February 2000 Bulletin

Modified wave schedule keeps everyone happy

Wonder why your volume of patients goes from one extreme to another? Or why new patients arrive with a chip on their shoulder–after waiting days or months to see you?

If you don’t know, but are interested in increasing revenue, have your scheduler survey new patient visit requests, says Elizabeth Woodcock, an MGMA consultant for physician practices.

"Your scheduler should track either same-day or within-24-hour-time slot requests for a period of four weeks, categorizing them by either emergency appointments or routine appointments," says Woodcock. "If you have an average of six new visit requests per day, hold open four time slots. Release them at 9 a.m., noon or at 4 p.m. You don’t want to hold open six slots–just in case there aren’t six patients."

And if your practice routinely has "significant" urgent emergency visit demands, you might want to assign an orthopaedist to handle those cases, says Woodcock.

Sit down regularly with your scheduler and analyze the entire time a patient spends in your practice. For instance, your patient might see the nurse for five minutes, get X-rays or need physical therapy.

By analyzing this data per patient, you develop a "modified wave" schedule for your practice. "What physicians tend to do is only look at the provider schedule or the room resources rather than looking at the entire flow of patients," explains Woodcock. "By using a modified wave schedule, this allows you to have three patients in at the same time. One goes to the physical therapist, one goes to the nurse and another goes to the physician. It’s a way to double or triple book that allows you to do so with forethought. However, it’s a little more complicated from a patient scheduling standpoint."

Here’s where prioritizing comes into play.

In orthopaedics, you have to anticipate the type of orthopaedic care the patient needs, notes Betty Springer, director of clinical services, Seaview Orthopaedics and Medical Association which has four offices in Neptune, N. J. staffed with six orthopaedists and one physiatrist. Appointments are all computerized and the physician gets a day sheet. "It’s not all physician’s hands-on time for the whole appointment," says Springer. "For instance, if a new patient coming in with lower back pain is going to need X-rays, bracing, casting or suture removal, and the physician has already seen the patient and made the assessment, then instructions are given to other members of the allied medical team. The physician can move onto the next patient."

In general, Woodcock says orthopaedists really need to work together with their staff at getting new patient business. "I don’t think you can expect all the front office people saying, ‘hey, let’s get these new patients in," says Woodcock. "If you think about it, it’s really counter-intuitive to get new patients in late in the day because your assistants want to go home."

According to the American Medical Association’s Physician Socioeconomic Statistics 1999-2000 Edition, the average days of wait for an appointment by new patients of an orthopaedic practice is 10.3–one of the longest waits for any specialty. Orthopaedics is also rated as having the longest waiting room time among specialties: 25 minutes vs. 19 minutes for all physicians.

That’s why there has to be a meeting of the minds with you and your scheduler.

"We can all talk about the ‘modified wave’ business model and getting the patients into the office, but unless the scheduler, nurse, physician assistant and everybody around you understands that you need to get these new patients in the door, well, it won’t happen," says Woodcock.

Physicians also need to understand the nature of finances behind getting new patients. "An orthopaedist told me he had two new patients walk out, but said, ‘I don’t care cause my waiting room is full of post-ops,’" recalls Woodcock. "I asked, ‘are you getting paid for that?’ His response was, ‘no, nothing.’"

"Remember, new patients are the lifeblood of your business," stresses Woodcock.

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