Wednesday, January 16, 2019

Practice Check-Up: How scheduling strategies can reduce disruptions and long patient wait times

This is the second in a series of articles aimed at highlighting key areas practices should examine in an effort to improve practice performance. This month we focus on how effectively managing the appointment schedule can have a positive impact on both patient and practice satisfaction.

It’s rare that an appointment schedule in a medical office survives a day without any changes. No-shows, cancellations and last-minute emergencies will always crop up and cause shifts and changes. But these changes don’t have to disrupt the flow of the office. Here are a few things to consider:

To double book or not to double book
Many practices experience no-shows and/or a high demand for appointments when the schedule is full. To address these situations, many practices will book multiple patients into a single slot. However, double booking will likely guarantee some bad patient experiences. If you have a double booking system in place right now, the California Medical Association (CMA) recommends you review that process.

One thing to consider before double booking is the patient’s “show” record. Double booking two patients with perfect “show” records in the same slot is likely to guarantee a long wait for one of them. But, it may be a reasonable strategy to consider double booking if your scheduling system can provide information on the patient’s track record of showing up on time. If you have information on the probability of the patient keeping the appointment, consider double booking a patient with a perfect “show” record with another that has a poor “show” record. Double booking without this kind of information will almost certainly create a traffic jam at the practice and at least one unhappy patient.

Taking charge of your appointment schedule
Oftentimes, there is no rhyme or reason to how patient appointments are scheduled. In an effort to meet patient demand, sometimes patients are simply crammed into an already busy schedule without considering the appointment type and/or the amount of time needed for the appointment. For example, new patient visits generally require about twice as much time as an established patient visit, while follow-up appointments are typically the shortest.

If your practice doesn’t have a schedule template, create one by identifying the amount of time required for each different type of appointment. Working with the physician(s), determine the average amount of time the physician needs for new patient visits, established patient visits, follow-up visits, well care visits, etc. Build that information into your scheduling system so when you are creating an appointment, the amount of time is automatically calculated based on the type/need.

More in-depth triage
Beyond the schedule template, it can also be helpful for schedulers to do a more in-depth triage with patients to identify whether additional time will be needed. For example, an established patient visit to address multiple complaints will likely require more time than the average established patient visit. Training your office staff who are responsible for scheduling to ask specific questions such as, “Do you have any other issues to discuss with the doctor?” as well as encouraging patients to be on time (or even early) in order to prepare them to see the doctor will help to keep your practice running on schedule.

Pad the appointment time
Practices often make the mistake of advising patients to arrive at the time of their scheduled appointment. However, if the patient’s appointment is at 8 a.m. and he or she arrives at 8 a.m., after check-in at the front desk, completion of any necessary paperwork and rooming of the patient, it would be impossible for the physician to actually see the patient at 8 a.m. and therefore immediately puts the physician behind schedule. Imagine how far behind the physician will be if that patient is late to their 8 a.m. appointment!

While some practices report they advise patients to arrive 10-15 minutes early, let’s face it, most patients don’t comply. They remember their appointment time and rarely arrive any earlier.

One way to address this is to pad the appointment time by 10 minutes or so. For example, if the patient’s appointment is at 8 a.m., the practice may wish to advise the patient that the appointment is at 7:50 a.m. This allows time for check-in, paperwork and rooming so the patient is ready to see the physician at his or her scheduled appointment time of 8 a.m., which maximizes valuable physician time.

Following some simple, but well thought-out scheduling strategies can maximize the number of visits in a day, prevent a chaotic work environment and improve patient satisfaction.

It's Finally Over! The Medicare SGR is Dead!


After a decade of battling, the U.S. Senate, in a whopping vote of 92-8, passed H.R. 2, the monumental, bipartisan Medicare SGR Payment Reform and Children’s Health Insurance Program (CHIP) Reauthorization Act. Both California Senators Feinstein and Boxer voted in the affirmative. Two weeks earlier, the U.S. House of Representatives adopted the legislation in a landslide vote of 392-37. This was a rare, bipartisan achievement in a deeply divided Congress. RCMA, CMA, AMA and more than 780 state and national physician organizations supported the bill. In 2013, the policy was jointly developed on a bipartisan basis by the three House and Senate health committees. This year, U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are credited with negotiating the final budget offsets to fund the SGR bill.

RCMA/CMA extends a sincere thank you to all physicians for the extraordinary campaign this last decade to end the SGR. We have kept up the fight these last two years to hold Congress’ feet to the fire to develop a comprehensive bill to reform Medicare physician payments. The unity within organized medicine finally put this over the finish line. Moreover, 52 out of 54 Members of the California Congressional delegation voted to support physicians. This is an incredible achievement in one of the most dysfunctional Congresses in history.


While H.R. 2 is far from perfect, it represents a significant improvement over the current Medicare program which mandates penalties up to 13% in the coming years with no opportunities for payment updates or bonuses. This bill consolidates the burdensome reporting programs and reinstates significant bonus payments. By repealing the SGR and providing annual updates, it provides stability to physician practices that allows for longer term planning. Significantly, it allows physicians to design new payment systems that work for physicians and patients instead of government bureaucrats. And it mandates physician involvement in defining and developing quality measures. Moreover, once the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system (such as increasing the annual update) at a lesser cost. The enormous cost of the SGR has been a barrier to making any improvements.

Note that Medicare should begin processing claims today for services provided in April at the rates that were effective before the 21 percent cut was scheduled to take effect. Under the provisions of H.R. 2, the fee schedule conversion factor will be increased by 0.5 percent on July 1, 2015, and by another 0.5 percent on January 1, 2016.

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