Schedule Management

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16

• Schedule Management

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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.

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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.

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Introduction

• Scheduling systems
• Types
• How each is used
• Scheduling situations
• Appointment book
• Legal aspects
• Documentation

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The Appointment Book

• A well-managed appointment book
• Creates an efficient patient flow
• Shows respect for everyones time

• Unexpected events that occur
• Early and late arrivals
• Emergencies
• Patients who require extra time

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Computerized Scheduling

• Lock-out feature
• Access
• Identification of problem patients
• Search feature
• Reports feature
• Color-coding feature

Screen 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 Knowledge
What 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.

Good Answer!
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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
• Patients 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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Apply Your Knowledge
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)
ANSWER
S/R CPE f/u CAN PP
suture removal 1020 min.
3 5 2 1 4
complete physical examination 30/60 min.
GOOD JOB!
follow-up appointment 515 min.
cancellation 0 min.
Pelvic examination and Pap Smear 1530 min.
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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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Appointment Scheduling Systems (cont.)

• 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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Appointment Scheduling Systems (cont.)

• 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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Appointment Scheduling Systems (cont.)

• 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

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Apply Your Knowledge
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.
Right!
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Organizing and Scheduling Appointments

• Be professional
• Accommodate patients needs if possible
• Time needed
• Patient status
• Chief complaint

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New Patients

• Those not established at the medical office
• Obtain all necessary information
• Contact information
• Insurance information
• Co-pay information
• New patient forms

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Established Patients

• Currently seen by the practice
• Return appointments
• Make as patient is leaving office
• Set pattern
• Appointment reminder card

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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

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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

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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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Apply Your Knowledge
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.
TERRIFIC!
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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 patients
  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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Special Scheduling Situations (cont.)

• Late arrivals
• Schedule chronically late patients toward the end
  of the day
• Document late arrivals or missed appointmentsin
  patient record

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Special Scheduling Situations (cont.)

• 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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Special Scheduling Situations (cont.)

• Cancellations
• Thank patient for calling to cancel
• Mark appointment as canceled
• Attempt to reschedule
• Document cancellation in the medical record

S Smith 098-765-4321
R Hansen 456-789-0123
M Fitz 321-456-0987
J. Jones 123-456-7890 cancelled
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Special Scheduling Situations (cont.)

• 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

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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.
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Apply Your Knowledge
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.
SUPER!
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Scheduling Outside Appointments

• Verify insurance coverage
• Obtain referral or approval if needed
• Make appointment
• Instruct patient
• Document in medical record

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Reserving an Operating Room

• Call OR scheduler to reserve space
• Preferred date and time
• Type of surgery
• Relevant patient information
• Insurance requirements
• Patient instructions

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Apply Your Knowledge
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
patients insurance.
Very Good!
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Maintaining the Physicians Schedule
Maintain a Balance
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Visits Outside the Office

• House calls check on home-bound
• Hospital rounds
• Nursing home visits
• Mouse calls

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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

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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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Apply Your Knowledge
Why is it important to maintain a balance in the
physicians schedule?
ANSWER To help the physicians use their time
efficiently.
Right!
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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.

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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 Xd 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.

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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 patients 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.

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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 patients medical record for legal purposes.

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In Summary (cont.)

• 16.6 In order to schedule outside appointments
  you will require the patients 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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End of Chapter 16
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)