August 1999 Bulletin

No magic in good schedules

Interspersing new, established patients works well

By Sandra Lee Breisch

Is scheduling patients a matter of simple math? Add time to one patient's visit and subtract from another's? Or is there some magic formula that keeps patient wait times down?

"I don't think there's any magical formula for scheduling," explains Elizabeth Woodcock, an MGMA consultant for physician practices. "But a lot of people have this big question, 'how many slots are to be held open?'"

So much of how a physician schedules patients depends on the practice's specialty, history and the patient mix, explains Woodcock. "If a physician or a group practice can capture their own information, they can manage their schedule better."

Physicians can do this by utilizing appointment codes in the management information system in order to identify types of visits. "For instance, they can identify if it's a post-op or pre-op visit, casting visit only, initial consult, etc.," says Woodcock. "And this is very standard for information systems to handle."

A good idea is for physicians to get together with their schedulers. "The scheduler may know of information that no one else knows how to reach [in the information system] and will know what information is currently available and hopefully know what additional information can be collected," explains Woodcock. "The scheduler will know how easy it will be to implement new ideas, for example, the addition of appointment codes."

After a group of 19 physicians in nine satellite locations at Willamette Orthopaedic Group in Salem, Oregon regularly sat down with their scheduler, lengthy wait times were diminished.

So says Evalyn P. Cole, executive vice president of the group. "Our doctors get together with their scheduler a couple times a week or weekly,"she says. "They look at their appointments to see which patients will take the longest time when they set up their template for their schedule."

Interspersing new patients between established patients works well, says Cole. For instance, a new patient might take a half an hour's time because they'll get sent for an X-ray, the cast room or other procedure. While that patient is gone, an established patient can be seen in 10 or 15 minutes. "Most of the orthopaedists limit themselves by taking no more than three new patients a day, usually scheduling one at 8:30, one midway through the day and one at the end of the day," explains Cole.

Cole says 30 patients a day in an 8- to 10-hour period is an average patient load for each physician.

Generally, a new physician versus an established physician will require more time with patients and have more open slots available because they're not as booked as an established physician, notes Woodcock. "Orthopaedists doing nonsurgical consults are also going to have more open slots for walk-ins, emergencies and referrals than a spine or hand surgeon who has a better command of pre-op and post-op visits."

"The beauty is that as a practice you have that data available to you," says Woodcock. "But I'm shocked by the number of practices that never record 'no shows' patients into their charts or information systems. If I go to a practice and they have a 10 percent no show rate, then I'll say 'you should be booking 33 patients a day.' So, if you want to see 30 patients a day, you should be booking 33. And that number will fluctuate when all patients will show up."

So, what if all of your patients show up? Just how long is an acceptable wait?

"The industry norm is a 20-minute wait," says Woodcock. "Anything after that is, generally, not acceptable."

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