Time Is on Their Side

While other industries strive for seamless customer service, many physician offices still struggle with the problem of patients waiting, waiting - 20 minutes, 30 minutes, or longer - for an appointment.

"The ideal wait time for patients is actually zero minutes," stresses Jayne Oliva, principal of The Croes Oliva Group, a practice management consulting firm in Burlington, Mass. "While this may seem unrealistic or undoable, some of our clients have achieved this in order to provide ultimate consumer service."

Oliva is quick to draw a comparison to the banking industry. Just 15 years ago, bank customers had to wait in lines to withdraw money or deposit paychecks. Now, those customers can walk up to any ATM around the world and accomplish the same tasks, usually with little or no wait. Patients are beginning to expect the same kind of immediate access, and some consumer-savvy providers are trying to meet these needs. "We have one client who promises you can see the provider of your choice on the same day you call for an appointment," says Oliva.

While that scenario may seem like something from a dream, practices can take certain steps to make that kind of access part of their everyday reality.

Stay on task

As a first step to improving wait times, practices should strive to maximize provider capacity. Physicians need to focus ex-clusively on patient care, while mid-level practitioners and support staff handle other tasks.

One of Oliva's physician clients estimated he was spending 75 percent of his time coordinating X-rays, contacting referral sources, and doing other non-clinical work.

"I learned from him that only 12 percent of that time was related to tasks that had to actually be performed by a physician," says Oliva.

Less payroll-intensive staff can better take care of follow-up activities, leaving the physician free to see patients, make diagnoses, and handle clinical decision-making.

Nancy Babbitt, administrator at the Roswell Pediatric Center near Atlanta, says her three-office practice has a specific process to ensure efficient use of time. Physicians and nurse practitioners rotate in and out of exam rooms so that physicians make brief visits with checkups and concentrate on sick visits, while nurses focus on follow-up work associated with checkups. "It's a good method to get good utilization of the physician's time," says Babbitt. As a result, patients are seen quickly, not sent to the exam room to wait some more.

Practices seeking to improve wait times should also consider those patients who are using office resources without actually coming to the office. "One thing we've done to help the flow and manage patients is place full-time phone nurses in each office," says Babbitt. "Usually one is doing nurse visits, the other two are taking calls, giving parents advice. If they're not sure whether they need to come in, maybe they can treat [the child] at home" - before or instead of - an office visit. When considering how to assign staff responsibilities, practices should be aware that Medicare reimburses for services provided by non-physician providers - physician assistants and nurse practitioners, for example - at a lower rate than physicians. However, these services can be billed at the full physician level, provided they were delivered "incident-to," or as follow up to, a physician's treatment.

Simple things count

Even practices operating on a shoestring can implement simple and inexpensive steps to prevent long patient wait times. Look at the office space; try to picture it differently. Sometimes backups in an office occur for simple reasons, such as having a single scale in a well-trafficked area. Placing scales in all the exam rooms can eliminate this problem.

Teri Ownbey, practice administrator for Asheville Orthopaedics in Asheville, N.C., found that closing the door between the reception and patient care areas prevented a bottleneck that used to occur when patients wandered in and out unannounced. Babbitt adds that the Roswell offices have separate entrances and waiting areas for sick and well visits, which facilitates its rotating provider process. Office managers have a snapshot of the number and types of visits and move patients along accordingly.

Regardless of what steps are taken to improve scheduling, Oliva emphasizes that it's important to set specific targets for reducing patient waiting time. "Making sure that patients are seen by the physician within 15 minutes is an example of a concrete, measurable target," says Oliva. "Once a goal is established, physicians and staff can begin to work together to schedule and deliver services with a consumer-driven orientation."

Log on to efficiency

Many practices have improved scheduling issues, as well as productivity, through the use of automated information systems; some groups have even begun exploring the Internet as a vehicle for patient scheduling. Bette Warn, until recently the practice manager for The Clinic for Plastic Surgery in Denver, saw that practice's patient scheduling improve after a patient flow module was added to her automated system.

"The program shows clearly on the computer screen where a patient is at each stage of their appointment," says Warn. "It can also track how much time they spend in the waiting room, X-ray room, and exam room, to make sure there are no unnecessary delays."

Programs like this are especially helpful to practices with multiple waiting areas, she adds. Patient coordinators keep track of patients via computer, watching for bottlenecks by clicking between the scheduling program and the patient flow module. If they see that a patient has been waiting too long in a certain area, they will direct a physician or appropriate staff member to that location. Serving as floor managers, the patient coordinators always know which exam rooms are free. A good rule-of-thumb for practices considering this option is one floor manager or patient coordinator for every seven physicians. The computer-based system can also classify patients as new, post-operative, or follow-up, allowing schedulers to more accurately target the number of patients that can comfortably be seen in a given hour.

While The Clinic for Plastic Surgery is taking advantage of technology - and even has a Web site (www.beautifulme.com) - Warn thinks it will be a while before many practices can use the Internet as a scheduling tool. "It's kind of like the electronic medical record when it was first introduced - there's all this hype about how great it will be when patients can schedule their appointments online, but there are still a lot of bugs that need to be worked out," she says.

Despite the bugs, automated time-saving tools will undoubtedly become increasingly user-friendly and technologically efficient. In the meantime, practices struggling to unclog their waiting rooms should consider using more immediate resources - their staff and office surroundings - to restore the flow.

Carol Daus can be reached via editor@physicianspractice.com.

This article originally appeared inthe May/June 2001 issue of Physicians Practice.