Scheduling problems? There may be legal reasons to solve them

Not to mention improving patient satisfaction and practice revenue

The more managed care permeates the medical marketplace, the more regulations practices find they have to meet. These rules come not just from the payers, but also from state legislation in reaction to citizen complaints, newspaper horror stories, and anecdotes from patients dissatisfied with managed care. The bottom line: The demand for open access has led to mandates that practices see patients within a certain amount of time.

In New Jersey, for instance, a state law requires HMOs to have large enough physician panels to provide for four patient visits per year, with no physician seeing more than four patients per hour. Payers, in turn, are putting more pressure on physicians to see patients in a timely manner and not overbook their schedules, an increasing problem as capitation takes hold and practices try to increase revenue by packing in patients.

There are ways you can deal with scheduling difficulties, from changing your office hours to being stricter about late patients. Practice Marketing and Management interviewed physician leaders and experts to learn techniques practices can use to solve this problem.

According to New Orleans urologist Neil Baum, MD, managed care companies have made it clear to his practice and others that long wait times can lead to their ouster from a panel. "Waiting is the number one complaint that patients have," he says. "The payers are surveying patients about whether we see them in a timely manner, and there is a real threat that if we don’t, we can be deselected."

Potentially, says John Gilliland, JD, an attorney in Crestview Hills, KY, practices that fail to meet state mandated access requirements not only face deselection, but also fines or other penalties. "If there is a statute on the books that says you have a duty to see a patient in a certain amount of time, then if you don’t, you could be liable for malpractice," he says.

At the very least, Baum adds, if you can’t see your patients in a timely manner, some other practice will. In his own practice, he had a real problem at the end of each work day. Urgent and emergent cases were being squeezed into a full schedule, leaving the patients at the end of the day running up to 45 minutes late. The result was an increasing number of patients asking for their charts and leaving his practice, as well as plummeting morale among staff who were forced to hear patient complaints and stay late themselves.

There is a solution

Baum solved the problem by setting aside 20 minutes in the middle of the day that can’t be booked. That time is used to see patients with sudden, urgent needs. As a result, patients have stopped switching to other physicians, and it is rare when any staff member has to work late.

To take action, though, you must be aware of the problem. Certainly, patient attrition is a big clue they’re unhappy. But you can head off a patient exodus through an early warning system that tracks how late you are. Keith Borglum, vice president of Professional Management & Market ing in Santa Rosa, CA, has developed a form (see sample, p. 155) that notes how late physicians see each patient and the average wait time for the day.

There are other things you can do to make your practice more efficient and see more patients, while still reducing wait times and improving access (for 10 quick tips, see box, at right).

One easy solution is to create more hours to see patients. Most practices close during lunch, for example, but staying open and staggering staff during those hours can help you ease patient flow. Sharon Humphreys, vice president of marketing at Beaver Medical Group in Red lands, CA is looking at extending hours even further — from 8 a.m. to 7:30 p.m., with one physician working each night per week. "That way, we can have time to make more appointments." It has the added benefit of creating a convenience for patients, she adds.

Your own schedule isn’t the only issue. Others’ schedules can have an adverse effect on your practice as well. A while back, Baum had a surgery scheduled for 11 a.m. When he got to the hospital, he was told there was a staffing problem, and the operating room he was booked in couldn’t be opened until 12:45 p.m. — the exact time he was due back at his office to see more patients.

"I offered to do it at 5 p.m., but they said that would cost them a lot of overtime," he recalls. "I said I wouldn’t allow their management problem to make me late for the day. They hemmed and hawed but did it. Now . . . I am back in control. If it was an emergency, that’s different, but if they are having a problem getting a nurse in, that won’t impact my practice."

And if patients are late, Baum also refuses to let that ruin his schedule. If patients are more than 10 minutes late, they are offered a voucher for a free cup of coffee at a nearby coffee shop and told to come back at the end of the day. "They aren’t usually late again," he says.

Practices often have no influence over the things that drive patients crazy — managed care or Medicare limitations, he says. "But the No. 1 complaint people have with health care is waiting, and it is the one thing we can do something about."


Keith Borglum, Vice President, Professional Manage ment & Marketing, Santa Rosa, CA. Telephone: (707) 546-4433.

John Gilliland, JD, Attorney, Law Offices of John Gilliland, Crestview Hills, KY. Telephone: (606) 344-8515.

Neil Baum, MD, Private Practice of Urology, New Orleans. Telephone: (504) 891-8454.

Sharon Humphreys, Vice President of Marketing, Beaver Medical Group, Redlands, CA. Telephone: (909) 478-5101.