CHAPTER 16 Schedule Management 16-2 Learning Outcomes (cont.) 16.1Describe how the appointment book is key to the continuity of patient care. 16.2Identify

CHAPTER

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16Schedule

Management

16-2


Learning Outcomes (cont.)

16.1 Describe how the appointment book is key to the continuity of patient care.

16.2 Identify how to properly apply a matrix to an appointment book.

16.3 Compare different types of appointment scheduling systems.

16.4 Identify ways to organize and schedule patient appointments.

16-3


Learning Outcomes (cont.)

16.5 Model how to handle special scheduling situations.

16.6 Explain how to schedule appointments that are outside the medical office.

16.7 Implement ways to keep an accurate and efficient physician schedule.

16-4


Introduction

• Scheduling systems– Types – How each is used

• Scheduling situations

• Appointment book– Legal aspects– Documentation

16-5


The Appointment Book

• A well-managed appointment book

– Creates an efficient patient flow

– Shows respect for everyone’s time

• Unexpected events that occur

– Early and late arrivals

– Emergencies

– Patient’s who require extra time

16-6


Computerized Scheduling

• Lock-out feature

• Access

• Identification of problem patients

• “Search” feature

• Reports feature

• Color-coding featureScreen captures of SpringCharts™ Electronic Health Records software are reprinted with permission from Spring Medical Systems, Inc. All rights reserved.

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Online Scheduling

• Not for all office types

• Cost and security have been barriers

• Prior to purchasing an e-scheduler– Assess practice needs

– Determine potential for use

– Research products

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Apply Your KnowledgeWhat advantages does a computerized scheduler have over a paper appointment book related to continuity of care?

ANSWER: •It enables you to identify possible noncompliant patients who cancel appointments, often arrive late, or are no-shows •It enables you to search for upcoming appointments to ensure follow-up care is given.•It allows for access from multiple areas so a physician could check for a patient in an examination room.

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Applying the Matrix

• Block off times the doctor is unavailable to see patients

• Schedule around those times

• Unblock appointments if physician becomes available

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Required Patient Information

• Obtain patient information– Patient’s full name– Home and work telephone

numbers– Purpose of the visit

• Use only approved abbreviations

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Standard Appointment Times

• Create a list – Standard appointment times

– Time needed for common tests

• This helps in choosing an appropriate appointment book or scheduler

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The Appointment Book as a Legal Record

• Keep appointment books 3 years

• Entries – clear and easy to read

• Corrections or changes

– Draw a single line through the entry

– Add appropriate comment

– Initial the entry

– Document in medical record

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Use your knowledge of abbreviations and scheduling to order these from least time required to most time required. (1= least time required and 5= most time required)

Apply Your Knowledge

S/R

CPE

f/u

CAN

P&P

suture removal 10–20 min.3

5

2

1

4

complete physical examination 30/60 min.

follow-up appointment 5–15 min.

cancellation 0 min.

Pelvic examination and Pap Smear 15–30 min.

ANSWER:

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Appointment Scheduling Systems

• Goals– Smooth flow of patients– Minimal wait time

• Open-hours scheduling– No appointments– Emergency room, urgent care centers and

some rural practices

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Appointment Scheduling Systems (cont.)

• Time-Specified Scheduling– Stream scheduling

– Patients are scheduled for specific times

• Regular intervals

• Amount of time – based on the reason for the appointment

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• Wave Scheduling

– Flexibility to allow for• Patients who arrive late

• Patients who require more or less time

– Uses an hourly target number of patients• Arrive at the same time

• Seen in order of arrival

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• Modified-wave scheduling– Patients scheduled in 15-minute increments – Four patients scheduled during the first half hour and

the second half hour is left free for catch-up

• Double-booking system– Two or more patients scheduled for the same time

– Used when patient with no appointment needs to be seen

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• Cluster scheduling – Groups similar appointments– Useful if specialized equipment has limited availability

• Advance scheduling– Scheduling weeks or months in advance– Leave a few slots open for unexpected needs

• Combination scheduling – using two scheduling methods

16-19



A large pediatrician office commonly must “squeeze in” patients in that have become ill. The practice also plans to begin offering immunizations only two days a week. Which scheduling system(s) would you recommend for this medical practice?

ANSWER: Combination scheduling system consisting of cluster scheduling for the immunizations and wave or modified-wave scheduling to allow for the needed flexibility of emergency patients.

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Organizing and Scheduling Appointments

• Be professional

• Accommodate patient’s needs if possible

• Time needed– Patient status– Chief complaint

16-21


New Patients

• Those not established at the medical office

• Obtain all necessary information– Contact information– Insurance information

• Co-pay information

• New patient forms

16-22


Established Patients

• Currently seen by the practice

• Return appointments– Make as patient is leaving office– Set pattern– Appointment

reminder card

16-23


Appointment Confirmations and Reminders

• Appointment cards– Enter appointment

in scheduler – Fill out card

• Do not rely on memory to enter appointment into book or scheduler

16-24


Appointment Confirmations and Reminders (cont.)

• Encounter forms/superbills – Receipt for payment

– Information about next appointment

• Reminder mailings– Postcard with time and date of appointment

– Put in tickler file on date it should be mailed

16-25


Appointment Confirmations and Reminders (cont.)

• Confirmation Calls – To confirm a scheduled appointment– Useful for frequent late arrivals or no-shows

• Recall notices – reminder to call for an appointment

• E-mail notifications– Patients enroll and receive a password– Notifications of up-coming appointment sent

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The doctor wants Mr. Lincoln to return to the office for a follow-up appointment in two weeks. What should the medical assistant do?

ANSWER: Offer Mr. Lincoln a choice of dates and times available. After entering the appointment in the book or into the computer, confirm the date and time with the patient and give him a appointment card.

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Special Scheduling Situations

• Emergencies– Seen immediately upon arrival at the office– Explain situation to waiting patients

• Referrals– See referred patients as soon as possible– When arranging referrals

• Provide choices• Be sure the facility accepts the patient’s insurance

• Document in patient record

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Special Scheduling Situations (cont.)

• Fasting patients

– Schedule as early as possible in the day

– Instruct patient about the need to fast and when to start

• Patients with diabetes

– Require regular meals and snacks

– Avoid late morning slots

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• Late arrivals

– Schedule chronically late patients toward the end of the day

– Document late arrivals or missed appointmentsin patient record


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• Walk-ins

– If it is an emergency, handle as such

– If no openings, offer to schedule an appointment

– Post a sign in the office if no walk-ins are allowed


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• Cancellations– Thank patient for calling to

cancel

– Mark appointment as canceled

– Attempt to reschedule

– Document cancellation in the medical record

J. Jones 123-456-7890

cancelled

S Smith 098-765-4321

R Hansen 456-789-0123M Fitz 321-456-0987


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• Missed appointments

– Document in the appointment book

– Document in medical record

– Inform the physician of no-shows

– Call or send polite reminder

• Wrong day

– Reschedule

– Attempt to accommodate if

• Patient came a long distance

• Made special travel arrangements

16-33


Physician Scheduling Situations

• Physicians may throw the schedule off by– Arriving late to the office– Being called away for emergencies– Being delayed at the hospital

If a physician is repeatedly late, you may want to add some buffer time to the schedule.

16-34



Mr. Washington needs a follow-up appointment in a week for a fasting lab tests. How should you handle this appointment?

ANSWER: The appointment should be made for the first or second appointment for that day. Mr. Washington should be reminded he should not eat or drink after midnight.

16-35


Scheduling Outside Appointments

• Verify insurance coverage

• Obtain referral or approval if needed

• Make appointment

• Instruct patient

• Document in medical record

16-36


Reserving an Operating Room

• Call OR scheduler to reserve space– Preferred date and time– Type of surgery– Relevant patient information

• Insurance requirements

• Patient instructions

16-37



What is the first thing you should do before scheduling an appointment for a referral to a specialty physician?

ANSWER: The first thing you need to do is to verify that the physician will be covered by the patient’s insurance.

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Maintaining the Physician’s Schedule

Maintain a BalanceMaintain a Balance

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Visits Outside the Office

• House calls – check on home-bound

• Hospital rounds

• Nursing home visits

• “Mouse calls”

16-40


Scheduling Pharmaceutical Sales Representatives

• Physician preference– Scheduled block of time

– By appointment

• New representatives – Request a business card

– Check with the physician before scheduling an appointment

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Making Travel Arrangements

• Travel and lodging arrangements

• Itinerary – several copies for physician and one for the office

• A locum tenens or substitute physician may cover practice while regular physician is away

16-42


Planning Meetings

• Find out number of people, length and purpose of meeting

• Secure location with adequate room, parking, and food services

• Secure AV equipment

• Send invitations

• Create agenda

• Prepare minutes

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Scheduling Time with the Physician

• Irregularities or changes in the schedule

• Other items for discussion– Practice finance – Taxes and other financial matters– Professional licenses – Renewal requirements for the medical staff

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Why is it important to maintain a balance in the physician’s schedule?

ANSWER: To help the physicians use their time efficiently.

Right!

16-45


In Summary

16.1 The appointment book or electronic scheduler and its matrix, when used properly, allow the office staff to respect the time of both the physician and patient, by keeping an efficient and timely flow of patients throughout the day.

16-46


In Summary (cont.)

16.2 To create a matrix you must know the usual schedule of physician availability to see

patients as well as the times the physician (or practice) will not be open to see patients.

The latter times should be X’d out with a short reason given as to why the time is

unavailable.

Follow the instructions for the electronic scheduler to block out the appropriate time frames.

16-47


In Summary (cont.)

16.3 The most commonly used types of scheduling systems are open-hours, time-specified, wave, modified wave, double booking, cluster, and advance scheduling.

It is also common for offices to use any combination of the above as best suits each practice.

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In Summary (cont.)

16.4 When organizing and scheduling patient appointments, always maintain a positive, professional image.

The patient’s status should be considered as well as patient preference.

The goal is to accommodate the patient, while still maintaining an efficient schedule.

Appointments should be confirmed through appointment cards, phone calls, email

notification and mailing recall notices.

16-49


In Summary (cont.)

16.5 Handling special scheduling situations requires critical thinking skills and creativity.

Scheduling situations can arise if the physician is running late or if a patient requires an emergency appointment.

Other scheduling problems may also include a patient who does not show, arrives late, or arrives on the wrong day.

Document any patient-related appointment issues the patient’s medical record for legal purposes.

16-50


In Summary (cont.)

16.6 In order to schedule outside appointments you will require the patient’s demographic and health insurance information along with the procedure or service to be performed and the reason for the service.

Preferred dates and times should also be noted.

If referrals or prior authorizations are required, you may also be required to obtain these.

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Taking a few extra minutes, going that extra mile, and giving that added special touch can make a world of difference in a very difficult situation.

~ Lisa Lockhart

(From A Daybook for Nurses: Making a Difference Each Day)

End of Chapter 16

Documents

CHAPTER 16 Schedule Management 16-2 Learning Outcomes (cont.) 16.1Describe how the appointment book is key to the continuity of patient care. 16.2Identify