Oh, By the Way …'

Question: How can we keep short appointments from dragging on? Patients always seem to have one more problem for the physician.

Answer: Don't let last-minute questions get you off schedule. Here are some tips for staying on track:

• Create a scheduling script. What are your schedulers asking patients when they call in for an appointment? You might get a better idea of your patients' concerns ahead of time if schedulers take an extra minute to follow up. Try: "The doctor wants to have enough time to meet your healthcare needs. Is there anything else that you want to discuss with him?" or "We've scheduled a visit for XYZ problem; are there other healthcare needs that you have for which we can schedule an appointment?" Although it won't work every time, setting expectations upfront can help.
• Discuss it another time. If you can address a patient's last minute concern quickly, go for it. Otherwise, there is nothing wrong with asking them to schedule another appointment. Say something like, "This is an important discussion for us to have, and I want to set aside enough time for it. Since we allocated the time for this appointment to address only your XYZ concern, I would like to schedule another visit with you so that we can really have time to address this." It might help to have reading material handy on frequently asked questions so that patients aren't sent away completely empty-handed.
• Be proactive. Patients often save the common questions for the last minute. Address patient concerns proactively instead of waiting for them to bring them up. HRT, for example, is on the minds of most post-menopausal women. If you are managing the care of this population of patients, preempt the "oh, by the way" by handing the patient some written material and directing her to web sites you endorse. Prep your MA or nurse to provide counseling on issues affecting your patients. After you have offered a brief summary of your advice, have the nurse come in and sit down with the patient while you move on to the next encounter.
• Recognize your reputation. Needy patients gravitate to physicians who have a reputation for serving needy patients. Spend a year or two addressing their needs, and you'll quickly find every patient having them. You might be fine with that - just be sure to adjust your schedule to allow for the extra time you will need.
• Get paid. If you do accommodate these patients during the encounter, at least make sure that you know how to code and bill for them. Understanding E&M coding, in particular, as well as the use of modifiers to indicate extra work, can help you be reimbursed what you deserve.