Same Day Medical Appointment-Just What the Patient Ordered

No one knows for certain what the future holds for American Medicine. What we do know is that reimbursements are going to decrease in the near future. We are challenged to find ways to increase the volume of patients we see in our practices. An even greater way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices. On of the best ways to accomplish both goals is to see more new patients. We all know that seeing a patient in the 90-day global period is not as productive as seeing a new patient who is likely to need a work up, evaluation, and perhaps a surgical procedure. Remember there is no income generated by suture removal! After reading this article you will understand the concept of same day appointments and how to consider implementing this in your practice.

Why are same day appointments important?
SDA is what our patients want. Every patient with menometrorrhagia experiences anxiety about her condition and wants to be seen as soon as possible. Most patients do not wish to wait weeks or months for an appointment regardless of the fame and reputation of the doctor. That medical doctors are in a service industry and it behooves us to cater to our patients needs. If we are honest with ourselves, doctors who have long waiting times from weeks to months to see a new patient are merely stoking their egos.

However, this philosophy and this practice of making patients wait to receive an appointment will not enhance patient satisfaction nor improve a practice’s performance. Patient satisfaction is vital in order to build and maintain a successful practice. You can be the most talented robotic surgeon and have a reputation for doing a laparoscopic hysterectomy in less than one hour with no blood loss, and less than 24 hours hospital stay, but if your patients are not satisfied with your care before and after their surgery you may find large gaps and openings in your schedule and a decrease in the number of surgical procedures you perform.

I see up to 35-40 patients/day, which may include 6-8 new patients! How do I do it? I suggest having a sufficient number of the right staffers with the right attitudes while providing them with the appropriate tools to do their job and accomplish their goals. I am solo practitioner and have 6 FTE employees. This is nearly twice the national average of 3 FTE/provider. However, a robust staff allows me to accommodate SDA in addition to seeing follow-up appointments and performing office procedure. I have motivated my employees to know that accommodating SDA is expected and I am willing to provide them with adequate staff and tools to see the extra patients. My ability to accommodate SDA is assisted by having a highly integrated practice management and electronic medical records system, which I fully exploit, makes my practice truly chartless.

Being able to offer SDA requires the proper attitude, which includes a positive, can-do spirit by the doctor. It starts at the top, i.e., with the doctor. It begins with the doctor arriving and ready to see patients on time. If the patients are to be seen at 9:00, that means patients are placed in the room and the doctor is ready to begin seeing patients at 9:00 and not 9:15 or later. If the doctor is late, you can be sure that the day will contain significant delays and the ability to accommodate SDA will not be possible.

I recommend that physicians leverage technology whenever possible to optimize your workflow. Using his electronic medical records system, he is able to see in real-time which patient has arrived, who has been roomed, and if the patients are running on time. He can see this information anywhere in the office by using his tablet computer. He can better “pace” himself when such information is available.

I suggest that you qualify patients when they call for a new appointment by making certain payer information and appropriate authorizations have been obtained, and that patients know in advance what the estimated cost and co-pay will be and that the fee is going to be collected prior to the visit. This requires a well-coordinated effort by the
front desk and the billing office, as well as having the necessary electronic and web-based resources to accomplish this complex task.

Physicians should not assume the liability of providing care without being compensated. It is a good idea for the demographic information and health questionnaire be completed before patients arrive in the office so as not to delay their visit. The patients are also informed to be on time as they will be seen within a few minutes of their arrival. Before
the patient is placed in the exam room, all the reports, supplies, and equipment needed to see the patient is in the room or already available in the electronic health record/chart.
It is a good idea to anticipate how many additional slots he will need by leaving openings to accommodate new patients. This takes minimal analysis of patient appointment demand patterns. For example, leaving additional slots on Monday afternoons as a few patients seen in the ER will likely be calling Monday morning for follow up appointments.

In the next blog I will describe how to accomplish same day appointments and how you can be the darling of your patients.

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