Nobody likes waiting to see their physician. In fact, a whopping 97% of patients are frustrated by wait times at the doctor’s office, a study has reported.1 That’s a lot of unhappy patients.
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Explore This IssueDecember 2015
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Fortunately, a practice can do many things to help keep patient appointments on time—beginning with proper scheduling techniques and monitoring patients’ progress during appointments.
Charlene K. Mooney, a consulting executive with Halley Consulting Group, a physician practice management and consulting firm in Columbus, Ohio, advises having a flexible, rather than a set, schedule, because this allows for adjustments to the time and length of appointments to fit patient needs. This entails having time slots with different amounts of time available for appointments. For example, a new patient should be scheduled in a longer time slot, and a patient having a blood pressure check would have a much shorter appointment.
“Designate specific times of the day for longer appointments and fill them in with shorter appointments if that type of appointment doesn’t schedule or show,” says Ms. Mooney, who also recommends keeping some slots open for urgent same-day appointments.
Carlos A. Sesin, MD, chief, Division of Rheumatology, Mount Sinai Medical Center/Vanguard Rheumatology Partners, Miami Beach, Fla., says his practice uses CareCloud practice management and electronic health record (EHR) software to track patients from check-in to check-out. “We can monitor how long patients have been waiting at every step of their appointment,” he says. “If we see that a patient is taking longer than expected in any of the steps, we identify the hold-up and try to move things along.” Another key is to not overbook patients.
Setting Guidelines Regarding Interruptions
Ideally, a clinician seeing a patient in the exam room should not be interrupted for calls or questions unless absolutely necessary, Ms. Mooney says. Instead, designate a specific time at the beginning or end of the day to handle tasks that could cause interruptions.
To help avoid interruptions at his practice, Peter Zigfrid Zadvinskis, MD, rheumatologist, Spectrum Health, Grand Rapids, Mich., says each rheumatologist is assigned to a clinical support person—usually a licensed practical nurse—to help maintain the schedule and avoid unnecessary interruptions.
Ideally, a clinician seeing a patient in the exam room should not be interrupted for calls or questions.
Nathan Wei, MD, FACP, FACR, director, Arthritis Treatment Center, Frederick, Md., allows interruptions only if another physician is calling and cannot wait, and Dr. Sesin encourages other doctors to send him text messages instead of calling.
By reviewing charts before patient appointments begin for the day and taking note of the visit’s purpose to see what preparations are needed, a medical assistant or nurse can avoid having to leave the exam room to retrieve test results and other medical reports, Ms. Mooney says.
Training staff in multiple areas can pay off during busy times. It’s best to prepare ahead of time though, and not have to teach someone when there is an actual need. “This can best be accomplished by shadowing—that is, spending a few hours observing someone else’s work, asking questions and performing tasks while the other person is there to offer input,” Ms. Mooney says. “The team member should be comfortable in her current position before training someone else.”
In particular, Ms. Mooney advises cross-training front-office staff on all positions in the front. Cross-train clinical staff in certain clinical tasks to better assist the provider.
At Dr. Sesin’s practice, almost all staff members are cross-trained. For example, if a medical assistant is tied up, one of the receptionists can bring patients in, take vitals and take them to an exam room. “Everyone knows how to make appointments and collect patient demographics over the phone,” he says. “We have biweekly meetings to keep all staff members up to date and informed of important updates and news, such as insurance, coding and billing changes.”
Dr. Wei’s small staff has specific scripts in place that all staff members have to memorize as part of the practice’s cross-training efforts.
Prioritizing Tasks for Staff
Another way to help a large practice run smoothly and, hence, keep patient appointments on time, is to dedicate staff to specific tasks to avoid bottlenecks—which can throw the entire office off track.
Specifically, Ms. Mooney recommends dedicating a staff member to answering the phone, enabling her to give her undivided attention to the call. Defining criteria on what calls or situations need to be transferred to a clinical person enables the receptionist to better route calls and messages. In addition, outlining criteria on how to schedule certain appointments to make the most of the provider’s time gives the front office staff more information to properly schedule the right amount of time for the appointment.
Assigning someone to check in patients at the window allows this person to give her full attention to the patient and expedite the check-in process. Meanwhile, a dedicated staff member can check out patients and also schedule additional appointments. Allocate one person to coordinate all prior authorizations and referrals, as well.
In the clinical back office, use support staff to help accelerate appointments. A scribe can obtain the patient’s preliminary information, round with the provider and record patient information right in the exam room. Consider using a midlevel staff person to support the provider, which will allow her to concentrate on interacting with the patient.
Dr. Sesin’s practice has trained staff to prioritize certain tasks. Because telephones are the lifelines of the business, staff is asked to answer within the first two rings. Urgent visits, such as gout attacks or swollen and painful joints, are prioritized and fit in within 24 hours. In the back office, all insurances are verified, and copays, coinsurances and deductible amounts are confirmed, so that patients are charged the proper amounts before leaving—since 50% of patients never pay their bills.
Analyzing Staffing Needs
Determine where bottlenecks occur by asking staff. “Have regular meetings in which staff can give input and share ideas on ways to improve,” Ms. Mooney says. You may also want to assign a manager or supervisor to have a strong presence in the front and back office to track patient flow.
“Ensuring that each staff member knows what is expected of them and monitoring performance can help identify if more training is needed or if there is a performance issue—which should be addressed at the time,” Ms. Mooney continues.
By reviewing charts before patient appointments begin for the day & taking note of the visit’s purpose to see what preparations are needed, a medical assistant or nurse can avoid having to leave the exam room to retrieve test results & other medical reports.
Consider asking patients for their input as well, such as by using patient surveys. If you choose this method, Ms. Mooney would suggest keeping it short and handing it to the patient when he exits. Ask him to complete it before he leaves, mail it or bring it in next time. Patients are more likely to toss out lengthy or mailed forms.
Another way to gauge patient satisfaction is simply to ask at check-out if there is anything more that the office can do for them and if they feel they had all their questions answered and received the care they were looking for.
Analyzing Your Own Time Management
On occasion, it’s good to take a hard look at your own time management—especially if you often have patient delays. For starters, you should begin your day on time. You should also be sticking to the timeframe allotted for breaks and lunch.
During a patient appointment, Ms. Mooney suggests limiting the patient visit to the reason for the appointment and encouraging the patient to reschedule if they have other concerns. “Appointments can get behind by addressing too many questions unrelated to the purpose of that visit,” she says.
Dr. Zadvinskis has found the electronic medical record system to be a great asset in organizing his day and keeping it on schedule. “I have learned to build time into my day and into each patient visit so that I can immediately update records and not let work pile up or get left for the end of the day,” he says. “This has worked well for both me and my patients, who have access to their own records via our app.”
Dr. Sesin, on the other hand, has found that multitasking throughout the day works for him. “As I interview patients, I input information into the EHR, and I discreetly monitor incoming text messages on my iPhone from doctors (inpatient and outpatient consult requests),” he says. Between patients, he checks e-mails.
Handling Tardy & No-Show Patients
In an effort to get patients to arrive on time and not miss appointments, Ms. Mooney advises confirming appointments and letting patients know what papers and information they should bring in advance. She also suggests asking patients to write down specific questions so the provider can address them.
If a patient skips an appointment, call them that day or the next one to ensure there wasn’t an unavoidable problem and to reschedule them.
You’ll also want to set policies and make patients aware of them. If a patient is late at Dr. Wei’s practice, they are given a gentle reminder to make sure they arrive on time the next time. Chronically tardy or no-show patients are first sent an “at risk” letter letting them know that being late or not showing up is jeopardizing their health. “If their behavior continues, they are discharged from the practice,” he says.
By comparison, Dr. Sesin will accommodate tardy patients, but they have to wait until they can be fit in. “Many of our patients are elderly, and we do not feel comfortable sending them home without seeing the doctor,” he admits. “Most of the time, their lateness has to do with transportation or traffic issues.” No-shows must pay a $25 “no call, no show” fee.
If your patients are often stuck waiting, you can do many things to keep your office on track. Work with staff to set priorities, handle patient delays and cope with busy times, while analyzing your own time management and streamlining your workday. Don’t add to your patients’ miseries by making them wait.
Karen Appold is a medical writer in Pennsylvania.
Winning Strategies for the Waiting Game
When a rheumatologist is running late, it’s best to be up front with patients about it. “Communication is a valuable tool in patient satisfaction, even when the message is something they don’t want to hear,” says Charlene K. Mooney, consulting executive, Halley Consulting Group, Columbus, Ohio, who suggests presenting it as an unavoidable delay or emergency. “Keep the patient apprised of the situation and periodically update them. Offer the opportunity to reschedule. When patients are made to feel their time is valuable and the practice is extremely sorry to inconvenience them, typically they will be understanding.”
“We do our best to be very transparent with our patients because we want to maintain a positive relationship,” says Peter Zigfrid Zadvinskis, MD, rheumatologist, Spectrum Health, Grand Rapids, Mich. “If an unexpected wait is likely, we are open about it right from the start. We have found that not telling patients what is going on is more likely to irritate them than being open and apologetic.”
Nathan Wei, MD, FACP, FACR, director, Arthritis Treatment Center, Frederick, Md., says his receptionist overestimates the time of a delay, so patients are pleasantly surprised if they don’t have to wait as long as expected. Staff members and Dr. Wei apologize to patients when they have to wait.
Carlos A. Sesin, MD, chief, Division of Rheumatology, Mount Sinai Medical Center/Vanguard Rheumatology Partners, Miami Beach, Fla., says the practice strives to make the waiting area as comfortable as possible, and updates patients every 15 to 20 minutes on delays. “We offer them water or coffee and free Wi-Fi, try to keep an interesting mix of reading material available and play relaxing music,” he says.
For the occasional upset patient, Dr. Sesin will address the issue. “I apologize and explain what has happened,” he says. “I explain that I’m the type of doctor who will see patients without an appointment for an urgent visit, such as a gout attack. Unfortunately, this means that from time to time I run late. In the end, patients realize that they would prefer to have an accommodating doctor like me than one who would make them wait to be seen for a few weeks.”
- McCormack M. How to treat patient wait-time woes. Software Advice. Accessed 2015 Sep 21.