The revenue lost by no-shows is hard to calculate. It depends on the factors specific to your practice, including the location and community. But no-shows and missed appointments, while important to the workflow of your practice, are not the only culprit of missed revenue and time management in your practice’s daily schedule. By scheduling with your patients and your team in mind, you can build a productive day that suits your team, your families, and your practice’s budget.
According to the AAP, the most common scheduling methods are variations of fixed and wave schedules.
Fixed schedules allott a patient a set segment of appointment time, for example, 10 or 20 minutes. Fixed appointments are good for getting to know the patients and families in your practice with dedicated time for each one, but have the drawback of rigidity. If one appointment goes over its allotted time or a patient is late, a busy provider will need to see other patients progressively later throughout the day.
Wave scheduling assigns a set number of patients to one time, allowing providers to see patients in order of arrival. Wave scheduling allows providers to see the patients who arrive on time first, while allowing others to arrive late. This method does not work well with patients who all arrive on time, since this could result in an unreasonable wait time. Variations of wave schedules may schedule patients for variations of the same segment -- for example, if the schedule is set in fifteen minute blocks, scheduling two patients for 1pm and two for 1:15pm, lessening the wait time for on time patients while allowing a smoother workflow for providers.
Open access appointments allow patients to make and arrive at appointments on the same day. This is an important piece in urgent-care facilities, and may also work as a daily method, leaving staff to focus only on the patients coming through every day, with a minimum of appointments made far in the future. This method may also reduce no-show rates, but in a busy practice reduces accessibility for families, as the practice is essentially first come, first served.
No certain scheduling patterns works better than any other, because each must be adapted to the needs of each practice. To determine if your current scheduling method works for you, or if a change is in order, you must first evaluate two things: how your schedule operates day-to-day, and how your team does the same.
“Change is hard. Do it -- it’s going to be worth it." Lynne Gratton, CPPM
Evaluating Your Schedule
The goals for any practice are to build a smooth workflow for staff, minimize patient wait time, and to reduce no-shows. To do this, and maximize the working, billable hours for clinicians, consider the following:
- Provider style: Does the provider operate well with blocks left open for charting and to catch up from a few patients that went over time? Do they prefer all their sick appointments or ADHD checks at once? Can multiple providers cover for each other?
- Team structure: Who makes up your team? Determine how changes in the schedule could benefit or hinder all clinical and administrative team members.
- Patient history: If your practice is old enough to know your community’s families well, consider their habits and history. Are certain families typically late? Does one child usually need a little more time, or do certain families bring siblings together?
- Workflow: Study the process of an appointment from check-in to check-out. Where are there opportunities for improvement? When is the patient waiting? Where are nurses or clinicians struggling?
- Appointment type: Depending on the time of year, you may wish to schedule appointments by type (e.g. sick, well, ADHD, introductory visits) according to the days of the week or hours of the day.
- Accessibility/open access: Consider your community and the families you currently see. Would there be an advantage to evening or Saturday hours, or opening the office for first-come, first-served patients? If you don’t have these hours but see patients after hours already, make sure to bill for after hours visits (99050 for patients seen outside published office hours).
- No-show rate: What’s your no-show rate? According to PCC’s Chip Hart, when it comes to no-shows, you should pin your focus on today’s schedule, and determine the highest risk patients for no-shows, then give them a call to determine what kind of no-show day you’ll have.
Take notes on your practice’s schedule for one or two weeks, or even a month. What trends do you notice? Do sick visits take half the time of well visits, or a third? This will help you determine which scheduling method works for you, but also help you get to know your patients’ habits and how you can incorporate these into your workflows. Ask other team members to record their daily schedules, and then meet to compare notes.
Build Your Smart Schedule with the Appointment Book
PCC’s Appointment Book is a tool for the entire practice to use to add, change, and visually scope out every appointment. Lynne Gratton, CPPM is an Implementation Specialist with PCC, and an avid proponent of the Appointment Book tool, as well as the subject matter expert that helped develop it.
The tool allows staff to see not only the patients scheduled for the day, but when they arrive, when they’re moved to a room, and when they’re being seen by the provider. Appointments are color coded by visit type (sick, well, recheck, etc) and can be filtered by location, date, and provider.
Gratton explains that the Appointment Book works for many types of appointments, including open access appointments. “Since the Appointment Book works with multiple providers, staff can create a provider called ‘walk in,’ and they can switch to the correct provider when the patient comes in. They can make five-minute appointments to fill in the time, if they have a lot of kids.”
Can office staff see a patient’s missed appointment history to check on their no-show potential for the day? “You can,” says Gratton. “If you have it configured in the patient details screen. You also want to review, do they have this appointment scheduled already?” Since moms, dads, and other caregivers can accidentally make an appointment twice, the Appointment Book allows staff to see this straight away.
Gratton’s favorite unique features of the Appointment Book are there to help staff apply some of the most common requests of parents -- namely, how to add siblings’ appointments one after another, and add appointments months in advance: “The add siblings feature is one of my favorites, because it’s so simple. The other one is the calendar view. You can search by visit type, sick or well, so being able to visually when that’s available… it’s killer.”
Having advised many practices on best practices for their front desk, and hosting a webinar on the subject, Gratton has sage advice for changing to a new schedule at your pediatric practice: “Change is hard. Do it -- it’s going to be worth it. Your staff will find it easier. In regards to the Appointment Book, if you have any kind of staff turnover at the front desk, training is minimal compared to other programs.”
Check out Lynne's webinar, "Why Your Front Desk Has the Most Important Job In Your Practice."