On Time Schedule management benefits physicians and patients

by Shellie Pruden, DCMS director of medical practice relations

The science of scheduling is complicated. Balancing a tight appointment schedule with the contingencies of emergencies, no-shows, and patient appointments that take longer than they should is often a monumental task.

Aggressive schedule management has to be a comprehensive study within the practice. Identifying the style of your practice is key. It’s amazing how revealing a clock and a little tracking can be. By tracking patients and making adjustments where the system seems to be slow, many practices find immediate efficiencies, as long as the physicians are committed to being on time.

Once a comprehensive schedule management program is put in place, some physicians find it beneficial to charge patients who don’t show or are late. “Our doctors who enforce the policy have reduced their no-show rate by about 50 percent,” says Jeff Duke, administrator, Medical and Surgical Clinic of Irving, PA. Such a policy should be posted and patients informed of the policy at the time of scheduling. Charges typically are $20 to $25 and are posted to a patient account, although usually not sent to collections if not paid. This charge is not covered as an insurance benefit and so chargeable only to the patient.

Some practices take a different approach. “We send out letters after the first no-show telling the patient that if he misses another appointment, we will no longer see him,” says Toby Bonham, officer manager for James B. Debusk, MD. The practice sticks by the policy and sends a discharge letter to the patient after a second offense.

While late and no-show appointments can be a hassle, some physicians accept schedule fluctuations as part of the patient relationship. “Patients often have to wait on me, so I’m pretty flexible,” according to Lisa Swanson, MD.

“I have a very busy life myself and can see how folks forget sometimes,” explains John Gill, MD. “I don’t charge no-shows and usually will see them if they call back.”

Other practices have explored the idea of calling no-shows, but have opted against it. “We don’t charge because we would spend a lot of time and money putting on charges and then writing them off, not to mention the bad feelings the patients would have toward us for doing this,” says Sharon Blackburn, officer manager, North Dallas Pediatrics, PA.

Enforcing a late policy also can be sticky. “You run into the problem of what is considered late,” Ms Blackburn says. “Patients will argue that our clock says ten minutes and theirs says eight.” She says the practice has attempted to address the issue for years, and has found no easy solutions. Even under the best scenarios, most physicians use discretion when applying this type of policy.

Policies can be effective tools in helping practices run more efficiently. When physicians respect their patients’ time by adhering to a schedule, the staff has leverage to enforce this policy on patients’ behalf. For sample copies of schedule management policies, see Sample No Show Policy.