TEACH Lesson Plan Manual for Kinn’s The Medical Assistant: An Applied Learning Approach 12th edition Chapter 10 Scheduling Appointments Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Lesson 10.1 Appointment Scheduling Methods 1. 2. 3. 4. 5. 7. 6. Define, spell, and pronounce the terms listed in the vocabulary. Describe scheduling guidelines. Discuss the advantages of computerized appointment scheduling. Explain the features that should be considered when choosing an appointment book. Explain how self-scheduling can reduce the number of calls to the medical office. Explain the importance of legible writing in the appointment book. Discuss pros and cons of various types of appointment management systems. Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Using Established Priorities for Appointment Scheduling Effective scheduling allows physicians to spend adequate time with patients Four factors for scheduling: Patient’s needs Physician’s preferences and habits Facilities available Duration of office visits Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Patient Needs Determining office hours and appointment times requires consideration of the socioeconomic status of the area being served Scheduler must allot visit time based on patient’s needs for each individual visit Balance between meeting patient’s needs and physician’s preferences and available facilities Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Physician Preferences and Habits All preferences and habits are important to scheduling Physicians also make phone calls, examine and dictate reports, attend meetings, answer mail, and other responsibilities Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Available Facilities Medical assistant must know how to pair patient needs with available facilities when scheduling Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 Duration of Office Visits Scheduler must know how long various office visits and procedures take Use office policies and procedures manual for procedure times Physician’s reimbursement from insurance companies is partly based on time requirements for procedure or visit Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Methods of Scheduling Appointments Two most common methods: Computerized scheduling Appointment book scheduling Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Computer Scheduling Software programs vary from simple to more sophisticated ones that can select the best appointment time based on information entered Also keeps track of future appointments Printouts of schedules help staff and physicians stay on schedule More than one person can access the schedule, so everyone is informed Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Appointment Book Scheduling Many styles of appointment book; some color coded Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Self-Scheduling Allows patient to use Internet to view a facility’s schedule and select his/her own appointment time Reduce call volume to the office; available to patient 24/7 Can also send e-mail reminders the day before an appointment to request confirmation Phoned-in appointments must still be offered Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Advance Preparation Block out time when physician is not available to see patients Note reason for time blocked off Most electronic scheduling systems use a template where you can block time slots automatically, such as lunch hours Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Legality of the Appointment Book Appointment book must be accurate because it can be used as a legal record Missed appointments should be noted in the medical record Pencil is used so that changes can be easily made Include patient’s name and phone number Book should be kept for state’s statute of limitations and then shredded when discarded for privacy reasons Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Types of Appointment Scheduling Different types of appointment scheduling to meet needs of facility, providers, and patients Some offices combine methods to make the right mix of activity during the day and to ensure the day runs smoothly Must be proficient at managing appointments Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Open Office Hours Facility is open at given hours when patients are told to return “in a couple of weeks” for follow-up Patients can come in at intermittent times, seen in order of arrival Eliminates broken appointments and prevents from running behind schedule Most commonly used at labs, imaging facilities, urgent care clinics, and emergency departments Disadvantages include crowding and long waits, waves of busy times and waves of slow times, potential overburdening of staff Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Scheduled Appointments Scheduled appointments allow practitioners to see more patients with less pressure Requires a person who is good at multitasking and being efficient Critical to understand how long each procedure requires and time for pre-visit paperwork Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Flexible Office Hours Because many families often have two working parents, many providers are using extended day and flexible office hours Flexibility is advantageous to both patients and staff at physician’s office Evening and weekend hours can increase size of practice because of convenience offered Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Wave Scheduling Attempt to create short-term flexibility within each hour Assumes time needed for all patients seen will average out over the day Rather than scheduling at intervals, several patients will be at office at once and seen in order of arrival Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Modified Wave Scheduling Example: Have two patients come in at 10 AM and one at 10:30, repeating cycle throughout day Example: Patients are scheduled to arrive at given intervals during first half of hour, then none are scheduled during second half of hour Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Double-Booking Booking two patients at once to see same physician is poor practice Exception: one patient will only take 5 minutes Double-booking should be avoided or reflected in the schedule Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Grouping Procedures Grouping (categorizing) procedures is another way to approach scheduling Medical offices may try several ways of grouping before finding the best way Medical assistant may find it helpful to colorcode sections for grouped appointments Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Advance Booking Appointments are often made months in advance Appointment card should be given to patient and should require 24 hours’ notice for cancellation Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Lesson 10.2 Special Considerations When Scheduling Appointments 8. 9. 10. 11. 12. 13. Explain the basic procedure to follow when the office is behind schedule. Discuss the benefits of offering choices to patients when scheduling appointments. Identify critical information required for scheduling patient admissions and/or procedures. Discuss several methods of dealing with patients who consistently arrive late. Name several reasons for failed appointments. Recognize office policies and protocols for handling appointments. Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 Time Patterns Special problems arise daily, and some time should be open daily for a physician to deal with minor emergencies These schedule slots reduce disruption during the day If possible, block out 15 minutes each morning and afternoon for a break for physician to return calls, verify prescription calls, or answer questions Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24 Patient Wait Time Patient wait time should be minimized because it adds to anxiety, stress, and frustration Patient should go to exam room at scheduled appointment time, but not wait too long in there to see physician If a patient has been waiting more than 15 minutes, explain the delay and offer to reschedule Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 Telephone Scheduling Be pleasant and helpful when scheduling over the phone Try to accommodate a patient’s requested appointment time, if possible If not, be considerate offering alternative times and dates Offering two choices for a time slot is encouraged so that the patient feels s/he is in control of her/his time Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26 Telephone Scheduling, cont’d Always repeat time and date of appointment at end of call and ask if patient has pen/paper to write it down Check appointment book or computer screen to be sure it is entered correctly Write legibly in appointment book and obtain a daytime phone number for each patient Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Scheduling Appointments for New Patients New patient scheduling requires time and attention to detail Tact, courtesy, and professionalism are very important Request preliminary information so that you know how much time to allot Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28 Scheduling Appointments for New Patients, cont’d Offer patient first available appointment, giving a choice between two dates and times Offer directions or physical address to office Provide parking information if needed Options for first payment should be discussed Repeat appointment date and time and thank the patient for calling Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29 Scheduling Appointments for New Patients, cont’d Some medical offices mail or e-mail an information packet to new patients If patient is a referral, you may need to call referring physician’s office for additional information before appointment Print and give referral information to attending physician before patient arrives Send a thank-you note to anyone who refers a patient to medical office Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 30 Confirming Appointments Many offices call patients the day before appointments Can eliminate last-minute cancellations E-mail and automatic dialers can also be used to send reminders May need to conduct preauthorization or precertification to determine patient eligibility for certain procedures Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31 Scheduling for Established Patients: In Person Most return appointments are arranged when patient is leaving office Have all patients stop by front desk before leaving in case information is needed or outside scheduling must be done Ordered tests or procedures can be discussed and scheduled Offer patient two choices for time and date Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32 Scheduling for Established Patients: By Telephone To find a suitable time in the schedule, only need to know when patient must return No need for directions or parking information Recheck information with patient if it has been awhile since last visit Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 33 Scheduling Other Types of Appointments Other types of appointments to schedule: Surgeries performed by physician at other facility Hospital rounds and consultations Outside appointments and meetings Possibly house calls Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34 Scheduling Admission or Treatments in Other Facilities Provide scheduler with patient’s name, address, phone numbers, SSN, insurance information, patient allergies, and procedures to be performed Send admitting diagnosis and orders to healthcare facility before patient’s appointment Patient will need to bring picture ID and insurance card Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 35 Scheduling Inpatient Surgeries When scheduling surgery, call facility where procedure will take place as soon as it is planned Provide all necessary information and state any special requests physician may have May need to provide insurance information and certainly phone numbers Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 36 Scheduling Outpatient and Inpatient Procedures Arrange laboratory or radiography appointments for patients Have all necessary information handy before calling facility to schedule Relay time and place of appointment, special instructions (also note in medical record) to patient Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 37 Scheduling Outpatient and Inpatient Procedures, cont’d Magnetic resonance imaging (MRI), computed tomography (CT) scans, x-ray evaluations, ultrasonography, and simple blood tests Provide patient with name, address, and phone number of facility where tests will be done Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 38 Scheduling Outpatient and Inpatient Procedures, cont’d Some patients require a series of appointments Try to set these up at the same time/day of week to reduce risk of patient forgetting May be responsible for scheduling inpatient admissions or inpatient surgical procedures Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 39 Scheduling Outside Visits If physician makes house calls or visits patients in skilled nursing facilities, block out regular time in appointment schedule Physician needs demographic information, and allow for travel time Physician’s medical bag should always be prepared and well stocked for outside visits Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 40 Late Patients For habitually late patients, scheduling them last for the day means if they arrive after closing time there is no obligation to wait Some tell habitually late patients to arrive 30 minutes before appointment time Make an attempt to work with patients who have occasional difficulties arriving on time Do not let schedule be disrupted by constantly late patients Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 41 Rescheduling Canceled Appointments Unexpected conflicts cause patients to reschedule Remember to remove first appointment day and time from schedule and then set new appointment Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 42 Emergency Calls Calls go through a screening process, prioritizing so that emergencies see physician first Screening is very important and requires experience and tact Emergencies can be emotional, as well as physical, crises Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 43 Emergency Calls, cont’d Patients who are acutely ill should be seen same day Urgency of calls determined by a list of questions prepared for reference Patient may need to be directly referred to hospital emergency department Never place emergency call on hold and stay on line until EMTs or other help arrives Obtain name, phone number, and location at start of call Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 44 Physician Referrals Most offices honor requests from referring physicians who ask that a patient be seen same day Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 45 Patients Without Appointments Physician must agree to a policy for patients with no appointments and medical assistants must follow through Patient requiring immediate attention should be accommodated somehow If immediate care is not needed, a brief visit with physician and scheduled appointment for later on can solve the problem Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 46 Failed Appointments Why do patients fail to keep appointments? Forgetfulness Owing money Denial about condition Important to determine reason for failed appointments to remedy the situation If patient’s health is in jeopardy, send a letter by certified mail to explain this and keep a copy for medical record Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 47 No-Show Policy Some patients do not realize importance of keeping appointments Patient who does not arrive is a “no-show” Policy must exist and be enforced Note first-time no-show on patient’s medical record and/or ledger card Second no-show, warn patient; third time, consider dropping the patient Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 48 No-Show Policy, cont’d Physician may wish to charge patients for noshows or rescheduling appointments Office policy manual must state patients are charged for not showing up, especially if time slot could not be filled Be understanding when possible, but do not let a patient take advantage of physician’s time Make a notation in patient’s medical record and in appointment book or database Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 49 Automated Call Routing Automated call reminders can contact patients scheduled for appointments Patient is asked to press a certain key on phone to confirm appointment and a different key to cancel appointment Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 50 Appointment Cards Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 51 Confirmation Calls Indicate in records the patient’s preferred phone number for reminders Privacy guidelines and standards require care when leaving messages for reminders Patient can sign a release form so that office staff may contact someone else to leave messages or reminders Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 52 E-mail and Mailed Reminders Many computer scheduling programs can send an e-mail to patients the day before an appointment as a reminder Office staff may mail reminder cards to patients Patient who is due for an appointment but has not yet arranged a date and time may be sent a reminder Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 53 When the Patient Cancels Keep a list of patients with advance appointments who would come in sooner if an appointment opens up due to cancellation Note each cancellation in patient’s medical record, with reason if possible Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 54 Physician Is Delayed Call patients and suggest they come later if advance notice of delay is known If patients have arrived, let them know of delay and explain it was an emergency If delays happen often, consider a different scheduling system Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 55 Physician Is Called to an Emergency Physicians frequently have emergencies, and most patients are understanding Tell patients they can wait or reschedule for another day Quickly call patients scheduled for later, if the schedule is affected, to cancel before arrival Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 56 Physician Is Ill or Out of Town Inform patients scheduled of physician’s illness If physician is called out of town, appointments must be canceled or rescheduled Typically, other physicians will proved care during absences For security reasons, state the doctor is unavailable, not that s/he is out of town Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 57 Other Types of Appointments: Physicians Another physician dropping by should be allowed to see the physician as soon as possible If physician is in with a patient, allow visitor to wait in a private room Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 58 Pharmaceutical Representatives Also called “detail persons” or “reps” and are generally welcomed, schedule permitting Screen reps and turn away those whose products would not be used in the practice Prepare a list with physician of reps who may visit When rep calls, give times of physician’s availability and give an estimate of wait time Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 59 Other Types of Appointments: Salespeople Salespeople from medical, surgical, and office supply houses regularly call physicians’ offices Usually, office manager or medical assistant in charge of ordering supplies can deal with calls Unsolicited salespeople should be firmly, but tactfully, sent away Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 60 Planning for the Next Day Before leaving, look over next day’s appointments Review medical records for scheduled patients If tests were scheduled at last visit, check for reports in medical record Prepare supplies for specific procedures scheduled Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 61 Closing Comments Person in charge of scheduling has a huge impact on overall office efficiency Friendly, helpful attitude and ability to make compromises are key Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 62 Patient Education Information booklet about office policies and procedures should be given to patients If facility offers Internet-based appointment scheduling, patients must be taught how to use the system Choose a simple, user-friendly program, and have a special phone number for patients to call with questions about the program Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 63 Legal and Ethical Issues Appointment schedule can be subpoenaed to court as a legal record Be sure all handwriting is legible and information collected is consistent Note all no-shows in appointment book and medical record Keep old appointment schedules equal to statute of limitations for your state Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 64 Questions? Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. 65