Automating Appointments Satisfies Physicians and Patients

Last year, Valley Medical Group, an 86-physician, multi-specialty practice in Amherst, Mass., started using a schedule automation program to help fill last-minute cancellations. A year later, the practice has enough data to conclude that the program has filled an average of more than 60 cancellations per month. It has also saved 16 administrative days of work, mainly through reception coordinators not spending time tracking down patients to fill the schedule.  

On the patient side, the average appointment wait time for those who use the program, QueueDr, has been reduced by two weeks.

Physicians Practice recently spoke with Martha Mastroberti, Valley's healthcare informatics manager, and Patrick Randolph, CEO of QueueDr, to discuss the pros and cons of using technology to streamline practice operations.

Explain how cancellations worked before Valley Medical Groups' appointment schedule was automated?

Mastroberti: A patient would call in and cancel. Sometimes they would be cancelling for that day or sometimes the next week. The reception coordinators [were] trolling through the schedule all day long and they would notice a hole, then go to the waiting list and [try to] fill the opening. [The coordinators] would call people on the waiting list, unfortunately we only had about 40 percent of our patients that had given us their mobile numbers. So, we end up calling their home numbers, and they are all working. We would leave messages for four or five patients about the opening. Eventually we may get somebody, but then the first three people we called would call back and we would say "oh, never mind, that was filled; sorry." We would end up with unfilled schedules, and that's not good for anybody.

And after scheduling automation?

Mastroberti: When a patient cancels an appointment, the system looks for patients who are scheduled for the future who have the same provider and the same appointment type. The system sends those patients a text message asking if they want this appointment. The first person to respond is moved from the schedule to the [opening]. We don't touch anything. For the other patients, if they responded, the system sends a "sorry, we'll try you again soon" kind of message. Our patients are interested in using technology to schedule and manage their appointments.

What is the biggest improvement schedule automation has made?

Mastroberti: The efficiency of a patient cancelling. Nobody has to look at it, nobody has to be aware of it, and nobody has to think. The system is aware of it and goes out and fills those slots with patients. We have a lot of very busy providers- if you want your physical next week and I tell you I'm booking into June- but we have this system where you could potentially get called in early [and it] keeps patients engaged. (Editor's note: The practice can see who is coming into the open schedule spot once they system fills the opening.)

What are the challenges of patient volume in todays practice?

Mastroberti: [At Valley Medical Group], the bulk of what we do is primary care. Patients are sicker today than they have ever been, with people living longer with many more complex diseases. The number of administrative tasks that get shuffled from the insurance companies and government just keeps growing, so our practitioners often say, "if all I had to do was take care of the patients that came into the office, my life would be fabulous." On average there are 32 tasks per patient visit. For every patient we see there are 32 other things we have to do: prior authorization, insurance paperwork, etc. Filling the schedule is important because, for us, that is 60 percent of our revenue. [In] fee-for-service, you see a patient, you get paid.

What do cancellations do to a practice?

Mastroberti: In the moment, the staff and providers say, "woohoo, we can go use the bathroom and catch up." But, we know there are people waiting to come and see us and with every cancellation we have wasted 

the opportunity to see to someone's needs. The bottom line, it’s see people, make money. I think there's a balance. We would all like a day off, but we need to take care of our patients.

Randolph: Cancellations affect everyone. Practices, providers, executives, and the patient. That's why we choose to tackle filling cancelled appointments. In Massachusetts, the average wait time for a primary care appointment is 44 days. Many people don't get the care they need, and they just give up. You can have groceries delivered to your house by this afternoon, but having to wait 44 days for a doctor is tough.

Do you have advice for practices hesitant to adopt scheduling technology?

Mastroberti: Try it. Try it small. Try it with one provider, with one appointment type and just see. Your patients are going to really like it.

Randolph: The point of technology is to give people more time. We want providers and their staff to have to do nothing. That's why we integrate our technology into the EHR. It makes it seamless. Docs need technology to integrate into their work flow.