PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

1. Chapter 12 Scheduling Appointments and Maintaining the Physician’s Schedule PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

2. Learning Outcomes 12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office. 12.2 Identify common scheduling abbreviations. 12.3 Identify different types of appointment scheduling systems. 12.4 Discuss ways to arrange appointments for patients.

3. Learning Outcomes (cont.) 12.5 Explain how to handle special scheduling situations. 12.6 Explain how to properly document no-shows and late patients. 12.7 Describe how to schedule appointments that are outside the medical office. 12.8 Discuss ways to keep an accurate and efficient physician schedule.

4. Introduction • Scheduling systems • Types • How each is used • Scheduling situations • Appointment book • Legal aspects • documentation

5. The Appointment Book A well-managed appointment book Unexpected events that occur • Early and late arrivals • No-show patients • Emergencies • Physicians spend extra time with patients • Creates an efficient patient flow • Shows respect for everyone’s time by preventing excessive wait time

6. The Appointment Book (cont.) • Preparing the appointment book • Create thematrix,or basic format • Block off times the doctor is unavailable • Examples of when time should be blocked off • Hospital rounds • Surgery • Vacation and holidays • Scheduled meetings

7. The Appointment Book (cont.) • Computer or traditional paper appointment book • Obtain patient information • Patient’s full name • Home and work telephone numbers • Purpose of the visit

8. The Appointment Book:Commonly Used Abbreviations

9. The Appointment Book: Commonly Used Abbreviations(cont.)

10. The Appointment Book: Commonly Used Abbreviations(cont.)

11. The Appointment Book: Commonly Used Abbreviations(cont.)

12. The Appointment Book: Determining Standard Procedure Times • Create a standard list of procedure times • Indicate how much time to allow for the tests • Use only as a guide • Helps identify appointment openings appropriate for the patient visit

13. The Appointment Book: Determining Standard Procedure Times (cont.) How Long Will Each Take? 5-10 min 30–60 min Complete physical examination 10-20 min 30 min Minor in-office surgery 15 min 15–20 min Emergency office visit 15-20 min 30 min or > New patient visit 10–20 min 15-30 min Suture removal Prenatal examination 30 min 15 min 30 min or > Follow-up office visit 5–10 min Pap smear and pelvic exam 15–30 min 30-60 min

14. The Appointment Book: A Legal Record • Keep appointment books for at least 3 years • Entries must be clear and easy to read General Tips... • Never erase a name or use liquid paper • Use blue ink and never pencil • Draw a single line through the name • Write the date, time, and reason for cancellations • Document cancellations and no-shows in patient’s record

15. 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) 3 5 2 1 4 S/R CPE FU CAN P&P suture removal10–20 min. ANSWER: complete physical examination30–60 min. GOODJOB! follow-up appointment5–10 min. cancellation0 min. Pap smear and pelvic examination15–30 min.

16. Appointment Scheduling Systems • Goals • Smooth flow of patients • Minimal waiting time • Open-hours scheduling • No appointments • Patients arrive at their own convenience • Seen on a first-come, first-served basis • Rural practices and urgent care centers

17. Appointment Scheduling Systems (cont.) • Time-specified scheduling • Stream scheduling • Patients are scheduled for specific times • At regular intervals • Time based on reason for the appointment

18. Appointment Scheduling Systems(cont.) • Wave scheduling • Large offices • See several patients at the same time • Seen in the order of their actual arrival • Flexibility for appointments that run longer than planned • Uses an hourly target • Number of patients to be seen hourly determined by dividing 60 minutes by the average estimated length of visits • Multiple patients at the same time can result in • Patient dissatisfaction • Annoyance

19. Appointment Scheduling Systems (cont.) • Modified-wave scheduling • Options • 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 • Two or more patients scheduled for the same time • Both patients will see the doctor within the scheduled period • One may be seen by NP or PA • Used when patient with no appointment needs to be seen

20. Appointment Scheduling Systems(cont.) • Cluster scheduling (categorization) • Groups similar appointments together • Useful if specialized equipment has limited availability • Advance scheduling • Scheduling patients weeks or months in advance, such as with annual exams • Leave a few slots open for patients with unexpected problems

21. Appointment Scheduling Systems(cont.) • Combination scheduling • Using two scheduling methods • Computerized scheduling • Affords the following advantages • Can “lock out” selected appointment times • Information can be accessed from all terminals in the office • Help identify patients who are late, miss appointments, cancel, or require more time with the physician • Reports to help improve efficiency

22. Apply Your Knowledge A large pediatrician office commonly must “squeeze in” patients in that have become ill, so this new office plans to offer immunizations only twice per week. Which scheduling system(s) would you recommend for this medical practice? ANSWER: Combination scheduling consisting of cluster and a form of wave scheduling would be recommended to allow for the needed flexibility. Right!

23. Arranging Appointments • Offer choices • Dates • Times • Accommodate patient’s needs whenever possible • Confirm choice with patient

24. New patients Those not established at the medical office Obtain all necessary information Name Address and phone number Date of birth Insurance information Have patient arrive 15–30 minutes early to fill out forms Return appointments Ask patients if they need another appointment before they leave Arranging Appointments (cont.)

25. Arranging Appointments (cont.) Appointmentcards Reminder mailings • A postcard addressed to the patient that is mailed one week before the appointment • After appointment time is entered in the book, it is recorded and given to the patient Reminder calls Recall notices • Form letter sent to remind patients to call for an appointment • 1–2 days before the scheduled appointment the office calls the patient Appointment Reminders

26. 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: The medical assistant should offer Mr. Lincoln a choice of dates and times available to accommodate Mr. Lincoln’s needs. 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!

27. Special Scheduling Situations:Patient • Emergencies • Seen immediately upon arrival at the office • Explain to waiting patients without details • Provide opportunity to reschedule • Referrals • Referred patients should be seen as soon as possible • When arranging referrals for a patient • Provide choices • Be sure the facility accepts the patient’s insurance • Document in patient record

28. Special Scheduling Situations: Patient (cont.) • Fasting patients • Fast • Refrain from eating or drinking • Usually beginning the night before the appointment • Schedule as early as possible • Instruct patient about the need to fast and when to start

29. Special Scheduling Situations: Patient (cont.) • Patients with diabetes • Require regular meals and snacks to regulate blood glucose • Consider avoiding late morning slots that are close to lunchtime • Keep appropriate snacks on hand in the event a patient develops a low blood sugar

30. Special Scheduling Situations: Patient (cont.) • Repeat visits • Schedule regular appointments on same day and time • Late arrivals • Schedule chronically late patients toward the end of the day • Prevents disruption in the office schedule • Document late arrivals or missed appointments in patient record

31. Special Scheduling Situations: Patient (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

32. Special Scheduling Situations: Patient (cont.) • Cancellations • Thank patient for calling to cancel • Appropriately mark appointment as canceled • Attempt to reschedule while the patient is on the phone • Document cancellation in the patient’s medical record S Smith 098-765-4321 R Hansen 456-789-0123 M Fitz 321-456-0987 J.Jones 123-456-7890 cancelled

33. Special Scheduling Situations: Patient (cont.) • Missed appointments • Document no-shows in the appointment book and patient medical record • Inform the physician of no-shows • Wrong day • Reschedule if patient lives locally • Attempt to accommodate if patient required special transportation or traveled far H Plummer 234-543-2345 P. Lexar 098-765-4321 No show

34. Special Scheduling Situations: Physician • Physicians may throw the schedule off by • Arriving late to the office • Returning late from lunch or meetings • Being called away for emergencies • Being delayed at the hospital If a physician is late repeatedly, you may want to add some buffer time to the schedule and slot patients accordingly.

35. Apply Your Knowledge Mr. Washington needs a follow-up appointment in a week for a fasting blood sugar after the physician changed his medicine for diabetes. 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, and that he should not take his diabetes medicine prior to the appointment but should bring it with him. SUPER!

36. Scheduling Outside Appointments • Common outside appointments include • Consults with other physicians • Laboratory work • X-rays and other diagnostic tests • Hospitalizations and surgeries • Be sure to have a doctor’s order specifying • Procedure • When results are needed

37. Scheduling Outside Appointments (cont.) • Validate the patient’s insurance prior to selecting the outside physician or facility • HMOs often arrange referral and notify office when approved • Discuss possible appointment times with patient or give patient information to make appointment • Give pre-appointment instructions if necessary

38. Apply Your Knowledge Mr. Anderson calls at 0830 and cancels his 0900 but calls the office again at 1230 c/o redness and discomfort at his surgical site. What should the medical assistant do? ANSWER: The medical assistants should tell the patient to come right in due his complaints of incision redness and discomfort. However, Mr. Anderson should also be told that he will be “worked in” around other patients’ appointments. Very Good!

39. Maintaining the Physician’s Schedule Do Not Overbook Do Not Underbook Maintain a Balance

40. Overbooking Scheduling too many patients Office schedule falls behind Stressful for staff Underbooking Gaps in schedule Try to schedule another appointment in cancelled time slot Maintaining the Physician’s Schedule (cont.)

41. Emergencies or delays Apologize to waiting patients Offer choice Estimated waiting time Leave to run errands and return at agreed-upon time Reschedule appointment for another day Maintaining the Physician’s Schedule (cont.)

42. Maintaining the Physician’s Schedule (cont.) • Reserving operating rooms • Reserve the facility, staff, supplies, and equipment needed • Give preferred days and times, types and length of surgeries • Stocking the medical bag • Some physicians see patients in nursing home facilities • Block this time in the office schedule • The medical assistant may be responsible for stocking the physician’s medical bag • Check expiration dates • Supplies must not be taken from the bag in the office

43. Maintaining the Physician’s Schedule (cont.) • Scheduling pharmaceutical sales representatives • Called detail persons • Some physicians meet with them • Block time for this purpose • New representatives • Request a business card • Check with the physician before scheduling an appointment

44. Maintaining the Physician’s Schedule (cont.) • Making travel arrangements • Out-of-town meetings or events • Medical assistant may be responsible for • Airline arrangements (get itinerary) • Car rentals and lodging • Get confirmations for all reservations • A locum tenensor substitute physician may cover practice while regular physician is away

45. Maintaining the Physician’s Schedule (cont.) • Planning meetings • Find out number of people, length and purpose of meeting • Secure location with adequate room and parking • Prepare an agenda if requested • Secure equipment such as podium and microphones • Take minutes as needed

46. Maintaining the Physician’s Schedule (cont.) • Scheduling time with the physician • Meet regularly with the physician • Review schedule • Other items • State medical license • Drug Enforcement Agency registration • Documentation of continuing medical education (CME) requirements

47. Apply Your Knowledge ANSWER: When making travel arrangements for the physician, which of the following would be the responsibility of the medical assistant? • Locum tenens • Itinerary • Agenda Right!

48. In Summary • Proper scheduling = efficiency • Most medical offices select one or two scheduling systems that fit its practice • Special scheduling situations involve both patients and physicians • Maintaining a physician’s schedule may include making travel arrangements and planning meetings

49. End of Chapter 12 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)