Which of the following is an appropriate use of modified wave scheduling for one provider with 20 min appointments?

Patient scheduling. It seems like it should be simple. Scheduling patients is one of the most common tasks performed by practices...and it can also have a huge impact on your success. With 85 percent or more of a typical healthcare practice’s expenses fixed, ensuring patients are scheduled effectively and efficiently is critical to maintaining and maximizing your practice revenue.

You do what you can to keep missed appointments to a minimum and ensure your patients are seen by the doctor as close to their scheduled appointment time as possible. But there will always be patients who are running a few minutes behind, patients who require immediate emergency attention, or other unexpected events that put the entire day’s schedule behind. Whether it happens at the very beginning of the day or mid-afternoon, it is inconvenient and frustrating to both the patient and practice staff.

Patient scheduling in itself may seem like a simple process, but efficient patient scheduling is very significant and impactful to your patients’ delivery of care and your ability to keep wait times to a minimum so patient satisfaction stays high and practice profitability stays consistent.

Although you may not be able to control how on-time a patient is for their appointment, there are things you can do on the staff end to ensure the schedule stays fluid, or recoup time that is lost in order to get the schedule back on track whenever possible. Being able to master this will keep office stress to a minimum and make sure your wait times stay within reason.

How to schedule patients effectively

1. Schedule from noon. Try your best to schedule morning appointments from noon backward and afternoon appointments from noon forward. Establishing this as the standard will help you maintain maximum productivity and ensure that the bulk of the day is scheduled out. If morning or afternoon slots don’t get filled, you can use those blocks of time much more efficiently by holding your staff meetings then, or cutting down on overhead costs by allowing staff members to come in later or go home earlier. Empty slots throughout the day generally result in unproductive down-time, so implementing a scheduling a patient scheduling system or appointment scheduling software strategy such as this will help reduce wasted time.

2. Implement patient self-scheduling . Did you know that the average phone call to schedule an appointment takes over eight minutes? Multiply that by the number of appointments scheduled each day and your practice may be spending hours on appointment scheduling each day. Some practices field all appointment scheduling calls to a designated person who may typically be a relatively low-paid employee. Or if you are a smaller practice, you may have only one staff member who handles pretty much all front office management tasks. With new advances in technology, this is now an area where you may be able to cut back on the unnecessary expense of an “appointment scheduler” and recoup a significant amount of time that could be spent on much more significant tasks. Studies show that the majority of patients prefer to schedule their own appointments online. Even better, 26 percent of appointments scheduled online are for the same day or the next day, filling up empty spots on your schedule. Practices now have the ability to offer real-time patient scheduling anytime and from anywhere with Internet access. Online scheduling is new to healthcare and offers greater convenience for both practice and provider.

3. Prioritize appointments. Patient visits vary in degree of time requirement and level of care needed. Consider these factors as you decide where and when to schedule your patients or whether you even need to put them on the schedule at all.  Many patient issues can be resolved with a brief phone call or email. Have the staff member who fields incoming calls use their best judgement to evaluate each call to determine whether to schedule the patient or have your nurse or doctor address the issue via a phone consultation. This approach ensures patients needing the highest level of care have better access to same-day appointments if necessary and practice profitability is maximized by treating patients with more complicated or significant medical concerns.

4. Confirm appointments with text and email appointment reminders. Utilizing an appointment reminder software system will improve upon the number of on-time arrivals and kept appointments. No-shows are costly and inconvenient especially when you are a particularly busy practice and have a good size waitlist. Both provider and patients miss out when a no-show occurs.

5. Create a patient waiting list. Last minute cancellations may be frustrating; however, with a patient waiting list, you are armed and ready when this unfortunate event occurs. Try using a patient scheduling platform that includes the ability to keep a list handy and ready to be notified. Being able to send out a mass notification of your immediate open slot is a huge time saver and revenue maintainer. Instead of grabbing the phone when you get that dreaded appointment cancellation, quickly access your stored digital patient wait list and send out a quick message encouraging your patients to call you rather than the other way around which results in a waste of precious time that could rather be spent on more productive activities such as getting to know your patients better or increasing billing collections.

6. Use Automated Patient Recare and Recall. Having a patient recall system in place ensures that patients return for their regular care appointments keeping your schedule consistently fuller. This type of system can also bring back patients who haven’t been in to see you for their regular care appointments in years by simply sending out a reminder email, text or voice call letting them know it’s time to reschedule.

 Every practice has room for improvement, and there are many ways you can increase office efficiency in order to keep processes running smoothly. If you find your practice schedule is consistently too full or not full enough, discuss this at your next staff meeting. Take note of which days if any the schedule seems to be more inconsistent. Establish these 6 effective medical appointment scheduling guidelines and make sure all staff members are adhering to them and then be open to other ideas that could help fill in the gaps and create a more fluid schedule.

Read our case study about the Surprisingly Big Impact of Online Scheduling and how one practice has seen new levels of engagement and efficiency through automation. 

Perhaps one of the most important factors in the success of a family practice is patient flow. An office that can successfully smooth out the peaks and valleys in its schedule can see more patients more efficiently, reduce wear and tear on office staff and physicians and make more money.

Although much recent attention has been given to open-access scheduling, there are other, more moderate changes you can make in your scheduling that can yield significant results. You can begin by identifying where in your schedule peaks and valleys tend to occur. Several causes of peaks and valleys and strategies for dealing with them are described in boxes that appear throughout this article.

To address peaks and valleys in my practice’s schedule, I adopted “modified-wave scheduling,” a simple technique where patients are purposely double-booked at the front end of each hour and the end of the hour is left open for catch-up. I’ve used this system with much success for 19 years. It has increased my bottom line by almost 15 percent without increasing my overhead. Here’s how it works.

The first step to improving patient scheduling in your practice is identifying where the peaks and valleys in your schedule occur.

One way to smooth scheduling peaks is by using the modified-wave method.

The key to modified-wave scheduling is to double-book patients for the first slot of each hour, leaving the end of the hour open so there's time to catch up if the physician begins to run behind schedule.

I first encountered wave scheduling in the early 1980s when I was doing a rotation in pediatric cardiology. Patients traveled from throughout the region to the clinic where I worked, and they were all told to come at 1 p.m. Once there, they were told they’d be seen on a “first-come, first-served” basis. This was how original “wave” scheduling worked. Loading the patients at the front end of the day optimized the efficiency of the staff by guaranteeing there was never a lull in patient flow. While it was good for productivity, it was unpopular with patients. Some had to wait several hours to be seen, despite having arrived on time for their appointments.

The “modified-wave” method takes advantage of the principal behind the “wave” method, but it is more patient friendly. The key to the modified-wave technique is to load up the front end of each hour and leave open slots in the schedule later on to catch up. Perhaps the best way to understand the modified-wave technique is by comparing it to the standard method of scheduling [see "Standard scheduling vs. modified-wave scheduling"].

Using the modified-wave technique helps prevent long patient wait times by giving physicians free time at the end of each hour to catch up if they’ve begun to run behind. In my experience, patients rarely complain when they have to wait from 15 to 25 minutes to see the doctor. It’s when the wait exceeds the 25-minute mark that patients start to get upset and satisfaction begins to suffer. With modified-wave scheduling, if a physician begins to run late, the effect isn’t cumulative: There is time built into the schedule at the end of the hour to catch up.

Another plus of modified-wave scheduling is that because the first appointment of the hour is double-booked, the physician – aware that the next patient is either already waiting or is in the process of being put in an exam room – tends to use time more wisely. And patients who need more attention do not end up getting rushed through. Why? The modified-wave schedule allows physicians to borrow the unscheduled time from the end of the hour or from patients with less complex problems without having to rush to get back on schedule.

The geographic area where you practice will have a high and low season uniquely its own. One way to help smooth scheduling peaks is to encourage all patients with chronic diseases to have their comprehensive evaluations performed during your low season. How many times have you encountered a patient with complex, non-urgent problems scheduled into a 15-minute slot on a Monday during flu season? While these types of visits can't always be avoided, they can be minimized. We've found that once we schedule our patients with chronic conditions to come in for routine exams during low season, they stick to that schedule. Another way to move visits of this type to the less busy time of year is to adjust the number of refills you prescribe so that patients' refill requests coincide with your less busy months.

In addition to smoothing out your workload, scheduling comprehensive, non-urgent evaluations during low season allows you more time during the visit to discuss health maintenance issues and clean up the patient's medication list, problem list and the overall chart. There's also more time to ensure that your documentation and coding support the high level of care you provided. And, with a clear and organized chart, acute visits during the busy months can be handled much more efficiently.

An unanticipated benefit of scheduling complete evaluations well in advance is that patients arrive expecting a longer visit and don't seem to mind paying more for it. Early in my practice years, I recall several patients with whom I had spent twice the normal amount of time bitterly complaining that I had charged more than my usual rate. It didn't take me long to learn that when patients make an appointment for a regular office visit they expect a regular office charge. Scheduling comprehensive visits well in advance seems to increase patients' satisfaction that they're getting what they (or their insurance plan) pay for. Also, in our practice, where the low season is summer, many patients have already met their deductibles by the time they see us for these more expensive office visits.

Each of the following case examples is based on the mix of patient visits a family physician might encounter on an average morning.

Standard scheduling method

In this scenario, patient appointments are booked in 15-minute increments.

Number of patients seen: 10.

Number of patients who waited: 4 (2 waited for 25 minutes and 2 waited for 15 minutes).

Minutes “wasted” by the doctor: 35 minutes (20 minutes waiting for the next scheduled patients and 15 minutes for the no-show).

Modified-wave scheduling method

Again, patients are scheduled in 15-minute increments, but two patients are booked for the first time slot of each hour. A catch-up period is built into the schedule at 9:45 a.m., 10:45 a.m. and 11:45 a.m. During this time, no appointments are scheduled. In this scenario, more patients had to wait, but in my experience, patients rarely complain when they have to wait up to 25 minutes to see the doctor.

Number of patients seen: 12.

Number of patients who waited: 9 (one waited for 25 minutes and 8 waited for 15 minutes or less).

Minutes “wasted” by the doctor: 0.

Every physician has experienced being swamped several days before and several days after a vacation. Reducing the number of routine follow-up appointments before and after a vacation can help prevent this. The key is tapering. Several weeks before your vacation, have your receptionist block out progressively larger and larger portions of your schedule for the several days preceding your vacation. Do the reverse (i.e., block out progressively decreasing portions) for the few days following the vacation. The receptionist should be instructed not to schedule any routine appointments during those blocked-out periods. Then, perhaps one week prior to the vacation, open up the schedule so that when patients call with semi-urgent needs, they can be easily accommodated.

In a group practice, it is often just as important to block out some slots on the other physicians' schedules during the week(s) a physician is on vacation. Frequently, it is the remaining partner(s) who gets the brunt of the patient overflow. These appointment slots should be blocked out well in advance and should be reserved for same-day appointments.

After each vacation, the physician, the office manager and the person scheduling patient appointments can evaluate.

Finally, by stacking patients at the beginning of an hour or session, you ensure that physician and staff time isn’t wasted if one of the two patients booked at the top of the hour is a no-show.

To get even more out of modified-wave scheduling, you can group similar types of office visits in a single session. Some practices have surgical-procedure days, complete-physical days or all-pediatric days. For example, consider setting aside one midweek morning office session for physicals. If an average physical takes 25 to 30 minutes, two physicals can be scheduled at 9 a.m. and one at 9:30 a.m. The physician sees one of the patients at 9 a.m. while the second patient has testing done by the ancillary staff. Then, 20 minutes later, the patients can switch, and the first patient can have testing done while the second patient sees the physician. This way, both patients with 9 a.m. appointments have the perception that they’ve been seen immediately. The entire office gets into a groove, and you end up seeing more patients.

Many practices find that Mondays, and sometimes Fridays, are too busy. For example, at one of our practice sites, the office manager and the receptionist were pulling their hair out trying to handle upset patients who couldn't be fit into one physician's Monday schedule. These patients had waited since Saturday to see their own doctor on Monday, only to find they'd have to wait another day or two. Their anger was understandable. Furthermore, it took extra staff time to cajole patients into waiting another day or two for an appointment.

In this practice, the solution was simple. On Mondays, they allowed only two patients to be scheduled in advance for the first two morning appointment slots. That way, the doctor would be assured of starting on time. The rest of the schedule was filled as the calls came in on Monday. By the time the first two scheduled morning appointments had been completed, patients who had been added to the schedule that morning were already arriving at the office. The difference in patient and staff satisfaction was remarkable. Ill patients were told to come in almost immediately. There were also fewer phone calls to confirm patient appointments and less time spent on the phone on Mondays to triage patients away from an already full schedule.

Your practice may not need to block out such a large amount of time on Mondays, but you can use the same principles to help you determine the number of slots you'll need.

There is one valuable strategy that can make a huge difference in smoothing patient flow regardless of the scheduling method you use: Review the schedule several days prior to the appointment day. My medical assistant and I do this together prior to re-confirming appointments. That way, we can fix any odd glitches in the schedule by asking certain patients to come earlier or later in the day or even on another day, if necessary.

Why do I assign this task to my medical assistant and not the receptionist or scheduler? Experience has taught me that the scheduler is often too busy to put a lot of thought into how patients are scheduled. The medical assistant is generally the one who is most accustomed to the work style of the doctor(s) as well as to the idiosyncrasies of the patients, and, consequently, is better equipped to mix and match patients so that each hour is balanced. A final adjustment to the schedule prior to the appointment day can correct the mistakes before they become a reality that both the staff and the patients have to deal with.

Over the years, I’ve helped many practices implement modified-wave scheduling. I would be remiss not to mention having encountered a few problems along the way. Here are some past mistakes I’ve seen and what your practice can do to avoid them:

Pitfall 1. Filling the catch-up time slots with acute visits. Avoid this at all costs. Physicians who are double-booked at the front end of the hour and then have no unscheduled time at the end of the hour to catch up will fall markedly behind in no time flat.

Pitfall 2. Double-booking new patients, difficult patients or patients with complicated problems at the front of the hour. For example, if two new patients are scheduled at 9 a.m., the schedule can quickly turn into a mess. Don’t book these patients during peak time periods whenever possible, and try to ensure that their visits are mixed with others that are likely to take less time. If the patient asks, simply explain that 9 a.m. is a high-traffic time in the office and does not give the doctor sufficient time to spend with the patient.

Pitfall 3. Implementing modified-wave scheduling in a large practice (20+ physicians) with centralized scheduling. Practices with centralized scheduling can have terrible scheduling problems and have greater difficulty implementing this method. The only way that I’ve found to make modified-wave scheduling work in a practice with centralized scheduling is to limit a specific scheduler to a specific set of doctors, conduct frequent feedback sessions and commit to modifying the schedule on the fly. I generally discourage centralized scheduling altogether and encourage decentralized scheduling at the primary care office site. This way other issues such as billing matters can be dealt with at the time patients schedule appointments.

Successfully managing patient flow takes thought and careful planning. It is by far one of the most challenging aspects of practice management. But when done correctly, smoothing the peaks and valleys in your schedule using the modified-wave technique will increase the capacity and efficiency of your practice without increasing your overhead. Add to that staff and physicians who are less stressed and patients who aren’t enduring lengthy waits to be seen and you’ve got a better practice all around.

Which of the following actions is appropriate for a medical assistant to take before scheduling a patient for surgery?

What is modified wave scheduling in medical office?

Which of the following actions is appropriate for a medical administrative assistant to take when providing?

Which of the following action should a MAA take when scheduling a new patient for a physical examination?