January, 2013:

Optimizing Your Appointment Schedule

A thoughtful approach to the design of an appointment scheduling system can go a long way in improving revenue, preventing provider and staff “burn out” and increasing patient satisfaction in a medical practice.

Many practices have standardized schedules.   An example of this is 15 minute blocks throughout the day with staff knowing that an established patient takes one block, a new patient takes two blocks and a preventative visit takes three blocks.  While this is the simplest and most straightforward to set up, it has the potential to create significant issues  One example of an issue is a new patient being scheduled as the first appointment of the day and being a no show, the result being wasted provider time.  Another issue is the potential for multiple patients to present at the same time for different providers, resulting in a hold up in registration and patients being seen.  This method also has the potential to leave gaps in the provider schedule when the practice has a relatively high no show rate.

An alternative to this is the wave schedule (i.e., schedule all the patients for a given block to arrive on the half hour or hour).   In this method, instead of scheduling 4 patients each on the quarter hour, all 4 are scheduled on the hour, and the provider sees each one in sequence of arrival. The first gets seen upon arrival, the third gets seen after the second.   This takes into account that some patients arrive on time and others arrive late.  This method allows the providers to continue to see patients in the event of late cancellations or no shows.   The disadvantage is if they all arrive on time there is a registration delay, and the last to check in has to wait 45 minutes or more to be seen.  

A solution to this is use of the modified wave schedule.    With this approach, more than one patient is scheduled at the beginning of each hour, and the end of the hour is left open, allowing the provider to catch up, if necessary.  An example of this is two patients are given an appointment time of on the hour and an additional two patients are given an appointment time at 15 minutes after the hour.  This method gains many of the advantages of the wave, however lessens the disadvantages of long waits for check in and to see the provider for later appointments.

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.  Most patients anticipate having wait 15 or 20 minutes to see the provider.   When the wait exceeds that is when patient satisfaction scores tend to suffer.  With modified-wave scheduling, if a physician begins to run late, the effect isn’t cumulative as there is time built into the schedule at the end of the hour to catch up on seeing patients or documenting services.

Another advantage of modified wave scheduling is that because the first appointment of the hour is double-booked, the provider is aware that the next patient is either waiting or in an exam room the provider may use his/her time most efficiently.    The greatest benefit is that, for the most part, providers are able to start each hour on schedule and frequently have time to complete their documentation during the day rather than after patient hours.

Another consideration in developing an appointment schedule is the types of patients your practice sees and how to define them in your schedule.  As an example, it is not recommended that visit slots be identified by diagnosis unless your practice has historic data which states that a particular number of visits are needed per week for a particular diagnosis.  If this is the case we recommend that diagnosis specific visit slots become open within a specific number of days prior to the service date (typically 1-3).   While schedules should not be so tightly constrained that patient access is limited (i.e. 2 new patient slots per day with the next availability in 3 weeks), they should not be so open that there is the potential of multiple new patients in a row.

 Practices should also be considering how to maximize medical assistants and nursing staff.  By having ancillary staff perform patient intakes, process orders and review visit summaries with patients, provider time can be maximized.

Successfully planning for and managing of patient flow is one of the most challenging aspects of practice management.   Doing this in a thoughtful, methodical way using the modified wave technique will increase both patient and staff satisfaction without increasing your overhead.    Losing patients due to long waits and losing staff due to “burn out” are very costly to your practice.   Use of the modified wave methodology can positively impact both of these.

Healthcare Reform and Patient Access


Many of the key provisions of the Affordable Care Act  will be phased in over the next  year including an expansion of Medicaid and  the creation of health exchanges that will allow previously uninsured patients to obtain health insurance.  These provisions will have the effect of expanding the population eligible for healthcare coverage and allowing for greater choice on where patients seek care. 


Some organizations, such as Academic Medical Centers, neighborhood  health centers and public clinics, may face competition for patients that heretofore had little choice on where to seek care.  Community hospitals and physician practices will now have increased access to a new insured population.  A result of improved access to healthcare services will place a burden on many components of the healthcare sector that were already struggling to take care of their patients due to a primary care physician shortage and a lack of providers in certain specialties.  At the same time, there may be increased competition for patients.


This will place increased strains on the healthcare delivery system, particularly in terms of creating access to new patient populations seeking care.  Improving patient access, promoting more efficient operations and promoting patient satisfaction will be required to remain competitive.  Neglecting these critical opportunities could  result in a significant degradation of service and performance.  It is incumbent upon every healthcare organization, and especially physician groups, to focus on these important areas in the months ahead.

 By : Jeff Wasserman-Vice President of Strategy & Executive Leadership Services -Culbert Healthcare Solutions

EHR Optimization


Optimization of an Electronic Health Record system is the continual process of leveraging advanced application functionality to enhance workflows and improve resource productivity.  During the implementation process, many healthcare organizations make trade-offs between what system build will be completed as part of the initial go-live and what will be implemented after the go-live as part of an optimization effort.  Optimization ensures that the fullest potential of the software chosen is achieved by your organization.

Optimization is the key for maximizing the return on your EHR investment.  EHR ROI includes both financial and quality measures. From a financial perspective, optimization maximizes the return on your EHR investment, by improving overall physician and resource productivity, and ensuring the timely and appropriate capture of charge information. From a quality perspective, optimization ensures routine measurement and management of clinical quality measures and outcomes.