For Healthcare Professionals Only
For any medical practice, perfecting patient scheduling is like working one of those old hand-held puzzles where the player moves square after square to complete a picture. Dermatology practices face some additional challenges that make the game harder: full schedules, a limited number of repeat patients, and many referrals.
Yet the dermatology scheduling puzzle can be solved — and your patients' satisfaction increased. The keys are an understanding of your practice's patient volume and the flexibility to consider new approaches.
Experts agree that effective scheduling begins with an on-time morning and an organizational plan in place. To stay on track, carefully analyze each patient's appointment needs. The scheduler should ask specifically about the patient's concerns. Then, if a patient arrives with a dozen issues, the physician can tell the patient that he must schedule another appointment to address additional concerns.
Grouping appointments by type can keep things running smoothly. "I schedule knowing which procedure is at a certain time of day so that I'm not rushed," explains Donald B. Feinsod, MD, a dermatologist on Long Island, N.Y. He always sees patients before scheduling a surgical procedure so he can ensure the proper visit length and timing for the patient's needs. During the initial visit, Feinsod calls the desk and clarifies the type of appointment to be set.
A good scheduling system maintains the staff's sanity and minimizes stress. There are some industry reports of schedulers at overbooked, overstressed practices listing phantom appointments at the end of the day; these "patients" then cancel, allowing staff to go home on time but potentially delaying other patients unnecessarily. Don't drive your staff to these lengths; ask for and heed their feedback on how days are moving. If necessary, ask staff members to remind you how far behind you are during the day.
Some physicians remain firmly low-tech. "My technology is an appointment book," says Feinsod, who has been in practice for more than 30 years. "I have found that the good old-fashioned appointment book is as efficient as the computer."
Other practices are resolutely high-tech. Gregg Menaker, MD, a dermatologic surgeon with Evanston Northwestern Healthcare near Chicago, uses the scheduling features included with his electronic medical record (EMR) to tie the whole appointment together: "On the same computer terminal where I schedule patients, I can open up their record and figure out if I've seen them before, what I've done for them, and what they need. Then I can schedule appropriately for the time they need."
For Feinsod's practice, no-show patients make scheduling more an art than a science. "We schedule … 12 patients per hour, knowing that patients do not show up," says Feinsod. "Over the course of the day, I would say there's almost a 40 percent no-show rate." However, for Feinsod's new patients, the system has advantages. "[W]e can take walk-ins every day. If patients feel it's important to see them that day, I can fit them in."
Many practices leave a few slots open for same-day appointments — unless appointments consistently fall through. Feinsod notes, "Often, if you tell a patient to come back for a follow-up and they're better, they don't bother coming back and don't bother canceling."
No-show rates may be lower for some types of procedures than others; Menaker's no-show rate for skin cancer treatment is almost zero. Nevertheless, his office calls patients to confirm appointments; if they do have a no-show, staff try to fill the spot by moving up another patient's appointment. Try to schedule patients who are routinely late just before lunch or at the end of the day, when their delayed arrival won't hold up other patients.
"One benefit of the EMR for patients is that automatically, when they check in, the time is imprinted on the schedule, so we know exactly how long they've been sitting there waiting," Menaker says. Using the EMR, "We're better able to tailor the day's schedule to the type of people coming in. So we don't get backed up, and don't have patients wait too long."
Patients appreciate this kind of consideration for their schedules. If the day's schedule goes haywire, practices should try to reach patients to let them know the physician will be unable to see them that day until later — or not at all. Offer patients already in the office a chance to reschedule, or at a minimum, allow them to use a telephone to reschedule work, parenting duties, or transportation.
As practice managers know, patients' schedules have grown busier in recent years, requiring many physicians' schedules to change in response. Feinsod notes that, "Patients used to come into the office in the morning. Now they don't do that, because in these economic times they don't want to miss work or get in late." He's established more evening and weekend hours in response and now starts office hours at 10 a.m. rather than 8:30 a.m.
Feinsod also schedules all appointments for acne patients — primarily school-age children — after 3 p.m. And when Feinsod designed his offices, he considered scheduling issues when he created several light-box booths, small rooms designed for patients with psoriasis to receive ultraviolet light therapy at their convenience anytime during the day. Feinsod sees each patient himself, taking a minute to greet the patient and see how she is doing. A signal system outside each room indicates whether patients are waiting or using the light box. "It increases [access] for phototherapy [patients] without messing up the schedule for patient care."
Menaker has devised a hard-won system to suit his patients' needs: "Typically, I cluster long procedures in the morning and do only suture removals during time between those surgeries. That way I can focus on the big surgeries … and I can attend five to 10 patients in the morning while doing several surgeries." During the afternoons, he schedules three excisions at hourly intervals, allowing time between them for 15-minute appointments. The shorter appointments give him flexibility in case the surgeries take longer. For significant surgeries, Menaker devotes the whole day: "Patients have plenty of face time and feel like the only person in the practice that day."
Through experimenting with your patients' needs and your practice's demands, the pieces of the puzzle will fall into place. But remember that all puzzles require jiggling now and then.
Although a well-managed appointment book can certainly be used effectively for smooth patient scheduling in your practice, an EMR may be a boon to the process. Systems can automatically log patients' check-in times so you know exactly how long they've been waiting. Says one dermatologist: "Our mantra is that [the patient's] rear end doesn't hit the chair in the waiting room." EMRs can also allow you to adapt the schedule to the type of procedures you'll be performing on a given day, ensuring that no patient experiences a lengthy wait.
CONTENT PROVIDED BY:
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.