Same-day appointments raise satisfaction, revenue

Key Points

How do you increase the number of new patients you see? One way is to implement a same-day appointment (SDA) policy in your practice. This article will help you understand the concept of SDAs and how to implement them. It is based on an interview with John Lin, MD, a urologist in private practice in Phoenix, who has developed an SDA process for his very busy practice.

Put necessary staff in place

Dr. Lin sees up to 35 to 40 patients per day, which may include eight to 12 new patients! How does he do it? Dr. Lin advises having a sufficient number of the right staffers with the right attitudes, while providing them with the appropriate tools to do their job and accomplish their goals. Dr. Lin is a solo practitioner with six full-time equivalent employees, which allows him to accommodate SDAs in addition to seeing follow-up appointments and performing office procedures. He has motivated his employees to know that accommodating SDAs is expected, and he is willing to provide them with adequate staff and tools to see the extra patients.

Dr. Lin attributes his ability to accommodate SDAs to having a highly integrated practice management and electronic medical records system that makes his practice truly chartless. Using his EMR system, he is able to see in real time which patient has arrived, who has been roomed, and if the patients are running on time. He can see this information anywhere in the office by using his tablet computer. He can better pace himself when such information is available.

Dr. Lin emphasizes that SDAs require a proper attitude. It starts at the top; ie, with the doctor. If patients are to be seen at 9:00, that means patients are placed in the room and the physician is ready to begin seeing patients at 9:00, not 9:15 or later. If the doctor is late, you can be sure that the day will contain significant delays, and the ability to accommodate SDAs will not be possible.

Begin by looking at the big picture. Ask yourself and your staff these questions: How many new patients are you seeing per day, per week, per month? What is your ratio of new patients to existing patients? How long is your typical new patient waiting to obtain an appointment for a non-emergency complaint? What opportunities do you have to accommodate new patients? What do you need in the way of staff and tools to accommodate more new patients? What will be the advantages of seeing more new patients each day? What are the disadvantages? Do the advantages exceed the disadvantages? If the answer to the last question is yes, then get started with the process of scheduling SDAs.

Dr. Lin anticipates how many additional slots he will need by leaving openings to accommodate new patients. This takes minimal analysis of patient appointment demand patterns. For example, Dr. Lin leaves two to three slots open on Monday afternoons, as he knows that a few patients seen in the ER will likely be calling Monday morning for follow-up appointments.

Dr. Lin qualifies patients when they call for a new appointment by ensuring that payer information and appropriate authorizations have been obtained and that patients know in advance what the estimated cost and co-pay will be and that the fee will be collected prior to the visit. This requires a well-coordinated effort by the front desk and the billing office, as well as having the necessary electronic and Web-based resources to accomplish this complex task.

He suggests that physicians should not assume the liability of providing care without being compensated. He also suggests that the demographic information and a health questionnaire be completed before patients arrive in the office so as not to delay their visit. Patients are also instructed to be on time, as they will be seen within a few minutes of their arrival. Dr. Lin also recommends that all the reports, supplies, and equipment needed to see the patient are in the exam room or are already available in the EMR/chart before the patient is placed in the room.

SDAs offer three main benefits

SDAs bring several benefits to a practice. First, patient satisfaction is markedly improved when new patients or existing patients with urgencies and emergencies are seen the day that they call for an appointment. Dr. Lin has surveyed his patients, and one of the comments they frequently make is how much they appreciate same-day access to urologic care. Rarely were new patients experiencing lengthy visits once they were scheduled, the survey found. A recent time-motion study showed that only one patient had spent more than 1 hour of total time in his office (from time of check-in until departure). Rarely did an existing patient have to wait because a new patient was inserted into the schedule.

Second, this concept minimizes the risk of no-shows. When patients call with a request for an appointment and can be seen the same day, they invariably keep the appointment. Patients who call and request an appointment that is weeks or months in the future are frequently no-shows, leaving expensive gaps in your schedule.

Third, you can anticipate increased productivity and revenue when you grow your practice by offering SDAs. Remember, more relative value units per patient are generated when you see more new patients than follow-up or "established" patients. Dr. Lin points out that SDAs create positive word-of-mouth marketing buzz about your practice. You will attract more patients to your practice if you have a reputation for providing timely access to care.

Of course, with any new program, there are going to be some disadvantages. You can expect a disruption in your workflow and stress on your staff until the kinks are resolved, Dr. Lin cautions. He suggests that you work through it with your staff. Let everyone know your goal and your purpose, and request feedback and suggestions. This may help improve your overall workflow not only in seeing new patients, but also established patients.

In order to maintain staff morale, reassure them that this new process will not require them to stay longer or to work overtime. Dr. Lin was able to establish the SDA process without incurring overtime. He also suggests that a reward, either monetary or simply verbal recognition, is important when goals are achieved or exceeded.

The bottom line is this: Increasing the number of new patients seen each day is a process that can be accomplished by all urologists. By offering SDAs, you will significantly enhance patient satisfaction. SDAs offer you a tactical and strategic advantage and will make you a more productive, more efficient, and ultimately happier urologist.

Dr. Baum is a urologist in private practice in New Orleans. He is the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically.

Dr. Dowling is medical director of Urology Associates of North Texas, a 48-physician, community- based, single-specialty group in the Dallas-Fort Worth metroplex.