CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 Scheduling Appointments and Maintaining the Physician’s Schedule

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

2Scheduling

Appointments and Maintaining the

Physician’s Schedule


12-2

Introduction

• Scheduling systems– Types – How each is used

• Scheduling situations

• Appointment book– Legal aspects– Documentation


12-3

The Appointment Book

A well-managed appointment book

• Creates an efficient patient flow• Shows respect for everyone’s time by preventing excessive wait time

Unexpected events that occur

• Early and late arrivals• No-show patients• Emergencies• Physicians spend extra time with patients


12-4

The Appointment Book (cont.)

• Preparing the appointment book– Create the matrix, or basic

format• Block off times the doctor

is unavailable

• Examples of when time should be blocked off

– Hospital rounds– Surgery– Vacation and holidays– Scheduled meetings


12-5

The Appointment Book (cont.)

• Computer or traditional paper appointment book

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

numbers– Purpose of the visit

• Use only approved abbreviations


12-6

Determining Standard Procedure Times

• Create a standard list of procedure times– Indicate how much time to allow for the

tests

– Use only as a guide

• Helps identify appointment openings appropriate for the patient visit


12-7

30 min or >

30–60 min

5–10 min

15–20 min

15 min

15–30 min

10–20 min

30 min

5-10 min

10-20 min

15 min

15-20 min

15-30 min

30 min

30 min or >

30-60 min

Determining Standard Procedure Times (cont.)


12-8

A Legal Record

• Keep appointment books for at least 3 years• Entries must be clear and easy to read

Never erase a name or use liquid paper Use blue ink and never pencil

Draw a single line through the name Write the date, time, and reason for cancellations Document cancellations and no-shows in patient’s record


12-9

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

FU

CAN

P&P

suture removal 10–20 min.3

5

2

1

4

complete physical examination 30–60 min.

follow-up appointment 5–10 min.

cancellation 0 min.

Pap smear and pelvic examination 15–30 min.

ANSWER:

GOOD JOB!


12-10

Appointment Scheduling Systems

• Goals– Smooth flow of patients– Minimal waiting time

• Open-hours scheduling– No appointments

• Patients arrive at their own convenience

• Seen on a first-come, first-served basis

– Rural practices and urgent care centers


12-11

Appointment Scheduling Systems (cont.)

• Time-specified scheduling– Stream scheduling

– Patients are scheduled for specific times• At regular intervals

• Time based on reason for the appointment


12-12


• Wave scheduling– Large offices

• See several patients at the same time• Seen in the order of their actual arrival

– Flexibility for appointments that run longer than planned– Uses an hourly target

• Number of patients to be seen hourly determined by dividing 60 minutes by the average estimated length of visits

– Multiple patients at the same time can result in• Patient dissatisfaction• Annoyance


12-13


• Modified-wave scheduling– Options

• 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– Two or more patients scheduled for the same time

• Both patients will see the doctor within the scheduled period• One may be seen by NP or PA

– Used when patient with no appointment needs to be seen


12-14


• Cluster scheduling (categorization)– Groups similar appointments together – Useful if specialized equipment has limited availability

• Advance scheduling– Scheduling patients weeks or months in advance,

such as with annual exams– Leave a few slots open for patients with unexpected

problems

• Combination scheduling – Using two scheduling methods


12-15


• Computerized scheduling – advantages

– Can “lock out” selected appointment times

– Information can be accessed from all office terminals

– Help identify patients who are late, miss appointments, cancel, or require more time with the physician

– Reports to help improve efficiency

• Online scheduling – patients make own appointments via the Internet


12-16


A large pediatrician office commonly must “squeeze in” patients in that have become ill, so this new office plans to offer immunizations only twice per week. Which scheduling system(s) would you recommend for this medical practice?

ANSWER: Combination scheduling consisting of cluster and a form of wave scheduling would be recommended to allow for the needed flexibility.


12-17

Arranging Appointments

• Offer choices – Dates– Times

• Accommodate patient’s needs whenever possible

• Confirm choice with patient


12-18

Arranging Appointments (cont.)

• New patients– Those not established

at the medical office

– Obtain all necessary information

• Name• Address and phone

number• Date of birth• Insurance information

– Have patient arrive 15–30 minutes early to fill out forms

• Return appointments– Ask patients if they

need another appointment before they leave


12-19

AppointmentReminders

Appointment cards After appointment

time is entered in the book, it is recorded and given to the patient

Reminder calls 1–2 days before the

scheduled appointment, the office calls the patient

Reminder mailings A postcard

addressed to the patient that is mailed one week before theappointment

Recall notices Form letter sent to

remind patients to call for an appointment

Arranging Appointments (cont.)


12-20


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: The medical assistant should offer Mr. Lincoln a choice of dates and times available to accommodate Mr. Lincoln’s needs. 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.

TERRIFIC!


12-21

Special Scheduling Situations: Patient

• Emergencies– Seen immediately upon arrival at the office– Explain to waiting patients without details

• Provide opportunity to reschedule

• Referrals– Referred patients should be seen as soon as possible– When arranging referrals for a patient

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


12-22

Special Scheduling Situations: Patient (cont.)

• Fasting patients– Refrain from eating or drinking – usually

beginning the night before the appointment

– Schedule as early as possible in the day

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


12-23


• Patients with diabetes

– Require regular meals and snacks to regulate blood glucose

– Consider avoiding late morning slots that are close to lunchtime

– Keep appropriate snacks on hand in the event a patient develops a low blood sugar


12-24

• Repeat visits– Schedule regular appointments on same day

and time

• Late arrivals– Schedule chronically late patients toward the

end of the day• Prevents disruption in the office schedule

– Document late arrivals or missed appointments in patient record



12-25

• 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



12-26

• Cancellations– Thank patient for calling to

cancel

– Appropriately mark appointment as canceled

– Attempt to reschedule while the patient is on the phone

– Document cancellation in the patient’s medical record

J. Jones 123-456-7890

cancelled

S Smith 098-765-4321

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



12-27


• Missed appointments – Document no-shows in

the appointment book and patient medical record

– Inform the physician of no-shows

• Wrong day– Reschedule if patient lives

locally– Attempt to accommodate

if patient required special transportation or traveled far

H Plummer 234-543-2345

P. Lexar 098-765-4321

No show


12-28

Physician Scheduling Situations

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

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


12-29


Mr. Washington needs a follow-up appointment in a week for a fasting blood sugar after the physician changed his medicine for diabetes. 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, and that he should not take his diabetes medicine prior to the appointment but should bring it with him.


12-30

Scheduling Outside Appointments

• Common outside appointments include– Consults with other physicians– Laboratory work– X-rays and other diagnostic tests– Hospitalizations and surgeries

• Be sure to have a doctor’s order specifying– Procedure– When results are needed


12-31

Scheduling Outside Appointments (cont.)

• Validate the patient’s insurance prior to selecting the outside physician or facility– HMOs often arrange referrals and notify office when

approved

• Discuss possible appointment times with patient or give patient information to make appointment

• Give pre-appointment instructions if necessary


12-32


Mr. Anderson calls at 0830 and cancels his 0900 but calls the office again at 1230 c/o redness and discomfort at his surgical site. What should the medical assistant do?

ANSWER: The medical assistant should tell the patient to come right in due his complaints of incision redness and discomfort. However, Mr. Anderson should also be told that he will be “worked in” around other patients’ appointments.


12-33

Maintaining the Physician’s Schedule


12-34

Maintaining the Physician’s Schedule (cont.)

• Overbooking– Scheduling too many patients– Office schedule falls behind – Stressful for staff

• Underbooking– Gaps in schedule– Try to schedule another appointment in

cancelled time slot


12-35


• Emergencies or delays– Apologize to waiting patients and give an

estimated waiting time– Offer choice

• Leave and return at agreed-upon time• Reschedule appointment for another day

• Reserving operating rooms – Give preferred days and times– Provide type and approximate length of

procedure


12-36


• Scheduling pharmaceutical sales representatives– Block time for this

purpose

– New representatives • Request a business

card • Check with the

physician before scheduling an appointment


12-37


• Making travel arrangements for out-of-town meetings or events– Medical assistant may be responsible for

• Airline arrangements (get itinerary) • Car rentals and lodging• Get confirmations for all reservations

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


12-38


• Planning meetings– Find out number of people,

length and purpose of meeting

– Secure location with adequate room and parking

– Prepare an agenda if requested

– Secure equipment such as podium and microphones

– Take minutes as needed


12-39


• Schedule regular time with the physician– Review schedule

– Other items• State medical license• Drug Enforcement Agency registration• Documentation of continuing medical

education (CME) requirements


12-40


When making travel arrangements for the physician, which of the following would be the responsibility of the medical assistant?

a) Locum tenens

b) Itinerary

c) Agenda

ANSWER:

Right!


12-41

In Summary

12.1The appointment book is important in a medical office because it shows respect for the physician’s time and creates an orderly and efficient patient flow.

12.2Commonly used abbreviations save space and time when entering information into an appointment book.

12.3There are several different types of appointment scheduling systems. They range from open-hours scheduling to computerized scheduling.


12-42

In Summary (cont.)

12.4When arranging appointments for patients, be courteous and polite. Offer different dates and times; always confirm the appointment by repeating it to the patient.

12.5Special scheduling requires creativity and flexibility.

12.6Document late arrivals and no-show patients. Call to discuss reasons for lateness or no-show.


12-43

In Summary (cont.)

12.7Before scheduling outside appointments, ask the doctor for exact procedures that need to be performed, and which results will be needed.

12.8Your job as a medical assistant is to keep the physician’s schedule accurate and efficient. Do not overbook or underbook.


12-44

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 12

Documents

CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 Scheduling Appointments and Maintaining the Physician’s Schedule