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Tight staffing and lower reimbursement have made patient volume - and effective patient flow - an imperative. You'll need to be innovative to squeeze more patients into your doctors' day.
Like most managers, you're no doubt already squeezing as much as you can out of your staff. You monitor monthly reports to keep productivity on par, use incentives to encourage peak performance, and invest in new technologies to deliver greater efficiency.
In today's tough healthcare market, though, that may not be enough. Shrinking reimbursements and the still-lingering effects of the economic recession have made patient flow the new imperative. Practices that hope to compete must see more patients daily, fit sick patients in without delay, and get new patients on the calendar in a timely manner.
A worthy goal, you say, but who can afford the extra bodies to pull it off? Not to worry. It can all be achieved through creative scheduling - and you might even save some coin.
Stagger your shifts
One of the best ways to use human resources wisely, for example, is to stagger your employees' start times. "Sometimes, practices have everyone starting at the same time in the morning, but you don't need your checkout person to start work before you even see patients," says Rosemarie Nelson, a consultant with the MGMA Health Care Consulting Group.
Ask your check-in clerks and telephone staff to arrive 15 minutes before the first patients arrive, and the checkout person to show up 15 minutes after the first appointment begins. Your clinical staff, likewise, should be staggered based on need - allowing one or two medical assistants to prep the treatment rooms before patients arrive, while the rest arrive with the first patients to minimize costly idle time.
At Eye Health Northwest, an ophthalmology group with 11 practices and two surgical centers in Portland, Ore., manager Cindy Rowe says some of her larger practices also stagger lunch breaks. "When the doctors stagger their lunch times it actually is very good because we can stagger their staff too, so there's more consistent staffing throughout the day," she says, noting the group is able to accommodate more patients in the middle of the day when they wish to be seen - during their own lunch breaks.
Extend your hours
You can take advantage of staggered shifts all the more by opening your doors 15 minutes earlier in the morning and 15 minutes later in the evening with a skeleton staff of one doctor, one nurse, and one front-desk clerk, thus allowing you to treat two extra patients per day. Depending on your practice, that could equate to $10,000 or more per year in income (not just revenue), says practice management consultant Elizabeth Woodcock, with Woodcock & Associates in Atlanta.
Some practices also offer a "sick clinic," either before or after hours with minimal staff - say, between 7 a.m. and 9 a.m., or after 4 p.m. a few days a week - to focus on acute patient visits. That's where part-time staff can help. "A part-time person is usually happy to get very early or very late hours because they are accommodating another job or lifestyle choice," says Nelson, noting one pediatric group she worked with hired only part-timers for all positions, including their managers. One manager worked Monday and Tuesday, the other on Thursday and Friday, and they both showed up for part of the day on Wednesday, overlapping for a few hours in the middle of the day. "At first I thought it was a bit crazy, but it really worked and it allowed the practice to have longer days covered without excessive overtime," says Nelson.
When your schedulers make appointments, they should also be instructed to allot for time based on the reason for the visit - rather than reserving a fixed number of minutes for every patient who calls in. New patients, for example, might require 20 minutes, while an existing patient who's stopping in for a quick check-up might need only 10 minutes. Those patients scheduled for a surgical procedure, meanwhile, could require 90 minutes or more. A few quick questions can help you budget time more effectively. "We try to get somewhat of an assessment on the phone of each patient's needs before we make an appointment, and our staff does a pretty good job of that," says Maria Bettencourt, manager of Mystic Valley Dermatology Associates in Stoneham, Mass. Her staff is also instructed to book two surgical patients for each 90-minute slot, allowing the doctor to attend to the second patient while tissue samples are examined for the first.
You should also build in flexibility. If you book your schedule solid for the next three months, you'll never be able to accommodate last-minute sick visits or new patients fast enough. Don't be afraid to set blocks of time aside. Some of the busier doctors at Rowe's practice, for example, reserve one or two appointment slots each day specifically for new patients so they never have to turn business away. "If they can't fill it, they typically release those slots the day before to any type of appointment," says Rowe, noting her practice makes it a policy to fit sick patients in on the same day they call for an appointment.
Involve your staff
Effective scheduling can help your practice work smarter, boost revenue, and improve patient satisfaction by delivering greater flexibility in scheduling appointments. But before you establish any new protocols, be sure to check with your staff for their input. Often, the best ideas are generated by those in the trenches. "If you ask the staff team collectively how the practice might be able to see another patient or two each day, they may have even more ideas," says Nelson. "I know many providers who would prefer to work straight through the day with no lunch break, but they need support to do that - both in terms of rooming and discharging patients, and in terms of phone support."
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via email@example.com.
This article originally appeared in the May 2011 issue of Physicians Practice.