Why Fewer Patient Appointments May Increase Profitability

June 26, 2013

As practices struggle with declining reimbursement and increasing overhead, it can be tempting to try to squeeze as many patient visits into each day as possible. It is a mistake.

Aggressive scheduling - defined as setting appointment slots to the minimum length acceptable to the provider, and scheduling patients for every available appointment time - actually decreases productivity; profitability; and patient, physician, and staff satisfaction. Here's why:

Aggressive scheduling assumes physicians and staff have no work to do other than direct contact with patients.
• No time is allotted for managing prescription refills or sample inventory, reviewing abnormal lab results, getting ready for the next day, answering calls from other physicians, returning calls from patients, or any of the other tasks involved in the running of the office.
• There is no time for equipment maintenance, restocking supplies, staff meetings, or the duties of general administration.

Aggressive schedule assumes the marathon of a full day can be run at the rate of a 50-yard dash.
• Adrenalin is a wonderful thing.  It can make it possible for the office to sprint through patients for a couple of hours, but no one can sustain a whole day at an accelerated pace.  Put simply, the minimum acceptable time for an appointment is not sufficient as a standard because it is not sustainable.

Aggressive schedule makes no provision for the unexpected. 
• There is no allowance for same day appointments and the only option is to double book.
• If a patient is late or requires more than the allotted time, or a piece of equipment is not immediately at hand, there is no way to adjust without throwing the office behind schedule.
• Any event not explicitly on the schedule throws a wrench in the works; all subsequent appointments are delayed; and the delays accumulate.  If each of the first five appointments takes an extra ten minutes, the sixth patient is waiting at least fifty minutes. 

Aggressive scheduling leads to long wait times and predictable responses from patients.
• Patients complain about long wait times and feeling rushed. Staff and physicians spend time (not in their schedule) listening to patients complain and trying to assuage them.  Necessary as it is, this effort adds no value in terms of productivity.
* Once an office has trained its patients to expect an hour wait, the patients respond rationally and arrive late, or they don't feel compelled to show up at all.  This can result in the physician being idle.

Aggressive scheduling leads to wasted time.
• Patients leave without seeing the physician.  All the time spent with the patient in scheduling and preparing for the appointment is wasted.  It is even worse if the practice collects copays before the visit, because the payment will need to be unwound.  If the patient calls to reschedule, staff will spend time lost listening to complaints.
• Patients call multiple times with the same questions or requests because the receptionist is tied up answering the phone, taking duplicate messages, and listening to the patient complaints.  In really bad cases, the physician or nurse returns the call multiple times because she is working off a duplicate message.  This is a waste of everyone's time.

Aggressive scheduling leads to staff overtime.
• Since a completely full schedule effectively guarantees that the work will not be done on time, staff consistently clocks overtime. Staff is paid 50 percent more to do the same work, so one could say that productivity is down by 33 percent.  It is worse than that.  The overtime is unplanned, so all of the overtime cost is wasted money.

Aggressive scheduling makes regular work take longer
• The office gets progressively more disorganized and the physicians and staff spend more time looking for things.  After all, there's no time allotted to housekeeping and overtime is already out of hand.
• Tasks are interrupted by urgent requests, and more time is spent switching from one task to another than on productive work.

Aggressive scheduling leads to high staff turnover
• It is not pleasant to work in a frantic and disorganized environment, and staff leaves as soon as possible.  The exodus will continue until the whole staff is unemployable elsewhere.
• The practice is constantly trying to hire and train new staff, which is always a drain on productivity.  The damage to productivity is worse in an over-scheduled practice because it is constant and no one has time to devote to reasoned hiring decisions or training.

To avoid these negative consequences at your practice, schedule patient appointments for no more than 80 percent of the workday.  It is counter-intuitive but true that less aggressive scheduling will boost productivity and profitability, as well as patient, physician, and staff satisfaction.