Physician Appointments 03/15/02
A GFP member is interested in learning how other organizations schedule physician
clinic appointments. Specifically, is there an overall appointment center for all
physicians?
If so, is it funded by the practice plan, the hospital, or is it a joint effort? Where does the
management control reside?
If not, how are appointments made? Is the process working well and, if not, what are
some of the biggest issues you face with the physician appointment process? Is timely
patient access to physicians a problem in your institution?
Contact
Tim
Mashburn
School
U Tennessee
Reply
UT Medical Group does have a centralized call center, which handles
incoming calls for the private offices of the Departments of Medicine and
Pediatrics. In the near future, we will be adding calls from the Department of
Otolaryngology as well as the Department of OB/Gyn. Approximately 40% of
the incoming calls involve scheduling physician appointments, and we use the
IDX appointment scheduling system. The other calls include prescription
refill requests, calls for medical advice, requests for lab results, etc.
Therefore, in addition to scheduling patient appointments, our customer
service representatives take messages and send them electronically to nurse
triage queues in the various clinic offices. The calls are then answered or
resolved, closed in the system, and documented in the medical record.
In addition to providing a central service for scheduling appointments, we have
the capacity to schedule appointments on site in each clinic location.
Typically return appointments are made upon checkout at point of service.
It should be noted that this centralized call center is funded entirely by
the practice plan, and the expenses are allocated to all clinical
departments (whether they use the call center or not) along with the costs
other central services including medical records, revenue services
(billing), and information systems. This call center does not handle
physician scheduling for hospital outpatient clinics. At the present time,
our primary teaching hospital staffs a separate call center which schedules
appointments in the hospital outpatient clinics, and the hospital bears the
cost of this center. Consideration has been given to consolidation of these
services, but for various reasons, the centers remain separate.
We have invested significant resources in the development of the Call
Center, and we are continually working to make these operations efficient
and effective. One of the greatest challenges that we have faced is high
employee turnover. This is not unusual in call center environments, but it
stretches us to attract and retain a sufficient number of qualified agents
who are appropriately trained. These jobs are rather complex due to the
huge number of variables -- multiple specialties, multiple visit types,
multiple physician preferences, hundreds of insurance carriers with
different referral and authorization rules, etc. Another major challenge
for us to deal with widely variant call volumes. Certain days are twice as
busy as other days, and certain hours of the day are so busy that patients
can want in relatively long queues before having their call answered.
Obviously, trying to staff the center for an acceptable service level at all
times is extremely difficult.
In response to your question about timely patient access to physicians, we
do have access problems, particularly in certain specialties such as
dermatology, rheumatology, and endocrinology. This really doesn't have
anything to do with the centralized scheduling center. The schedules are
still dictated by the physicians in terms of visit lengths, clinic duration,
and authorization to overbook. We are doing a better job of measuring and
reporting these variables in an attempt to bring about more standardization
of clinical practice, but we have a long way to go.
Racy Peters Vanderbilt
Yes, we use Epic Cadence for scheduling.
Funded jointly.
Managed by the executive office of the COO for the clinics.
Yes the process is working well.
Some of the biggest issues are:
Failure to match demand with physician capacity.
Failure to create templates that match practice styles.
Yes timely patient access to physicians is a problem.
Jane
Schumaker
M C of
Wisconsin
Yes, used by all clinics (included hospital based) for new appointments and
some returns.
Joint effort, funded by major teaching hospital affiliate and practice.
Management control resides in practice.
Return appointments for some clinics and a few new appointments are made by
individual clinics or physician's academic staff.
Tony
Windebank
Mayo
We have departmental or center based appointment systems.
There is a central scheduling system for tests or interdepartmental
consultations.
Patients are registered to a department and then all appointments and tests
are scheduled by the appointment office in that department.
We don't have hospital-based appointment systems
Patient access is a continuing challenge because demand is usually in
excess of supply. Most appointment offices therefore have a triage system.
The system works very well.
Kathleen
O’Donnell
Andy
Ziskind
Columbia
It is all handled and funded by the Hospital for the Hospital clinics. Faculty practice
is handled through departments and individual physician offices.
U
Washington
We have a centralized point of scheduling, a virtual front desk, for our primary care
clinic network. It is highly successful and has achieved adequate scale (40-50,000
calls a month) that it saves money. We did try applying this model to a satellite
multi-specialty practice site, with less success due to the need for greater
information linking to the practice site. For specialty care, matching the right patient
with the right provider is more complex compared with primary care.
I'll be happy to speak with anyone who would like to discuss this further.
Bruce
Deschere
Wayne
State U
Wayne State U., Detroit. We do not have a central appointment area. Most
practices do their own schedules although the hospital does hospital based
physician scheduling through a Cerner product called Capstone.
Timely scheduling is a severe problem for some of our specialties. Eventually, we
will all be on a common IDX product that the docs will pay for and control.
Denise
Fetters
Steve
Valerio
Wake Forest
U
We schedule appointments through the individual departments and the expense
falls upon the department.
Indiana U
Appointments are still being scheduled by individual departments. Timely
access is a significant problem at IU; however, as yet the political will has
not been developed to change the process.
Bob
Kreisberg
U South
Alabama
Lorraine
Manzella
SUNY
Syracuse
Most of our appointments are made thru a central appointment desk; although
some MDs still control their appointments; it is working better but there are weekly
examples of it breaking down; usually when a pt call for an appt and is told by staff
that he/she is booked; when the physician learns about it he/she is upset because
they would have worked the patient in if asked; part of the problem has noting to do
with centralized appointments but the fact that time to the next appointment is
unusually long for some specialties; clearly it is impossible for some specialists who
have only one associate or colleague to provide daily office hours(e.g. Urology)
whereas a group practice of 4-5 urologists can always have one in the office every
day;, compound this with teaching responsibilities, committee work etc and it is
impossible for small institutions to provide timely and responsive medical care.
Hope this helps.
There is no overall center, although the hospital tele-services supports
appointments for some of the hospital based clinical services.
Management control resides at the Hospital.
We do have a hospital support MD Direct that can facilitate an appointment.
However most doctors like to call directly to the referring physicians they
know. We have some problems with access and although we've established
standards and etiquette expectations, we continually struggle with some
departments to be more patient friendly and accessible.
Timely patient access to physicians is a problem for many reasons. Sometimes
there is a capacity issue; sometimes it is an inappropriate "dump" case (e.g. back
pain for a patient who has been to everyone and run out of insurance, etc.); and in
some cases the department is not accessible enough due to poor functional
operations, etc.
Jim
Schneider
Marshall U
At Marshall University physician appointments are scheduled at the
department level and sometimes on an individual physician or nurse basis.
Although we have made some attempts at inter-departmental scheduling using
our IDX scheduling module it has generally not been well received. The
physician's schedule seems to be the "third rail" of practice management.
Most of our departments have set standards for acceptable delays in
scheduling various appt. types but its very specialty and department
specific. All of our primary care departments staff "walk-in" clinics so
their is always a way to see the doctor "right now", provided that you may
have to wait 2-3 hours and it might not be the right doctor.
Dave
Spahlinger
U of
Michigan
We have been moving to call centers but along departmental lines and therefore
have been expenses within the department. Areas such as customer service in the
billing office are group expenses since they serve all. The biggest reason to move
to appointment centers is to separate the check-in and checkout process from the
appointment scheduling process and to allow for cross scheduling across multiple
sites. A call to one number can schedule into 5 different cardiology locations and
find the earliest appointment.
Doug
Sjoberg
U of
Colorado
We have a joint funded (with the hospital) scheduling system, centrally
maintained, but run on the UPI computer system. Our system is IDX and is
integrated with billing and collection and our managed care system. The
system is controlled jointly with the hospital and each clinic runs their
scheduling templates as a separate entity, but under the guidelines created
by UPI and the hospital. This gives us the advantage of tracking wait
times, cancelled appointments, and a lot of other management information in
assisting in creating an efficient clinic system. The system works well and
has been in place for over 5 years. The physicians and the clinic personnel
like the system, and it has improved our efficiency dramatically.
No overall appointment center for University of Florida Physicians.
Ellen Meier U of Florida
Some appointments are scheduled in the clinics, some in the College of Medicine
clinical departments. Some are distinguished as to location of scheduling based on
whether the appointment is new or return. This process does not work well from a
consistency standpoint and is confusing to patients and referring physicians as
well. We are measuring access and providing feedback to the departments to
attempt improvements in meeting standards. We are also beginning discussions to
bring all scheduling staff into the clinic management model.
Thomas
Skinner
U of
Mississippi
Jim Patyraj
West Virginia
David
DiLoreto
Louisiana
State U
At the University of Mississippi Medical Center physician appointments
are made through the Hospital resource scheduling system for Hospital
clinics and appointments for physician clinics are made through the
physician resource scheduling system. The physician resource scheduling
system is decentralized so that each clinical department is responsible
for its own appointments. Only the demographic information is shared
by all departments and the management of the physician scheduling system
is centrally controlled by the Practice Plan. At the present time, having two
systems for appointments seems to work well. Patient access is a problem
for some specialties at the University Medical Center.
We have both centralized and decentralized appointment scheduling. All of it
is funded through the Practice Plan.
The overall appointment center for all physicians is the practice plan, and this is
also where the management control resides.
Timely patient access to physicians is not a problem.
Tom
Heckler
Oregon
Health
Systems
We do not have a centralized appointment center, the practices are generally
unwilling to delegate that much control over individual provider's schedules. Our
current system works well in some areas, poorly in others.