1844 Canadian Family Physician•Le Médecin de famille canadien❖VOL 47: SEPTEMBER • SEPTEMBRE 2001
practice management ❖gestion de la pratique
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ur previous ar ticle, “Taking control of your appointment schedule. Part 1: Reconciling income expectations with patient visits” (Can Fam Physician 2001; 47: 1272-1273), focused on how to create an appointment schedule and policies that reflect your core values and practice style. In addition to develop- ing good scheduling discipline in yourself and your staff, you will also need to consider two other initia- tives: managing your patients’ habits and expectations and scheduling your appointments on a computer.The best way to inform your patients of your appointment policies is through a patient information brochure. Rather than simply stating the rules, focus on how your system tries to increase access and min- imize waiting times in the office. If you emphasize the positive aspects of your policies, patients are more likely to accept their role in helping your office run smoothly.
Modifying expectations
Educating your patients will not in itself assure suc- cess; you must also manage their behaviour.
Whenever possible, get your scheduling staf f to determine the reason for a given visit at the time of booking so that they can set aside the appropriate amount of time for patients’ needs. For longer visits that are booked well in advance, such as complete physical examinations, have your staff phone patients to remind them 1 or 2 days before the appointment to avoid “no-shows” that will leave large gaps in your workday. Another useful strategy is to have your staff clearly flag the charts of patients who were accommo- dated as last-minute fill-ins: if you are aware which patients were granted one of your same-day slots, you can much more confidently deal with the common scenario of patients trying to get you to address addi- tional, nonurgent problems at the same visit.
Perhaps the most difficult appointment policy to introduce to your practice is billing patients who miss their appointments. Patients will often have reason- able and easily forgivable reasons (car trouble, family illness, etc) for not showing up for a scheduled visit, yet most practices have several patients each week who simply forget about their appointments. While many overbooked physicians welcome missed
appointments, in a well managed scheduling system, patient no-shows translate into loss of both revenue and the opportunity to serve another patient.
In our experience, billing patients for these occur- rences is a win-win situation: most people will be embarrassed and happily pay the fee, and those who take exception are likely sending a message that they are not terribly committed to continuing in your practice. When people question your no-show policy, you should refer them to the patient information brochure, and if they continue to protest, you will likely be best off suggesting that they find them- selves another doctor. If you work in an underser- viced area, where it can be especially dif ficult to terminate a patient ethically, you might need to send several written warnings before taking decisive action. As with all patient charges, you should con- sider waiving or reducing the fee for a missed appointment if payment will create economic hard- ship for patients.
What computers can do
As we travel throughout Canada, one of the most common questions we are asked about appointment scheduling is “Should I use a computer?” In our experience, family physicians can gain four substan- tial benefits by automating their scheduling system.
First, a good appointment program is faster and more accurate than pen and paper. Staff can navigate for ward and backward more quickly, and when booking a particular patient, well designed software will require only the first few letters of the last name and a few arrow keystrokes to select the appropriate patient and insert the name and phone number into the schedule.
A second impor tant advantage of computer scheduling is the ability to search the appointment schedule; patients often forget the time or date of their appointments and will call your office to con- firm when they should arrive. Further, you or your staf f will at times want to verify either a past or future patient visit. With a paper book, it is extreme- ly time-consuming and difficult to locate a specific appointment, but a computer can find the informa- tion effortlessly.
Taking control of your appointment schedule
Part 2: Establishing expectations and scheduling with computers
Mark Dermer, MD, CCFP Tom Faloon, MD, CCFP, FCFP Steve Pelletier, MD, CCFP, MBA Sue Swiggum, MD, FRCP
VOL 47: SEPTEMBER • SEPTEMBRE 2001❖Canadian Family Physician•Le Médecin de famille canadien 1845
practice management ❖gestion de la pratique
The third valuable feature is access from many locations. The larger the office, the more important it is for staff to be able to schedule appointments from any computer workstation, rather than to track down the single copy of a paper logbook.
Most important, a good scheduling program will link with your provincial billing software and verify that you have billed for each patient seen. Even the most thorough paper procedures generally fail to cap- ture several ser vices each week, with consequent loss of revenue. In our current environment of wors- ening medical practice economics, getting paid for everything you are entitled to is especially important.
Unfortunately, currently available scheduling soft- ware varies greatly in its effectiveness. We have seen many programs that are fast, easy to use, and integrat- ed with companion billing programs. However, we have also spoken to doctors who have toiled for sever- al months with a new program and ultimately aban- doned it. As with all software purchases, speak with several colleagues who are currently using a given program before buying and installing it in your office.
Reconciling competing pressures
To make the most of their precious work hours, all physicians need to optimize their appointment schedules. Creating a structured template, develop- ing clear policies for staff and patients, and exploit- ing computer systems will all contribute to streamlining patient flow. The most important step, however, is to examine carefully how much money you expect to make and how many hours you want to work. If you can reconcile these competing pres- sures, you should be able to better control your pro- fessional time and thus find greater satisfaction at work and in your personal life.
Drs Dermer, Faloon, Pelletier and Swiggum are physicians practising in the Ottawa, Ont, region; are teaching faculty at the University of Ottawa; and are prac- tice management consultants with MD Management Ltd.
Financial support for this article was provided by MD Management.
