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Some dermatology practices run like a fine-tuned clock with a well-managed, predictable schedule. This includes everything from patient flow to customer service and improved outcomes. But then there are those practices that just can't seem to bring it all together. Their days are out of control, as the schedule seems to fall apart with nonadherent patients who don't show up for appointments or demand to be squeezed in at the last minute.
These problems contribute to unmanaged patient flow, which compromises the ability to deliver patientcentered dermatology care. Reducing missed appointments makes for a predictable day that improves both workflow and patient care.
And missed appointments carry serious consequences. "Staff is underutilized. But more importantly, if follow-up is incomplete, there are malpractice implications," says Kathy Moghadas, a practice management consultant with Associated Healthcare Advisors in Fern Park, Fla. Most important of all is that no-shows are a big contributor to delayed treatment, which can compromise patient outcomes.
How can dermatology practices that struggle with these issues take charge of the daily schedule and better manage patient care?
WHO'S THE BOSS?
Don't let the tail wag the dog! If increasing numbers of patients are dictating when they will have appointments by calling in at the last minute or deciding it's OK not to show up at all, it's time to take back control. It's important to let patients know what is acceptable and what is not. Hold patients accountable—when they miss an appointment, call them on it, and explain the implications for the health of their skin. "In our practice, if a patient no-shows three times, it is grounds for dismissal," says Patti Fitzgerald-Belisle, business manager for Sand Lake Dermatology Center, PA, in Orlando, Fla.
Patient attitudes have changed over the years, and people are always pressed for time. If patients arrive in your dermatology practice only to wait half an hour in reception, they're bound to develop a lax attitude about appointments. "Patients feel their time is just as important as the doctor's time," notes Fitzgerald-Belisle, although remaining mindful of this throughout the day is admittedly challenging in a specialty facing severe provider shortages in some regions.
"If you make the patient feel important, treat them right, and see them on time, you'll have far greater compliance with scheduled appointments," advises Rebecca Anwar, a healthcare marketing consultant with The Sage Group in Philadelphia. "Missed appointments represent a lost opportunity to better serve your patients. Your relationship with them will suffer, and they may go elsewhere for their care," she says. A decline in patient service and interrupted care are important matters deserving of management's attention.
TARGET THE CAUSE
The appointment schedule itself can be part of the problem. When missed appointments become a chronic issue, it's time to take a critical look. This requires examining past appointment schedules to identify how many people were no-shows or canceled at the eleventh hour.
Dermatology practices will need to determine what types of appointments result in no-shows. Is it patients with a particular condition, those scheduled too far in advance, or those with certain demographic characteristics who don't keep their appointments? It could even be that the missed appointments are chronic during a certain time of day. Fitzgerald-Belisle agrees: "In dermatology, we have a large adolescent patient population. It has become apparent that they are more apt to ignore a scheduled appointment."
What dermatologists find out about their appointment trends can be eye opening. Leeann Marino, manager of Saperstein, Inc., a three-physician dermatology practice in Beverly Hills, Calif., discovered that her office's new patients are more likely to miss their appointments. The practice changed its scheduling template so that new patients are not on the books for the early morning or late afternoon, when demand from established patients is greatest. "Our working patients are thrilled with more availability at the beginning and end of the day," Marino says. This simple tweak, along with confirming patient appointments, resulted in a better-managed appointment schedule for this practice, which sees up to 200 patients a day.
Collecting historical data will guide dermatology practices to pinpoint the greatest contributors to no-shows and late cancellations. By understanding the patterns, dermatologists can establish realistic expectations, effect change, and provide better service to all their patients.
SIMPLE STEPS FOR CHANGE
Making follow-up appointments at the end of their visits gives patients the chance to schedule at a time that is most convenient. "We really emphasize the importance of follow-up care by requiring patients to make their next appointment while they are in the office," explains Marino. "If they wait until the week before they need to be seen, it is difficult to accommodate their requests."
How to change patients' habits? This is an educational process that takes time and determination. After all, the practice will need to change its habits as well. "Set up scheduling protocols. Traditionally, dermatology is all about preventive care and risk training," says Moghadas, so dermatologists already have many of the skills necessary for delivering effective patient education. "[B]e a better communicator," she adds, "so you and your patients are on the same page when it comes to managing their care."
Consultants and managers see appointment reminder systems as an important tool that helps dermatology practices do a better job of improving patient adherence and managing the schedule. Marino notes,"Our patient compliance with appointments really improved once we added PhoneTree," one of several popular systems that can be set to place automated reminder calls.
"We contact patients two days in advance, giving them time to call and change the appointment rather than not show up," adds Fitzgerald-Belisle. "We recently signed up with Cellminder, so we can even follow up more than once without using staff time to do it." Cellminder is a flexible one-way patient communication system that sends appointment reminders and has a recall program designed to improve adherence.
Virtual technology has become more advanced, too, with companies that offer services beyond the reminder system. Dermatology practices can expand one-way communication to patients by reporting negative test results, notifying them about an upcoming mole-check clinic, letting them know it's time to schedule an appointment, informing them when earlier appointments become available, or even reminding them that summer is on the way and it's time to replenish their stock of sunscreen. Although some practices prefer not to automate patient communications, this consistent, reliable form of communication can help reduce noshow rates and better manage risk.
When no-shows are chronic, staff may be contributing to the problem. They might unknowingly be sending patients signals that missing an appointment is no big deal. Dermatology practices can change this pattern with messages that emphasize the importance of keeping appointments. Here are a few examples of what to say when confirming appointments:
The words dermatology practices choose are important. For example, it is far stronger to tell a patient you are calling to "confirm" an appointment, rather than "reminding" her of it.
Counsel habitual no-show patients about the problem. The dermatologist can reinforce the seriousness of missed appointments by letting patients know how important scheduled appointments are for monitoring their care.
In the end, a well-managed appointment system requires valuing patient, staff, and dermatologist time. Attention to these areas makes for a happier staff and happier, healthier patients.
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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.