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Same-day scheduling, also known as “advanced access” or “open access” scheduling, allows medical practices to dramatically decrease patients’ waiting times for appointments. Very simply, it requires that practices do today’s work today by offering a same-day appointment to all patients who call. The result is more timely care, increased patient satisfaction and improved practice efficiency.
While the concept has great potential and has garnered much interest, it is often misunderstood. The key mistake practices make is thinking of same-day scheduling as a ready-made product or a specific solution guaranteed to reduce a practice’s waiting time. In reality, there is no such product or solution; however, there is a proven process and a set of proven principles, which if applied in a customized fashion to each environment, will result in improved access to care. The course of action is similar to any quality-improvement process and involves four steps:
The principles to apply throughout this process are fairly simple:
Same-day scheduling, then, is really all about the process and the principles, not about a specific product or solution. It will require some thought, customization and experimentation to apply these principles to your specific environment. If you’re ready to embark on that, read on. What follows are commonly asked questions about open-access scheduling submitted by FPM’s readers.
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Chapter Outline
Scheduling appointments is one of the most important administrative responsibilities performed in the medical office. Until the 1970s, people went to a medical office expecting to wait as long as an hour or more. Most physicians liked to see a full waiting room; it reassured them that their practice was healthy. In the twenty-first century, people have little tolerance for waiting in a medical office. Lifestyles have changed and people have busy lives. Many have to take personal time away from work to go to the medical office, and they feel that their time is as valuable as the physician’s time. Scheduling appointments correctly and efficiently is crucial to the smooth operation of the medical office. Many factors must be taken into consideration when scheduling appointments. The patient who has made an appointment weeks or even months in advance wants to be seen within 15 to 20 minutes after arriving at the medical office. The physician wants a smooth flow of patients during the time scheduled for seeing patients. Patients who are ill or have accidents want to be able to see their physician on the day of the illness or injury. They prefer to be given a specific time, even if it is later in the day, rather than come into the office and wait for an open moment.
Two methods are used to schedule appointments. Appointments can be scheduled manually, using an appointment book. They can also be scheduled electronically using a computer. These methods are described in more detail next.
Each day the list of the patients to be seen that day, called a daily appointment schedule, serves several functions. It is used as a guide for pulling the patients’ medical records for that day. It also is used as an office reference sheet of patients with appointments on that day. Usually the daily appointment schedule contains the patients’ names and telephone numbers and the reasons for their visits (e.g., new patient, physical examination, recheck). If the medical office uses an appointment book, the daily appointment schedule must be typed or hand-printed by the medical assistant. More commonly, a computer is used to schedule appointments, and the list is printed out in hardcopy form or viewed by staff directly on the computer. According to Health Insurance Portability and Accountability Act (HIPAA) requirements, the daily appointment schedule should never be posted in an office area accessible to patients. This list may be updated and reprinted if there are changes or additions, or changes can be made in dark-blue or black ink. The office must keep an updated record either on paper or electronically to verify tax returns and insurance claims.
Several methods are available to schedule appointments in the medical office. They include time-specified scheduling, wave scheduling, modified wave scheduling, double booking, and open booking. Many offices allow established patients to request appointments or schedule appointments using the Internet. In addition, appointments may be clustered or categorized depending on the type of patient or type of examination or treatment. The method an office uses to schedule appointments is based on the needs of the practice and physician preference.
Appointments are usually scheduled up to 6 months in advance. Before scheduling can begin, the appointment book or computer software must be set up to indicate the times when the physician will see patients. Times when the physician is not available to see patients must be blocked out. The appointment schedule showing only available times for appointments is sometimes called the appointment matrix (Procedure 40-1). Procedure 40-1 Setting up the Appointment Schedule
Outcome Set up an appointment schedule.
Equipment/Supplies
1. Procedural Step. Block times when the office is not open to see patients. This includes times before office hours begin, lunch and/or breaks, afternoons or days when the office is closed, and holidays when the office will be closed. Some offices set up the appointment schedule 6 months in advance, whereas others do it for a year in advance. In an appointment book, draw an X through times when the office is closed. If the office uses a computer program, set up times when the office is open and set the appointment interval (10, 15, or 20 minutes). Principle. In an effective appointment schedule, only available appointment times are blank. 2. Procedural Step. Block times when each individual physician is not available to see patients, including lunch and hospital rounds. In addition, block days when each physician will be away from the office for vacations, conferences, or other anticipated absences. If the physician has regular meetings or other regular commitments (such as nursing home visits), mark these also. In an appointment book, draw an X through the times when the physician is not available. If the office uses a computer program, schedule the meeting, vacation, or other anticipated absence like an appointment, using color-coding to show that the times are unavailable. 3. Procedural Step. For each physician, mark times when the physician does certain types of examinations, procedures (e.g., physical examinations, obstetric visits), or surgery. In an appointment book these are often highlighted with a marker or given a written title at the beginning of the time block. In a computer program these times may be set up as if for a separate physician (e.g., Dr. Gomez and Dr. Gomez—OB visits), or a color-coding system can be used. 4. Procedural Step. Depending on office policy, block out as much time as is anticipated for same-day appointments, catch-up time, and unexpected needs. Depending on the practice, catch-up time may be 15 minutes in the morning and afternoon for each doctor, and time for same-day appointments may be an hour or longer for all physicians or one particular physician on a rotating basis. These times can be marked in various ways as long as office staff understand that they must be saved until the scheduled day. Example: On this day, the office will be open from 9 to 5, but Dr. Warner will be available to see patients only from 9 to 1 because he plans to attend a conference in the afternoon. The appointment interval is 15 minutes. Dr. Warner likes to have 15 minutes set aside for catch-up time at 10:30 in the morning. How the times are blocked out depends on the scheduling method used by the office. If the office uses an appointment book, the times are blocked out by drawing lines through the blocked times. If a computer is used to schedule appointments, the times are blocked out by setting aside blocks of time. Various types of color-coding are used in a computer scheduling program, but blocked times are different colors than open appointment times (Figure 40-4). The appointment schedule must take three variables into consideration: the scheduling system, the physician’s preferences and needs, and the facilities and equipment requirements. Each of these is discussed later.
Appointments are usually scheduled at intervals of 10 minutes, 15 minutes, or 20 minutes in either a manual or a computer system. An appointment may be scheduled for more than one block, depending on the type of appointment. For example, if a 10-minute interval is used, an established patient coming to have his blood pressure checked might be scheduled for one 10-minute interval and a new patient might be scheduled for three 10-minute intervals. In this case, a 10-minute interval uses one line and a new patient uses three lines in the appointment book or on the computer schedule. If a 15-minute interval is used, all appointments are scheduled in multiples of 15 minutes. In general, more time must be allotted for new patients, physical examinations, and special procedures than for routine follow-up visits.
When scheduling an appointment, the medical assistant needs to obtain the proper information from the patient, document it accurately, and confirm it with the patient. The procedure for scheduling appointments varies depending on whether the patient is an established patient or a new patient.
For insurance billing, an established patient is defined as a patient who has received services from the physician or another physician of the same specialty in the same group practice within the past 3 years. If the patient is seen by another physician in the group who has a different specialty, this does not make the patient an established patient for that physician. For example, a patient has been treated for several years by a family practice physician who refers the patient to an orthopedic surgeon within the group. The patient is a new patient for the orthopedic surgeon. If the patient is seen by a different family practice physician for an urgent care appointment, the patient is an established patient for that physician. Patients who have not been seen within the past 3 years are typically treated as new patients, although their old medical records will be found if possible. If an established patient is scheduling a return appointment, the physician usually specifies a time period on the patient’s charge slip for the return visit (e.g., 1 week, 2 weeks, 1 month, 6 months). The appointment should be scheduled as close as possible to the date specified by the physician. The appointment must also be scheduled for the length of time preferred by the physician, which is usually 10 to 15 minutes. Before locating available appointment times to offer the patient, the medical assistant should ask what day of the week and what time of day are convenient for the patient. For an established patient, it is necessary to obtain the patient’s name, date of birth, and physician. If an appointment book is being used, it may be easier to ask the patient for a home and work telephone number than to look up this information. When a computer system is used, telephone numbers appear in the appointment window when the correct patient is selected. If the patient is at the office, the medical assistant should complete an appointment reminder card and give it to the patient. The medical assistant enters the patient’s name, the name of the physician, and the date and time of the new appointment on the card. If the patient has submitted an appointment request electronically, the medical assistant should attempt to accommodate the patient’s wishes when scheduling the appointment or make the appointment as close to the time requested as possible. The patient should receive an e-mail or letter verifying the date and time of the appointment.
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