The scene is a familiar one for anyone who has spent time in a Physician office. Arriving for the scheduled appointment early, you find a full waiting room and are promptly notified by the front desk staff that it’ll be an expected 30 minutes past your appointment time that the doctor will see you. Once 30 minutes have passed, the office staff calls your name and place you in an exam room where you will be interviewed by the nurse or physician assistant and wait … and wait … and possibly wait more.
One experience I recall with a physician I saw regularly as a high school student was very similar to the one I just described. At times, it would be 30, 45 or even 60 minutes passed my appointment time before I was placed in a room. All in all, the process of going to an appointment with this particular doctor averaged around 2 to 2.5 hours. Sometimes, that meant leaving the office after regular hours and as late as 7pm.
This experience only came of course after waiting two months to get an appointment.
A common gripe I’ve heard from physicians who I’ve worked with to optimize practice operations entails getting to the office early and leaving late with other professional demands on their time waiting for them once they leave their clinic. So, this poses the question: How do today’s physicians ensure they are meeting the needs of their existing patient populations while still maintaining a healthy pipeline of incoming patients by having the ability to accept new patient business?
The method I myself have employed in the past to facilitate a resolution to this issue involves an analysis of the schedule template and practice patterns. The process begins and ends in a discussion with the physician about the barriers impeding the physician’s office from running smoothly and how we might solve them together. This allows me the opportunity to get a better idea of what ‘success’ looks like from the physician standpoint and what might be on his or her mind as a key issue to fix.In the particular instance I will reference in this post, I was working with a multi-location specialty physician group that was experiencing challenges providing referred patients an appointment within a desired 2-3 day window.
An initial stratification of a year’s worth of scheduling data showed several patterns that prompted a further analysis. This led to several hours spent digging through data coding appointments into ‘types’ so that an in-depth analysis could be performed. These categories may be different from practice to practice. The categories that I used base on what the data showed me were: 1) Office Visit, 2) Treatment Visit, 3) Lab visit, 4) Financial Counselor Visit.
(These classifications would be important in the analysis of a year’s worth of visit data that would help shape recommendations on: exam room utilization, patient appointment times impact on arrival patterns, management of multiple physician schedule templates and their impact on patient wait times and treatment space utilization, capacity and productivity. These will be covered in a separate post.)
Next I took a look at the following statistics: a) time to first next new patient appointment available in days, b) time to second next new patient appointment available in days, c) number of new patients per week on current schedule template, d) number of follow-up appointment per week on current schedule template.
What I found was that across three sites of this multi-location, multi-physician practice, the average first available appointment was 11 days and the average 2nd available appointment was 14 days. A stated goal of this organization was that there would be an appointment available for new patients within 3 business days of the referral.
In addition, the physician templates showed variation in how they accounted for follow-up patient visits. Some set follow-up patient visits in 15 minute increments and others allowed 30 minute appointments. There was also variation in how locations and physicians distinguished new patient appointment visits. Some did not set aside a ‘new appointment visit’ and simply accounted for the longer time by blocking several follow-up appointment and some designated a longer appointment slot of about 45 as a new patient slot.
In working with one physician, their weekly schedule allowed for 1 new patient and 36 follow-up appointments per week (10 per day Monday, Tuesday and Friday and 6 on Wednesday morning). The actual patient visit patterns for this physician over a period of a year showed a weekly average of 28 follow-up and 5 new patient visits. This physician, like most of his peers within the practice save a few, was not meeting the stated goal of seeing new patient referrals within 3 business days and its schedule templates were compounding the problem.
In follow-up conversations with the physicians in this practice about practice patterns and the data above, we decided on the following. I would work with each physician individually to revamp their current schedule templates with two key goals in mind: 1) keep the same amount of actual follow-up patient visits in the new schedule template and 2) define follow-up patient appointment as 30 a 30 minute visit and a new patient appointment as a 45-minute visit on the new schedule. This would ensure the physicians did not have to sacrifice any of their current follow-up visit volume and that they had ample time to conduct the new patient visit.
With a little bit of tweaking and with feedback from the physician whose template we were testing the approach on, we settled on the following setup. The new template for the same physician designated several new patient appointments (NP) and placed them immediately before or near natural breaks in the schedule. This would allow for additional time to be spent with a new patient if needed without impacting the rest of the schedule adversely. In addition, the number of follow-up appointment slots in the new schedule allowed this physician to keep their follow-up appointment volumes at the same levels of observed volume.
The end result was a scheduling template for this one physician that increased new patients by 1 slot above their actual volume each week resulting in 52 additional new patients per year. Where before the change they were seeing 5 new patients a week and working them into the schedule, the new schedule template was able to accommodate 6 new patient visits. Overall, the redesign of the clinic templates and addition of new patient appointment slots to the schedule was significant in this case because it meant the physician was reaching more patients in need of care and the practice was able to provide an appointment in a more timely manner.
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