedures and various classifications of office visits.
Discuss the types of practices that would benefit from scheduled appointments.

25. Types of Appointment Scheduling
Scheduled Appointments
Other individuals than patients will make appointments.
Patients should not be moved to accommodate salespersons or pharmaceutical representatives.

26. Types of Appointment Scheduling
Flexible Office Hours
Evening hours
Weekend hours
Extended hours late in the evening
Early morning hours

27. Types of Appointment Scheduling
Wave Scheduling
Creates short-term flexibility within each hour.
Assumes the actual time needed for all patients will even out over the course of the day.
Schedules three patients for one time slot.
Those three patients are seen in the order of their arrival.
Discuss the types of practices that would benefit from wave scheduling.

28. Types of Appointment Scheduling
Modified Wave Scheduling
Two patients arrive at the top of an hour.
A third patient arrives at half past the hour.
This hourly cycle is repeated throughout the day.
Can be modified further, such as scheduling three patients for one hour and none the next hour.
Discuss the types of practices that would benefit from modified wave scheduling.

29. Types of Appointment Scheduling
Double Booking
Scheduling two patients at the same time. Often frustrating for patients.
Scheduler must consider the reason for the appointment when using this method to ensure enough time is allotted for the patients.
Grouping Procedures
Scheduling like procedures together
Talk about the problems that might arise from double-booking and grouping procedures. Discuss the advantages.

30. Types of Appointment Scheduling
Advance Booking
Set appointments far in advance whenever possible.
Give patients appointment cards to remind them of their time and date.
Confirm appointments as they approach.
Reschedule if needed.
Talk about the types of appointments that might be booked in advance, between 2 and 6 months out. Discuss whether these appointments are likely to be kept when made far in advance and what might improve show rates.

31. Time Patterns Leave some open time during each day’s schedule.
Keep one available appointment in the morning and in the afternoon.
Schedule time for the physician to take a break in the morning and afternoon.
Discuss why the scheduling assistant should leave some time open in the morning and the afternoon. Talk about what tasks might be completed during those times.

32. Time Patterns
Remember that Mondays and Fridays are heavy phone and appointment days.
Allow for more buffer time on these two days.
Explain why Monday and Friday are usually busy days in medical offices. Talk about how those two hectic days can be less stressful.

33. Patient Wait Time
Be aware of the amount of time patients have been waiting.
Patients should be called to the back office at their scheduled appointment time.
Patients should not have to wait more than 5 or 10 minutes from then to see the physician.
Explain how the scheduling assistant can handle situations when patients have been waiting too long to see the physician. Talk about the phrasing that can be used to effectively placate the patient.

34. Patient Wait Time
If the patient has waited more than 15 minutes in the reception area, offer an explanation for the delay.
Give the patient the option of waiting or rescheduling.
Explain how to express situations such as the physician’s illness, lateness, or other reasons why the schedule is behind. Role-play these situations and determine professional responses.

35. Patient Wait Time (cont’d)
Discuss the body language that a patient may display and what signs might indicate that a patient is growing tired of waiting for his or her appointment.

36. Patient Wait Time
If the patients in the reception area have been waiting more than 15 minutes, always allow them the option to reschedule.
Talk about how to handle patients who grow angry or indignant when the medical assistant offers to reschedule.

37. Telephone Scheduling
Use excellent telephone technique when scheduling appointments.
Be considerate of requested times whenever possible.
Explain why a time is not available, and offer a substitution.
Review proper telephone technique as discussed in the previous chapter.

38. Offering Patients Choices
Offer the patient:
A choice of days
A choice of morning or afternoon
A choice of times
Offer the students several examples of this technique so that they understand offering choices to the patients. The same technique can be used for scheduling any appointments.

39. Writing in the Appointment Book
Write legibly.
Remember that the appointment book may be subpoenaed to court.
Put the patient’s contact phone number next to all entries.
Use cell phone numbers whenever possible.
The entries in medical records and the appointment book must be legible years after the documents are created.

40. Scheduling New Patients
Gather as much information as possible on the telephone when scheduling the first appointment.
Attempt to get all of the information needed to construct the patient’s medical record.
Determine the amount of time needed for the office visit.
Discuss the order of questions when taking information from a prospective new patient. Talk about why insurance information can be a touchy subject, and how to handle questions about the cost of the first visit.

41. Scheduling New Patients
Offer the first available appointment to the patient.
Remember to offer choices when scheduling the appointment.
Explain parking issues.
Give accurate directions to the office.
Explain the approximate cost for the first visit, and make the patient aware of payment policies for new patients.
Keep directions from a northern, southern, eastern, and western approach to the office so that they can be easily referenced.

42. Preparing for New Patients
Mail patient information packets if there is time before the actual appointment date.
Send the information via if possible.
Determine if the patient is a referral.
Send a thank-you note to the person who referred the patient.
Confirm the appointment the day before.
Many physicians’ offices keep new patient paperwork on the website for easy downloading and for saving time at the first appointment.

43. Scheduling Established Patients
In Person
Usually done when the patient is leaving the office after an appointment.
Offer the patient choices in day, date, and time.
Always offer an appointment card.
Provide excellent customer service to the patient.
Discuss the meaning of excellent customer service at the time the patient is leaving the office.

44. Scheduling Established Patients
By Telephone
Offer the patient a choice of day, date, and times.
Ask the patient if there have been any significant changes in address, phone numbers, or insurance coverage if he or she has not been to the office in a while.
Talk about handling situations in which patients do not make a return appointment but should have. Discuss ways the medical assistant can determine if there is a problem that needs to be addressed.

45. Scheduling Other Types of Appointments
Inpatient Procedures
Call the facility where the appointment is to take place.
Provide any information requested about the patient.
Determine what the patient should bring to the facility when arriving for admission.
Provide all appointment details to the patient in writing, if possible.
Talk about the advantages of getting to know the personnel at facilities where patients are sent for outpatient testing.

46. Scheduling Other Types of Appointments
Outpatient and Inpatient Procedure Appointments
Call the facility where the appointment is to take place.
Provide any information requested about the patient.
Determine what the patient should bring to the appointment.
Provide all appointment details to the patient in writing, if possible.
After the appointment is made, talk about what information should be relayed to the patient. Explain the best times to make the appointments – should the patient be at the office or called after the appointment is already booked?

47. Physician Orders
Some physicians give patients the orders to take with them for inpatient and outpatient admissions.
Often, orders are written on a prescription form for outpatient procedures and treatments.
Explain the medical assistant’s role in getting orders into the patient’s hands prior to outpatient testing or inpatient admission.

48. Series of Appointments
Some patients need a series of appointments for repeat or continued treatment.
Try to set the appointments for the same times and days for ease of remembering.
Provide appointment cards to the patient.
Talk about the advantages of scheduling repeat appointments on the same days at the same times.

49. Series of Appointments
Always provide the patient with an appointment card.

50. Outside Visits
Physicians may make house calls or see patients in nursing homes or other outside facilities.
Provide the physician with a list of appointments.
Provide demographic information, such as directions, facility names, room numbers.
Allow for travel time.
Stock the physician’s medical bag, if necessary, before he or she leaves the office.
Discuss what type of information the physician should return to the office after making rounds or appointments in outside facilities.

51. Special Circumstances
Late Patients
Be understanding when emergencies occur.
Make certain patients are aware of policies that affect late patients.
Tell habitually late patients to arrive 30 minutes before their actual appointment time.
Never allow a habitually late patient to dictate appointment times to the staff. Some offices book patients that regularly appear late for the last appointment of the day.

52. Special Circumstances
Rescheduling Canceled Appointments
Make certain to remove the original appointment before scheduling the new appointment.
Discuss whether charging for missed appointments is an ethical practice.

53. Special Circumstances
Emergency Calls
Screen the call according to policy.
First, make certain to obtain a phone number and address where the patient is located.
Project a caring and reassuring attitude.
Discuss situations that might be considered an emergency during office hours and how they may be handled.

54. Special Circumstances
Acutely Ill Patients
Follow office policy in deciding whether the patient should be scheduled for the same day.
Escort acutely ill patients directly to examination rooms if possible on their arrival.
Talk about when patients would be instructed to come to the office and when they might be sent directly to the emergency room or hospital for admission.

55. Special Circumstances
Physician Referrals
Honor requests for fast scheduling of patients who are referred by other physicians if at all possible.
Obtain patient information from the referring office, if possible.
Be as accommodating and provide the same level of customer service to patients coming to the physician for consultation.

56. Special Circumstances
Patients without Appointments
Follow office policy for seeing patients without appointments.
If the patient does not need to be seen immediately, schedule for the first available time.
Make the patient aware of the appointment policy.
Always follow office policy in the case of patients who appear at the office without an appointment.

57. Special Circumstances
Failed Appointments or No-shows
Confirm appointments according to office policy.
Attempt to reschedule the appointment.
Make certain the patient understands the cancellation policy.
Some offices charge patients for failed appointments if they do not cancel within 24 to 48 hours before the scheduled time.
Make sure that failed appointments are noted in the medical record. Simply write the date and the fact that they patient was a no-show and did not call to cancel or reschedule.

58. Other Types of Appointments
Other physicians
Pharmaceutical representatives
Salespersons
Miscellaneous callers
Be courteous to all visitors and callers at the practice.

59. Planning for the Next Day
Look over the appointments.
Review the medical records of patients to be seen.
Make certain all laboratory reports and other information is available for physician review.
Planning helps even the most hectic days run smoothly.

60. Summary of Scenario
Cooperate with other staff members to get patients seen as quickly as possible.
Be dedicated to providing great customer service to patients and visitors.
Be more efficient by knowing the job and learning new approaches and skills.

61. Closing Comments
The scheduler has a huge impact on the efficiency of the medical practice.
A friendly and helpful attitude is essential.
Offices that run smoothly and stay on time are seen as professional and the staff is considered competent.