We know patient experience can be affected by the perceived efficiency in the practice. From the patient’s perspective, this is often measured by how long it takes to go through the appointment process. Is anyone measuring throughput times in their practices? We are beginning to measure the time between check-in and when the patient is taken back to the exam room, as well as total time from check-in to check-out. We will also start measuring the time the provider is involved. We would like to see if anyone else is doing it, how they are doing it and what their measurements are. We are trying to determine appropriate standards for different visit types.
Jeffrey Rydburg, MGMA member, Brentwood, Tenn.
I would agree that these studies are invaluable. They can also be tedious and time-consuming. A lot depends on the system that you use, as some will easily track all phases and give you a good print-out. Many still require manual work on the part of the staff.
The data also helps with staff evaluations and can provide physicians with real numbers showing their contributions to the lack of timeliness.
Retha Reeves, MGMA member, consultant, Bellaire Dermatology Associates, Houston, rreeves55@gmail.com
One thing to chart as you do the flow analysis is whether you are fully staffed — noting who is in or out — and if one of the providers is on call, as that can affect schedules and wait times.
Pam Trombley, COPM, MGMA member, practice administrator, Petoskey Ear, Nose & Throat Specialists, Petoskey, Mich., ptrombley@petoskeyent.com
It’s important to monitor the schedule and wait times. That can be as simple as reviewing patient status in the EHR. Most will track “patient seen” when they check out, or you can delve more deeply into tracking each step along the way.
Usually, throughput problems fall into two categories: Either the provider is chronically late/slow, or there wasn’t sufficient time to accomplish the requirements of the appointment with the resources available (staff, equipment, location, etc.). If everything is booked as a 10- or 15-minute appointment, but some conditions/procedures routinely take longer, that’s a scheduling problem rather than a provider problem. If registration, check-in or rooming processes involve tasks that can cause delays, that’s not the doctor’s fault. The worst-case scenario is a clunky, unpredictable process paired with providers who don’t care about productivity — they amplify each other’s dysfunction.
We’ve found that allocating staff resources ahead of time — so that there are virtually no delays — keeps everyone happily productive. Conduct registration and insurance verification ahead of time. Administrative staff review records to make sure everything the doctor will need (labs, consult notes, etc.) is available prior to the appointment. Allow providers to review most charts one day prior. Same-day appointments are triaged by a nurse, who documents some clinical data ahead of appointment. Make sure clinic staff have equipment, procedure trays and rooms stocked and know what’s coming – no surprises, no drama.
Jane Dodds, MPH, FACMPE, MGMA member, practice administrator, Women Gynecology & Childbirth Associates, P.C., Rochester, N.Y., jmdodds@aol.com
We measure our time to third next available appointment (TNAA) for new and established appointments per provider, the theory being that the first one or two available appointments might be last-minute cancellations. The third available appointment is going to best illustrate the availability of your providers. We get this data from a script that looks at our schedule in the middle of the night (when the schedule is at rest) and records the information, counting M-F days. We can look at the data as often as needed by provider, by day of the week and location. Honestly we don’t need to look very often, but it does come in handy. And it is impossible to recreate that data (at least in our system) if we don’t collect it as we go along.
At the time of the actual appointment we measure the amount of time each registrar takes with patients, and we can average this over time and by new or established registration per staff member. We also measure “the later of” a patient’s arrival time or the appointment time from the time a patient is finished with the registrar until the patient is roomed. We subtract registrar time and now have our “lobby wait time.” We get automated reports emailed to us with lobby wait times for certain schedules, such as our walk-in clinic.
Using this data we’ve created an electronic “on-time board” that displays our providers and whether they are running on time or not. This is displayed behind every receptionist in our three primary locations, and it updates every 60 seconds. It moves to “15 minutes late” at 16 minutes, and goes up or down in five-minute increments. ... The times it uses are times that are the scheduled time, and times are gathered when the patient checks in (in-person or via on our kiosks), when patient finishes with registrar, is roomed, etc. We are making use of the internal time stamping that was happening already.
Our supervisors and certain front-office staff can see the “whole picture” of what’s going on in the front office (how long the waits are and so forth) from a dashboard view of the entire office. We also get notifications if a registrar has been with a patient for an excessive amount of time. Maybe it is a difficult patient/new staff member or some other struggle that needs a team leader to step in. We also can query this data (as it is saved throughout our office days) by location, provider and appointment type. When everything is running smoothly we don’t need a lot of this data, but it is very valuable from time to time, such as evaluation time for registrars or when providers are thinking about tweaking their appointment templates.
Mona Reimers, MBA, CPC, FACMPE, MGMA member, director of revenue services, Orthopaedics Northeast, PC, Fort Wayne, Ind., mreimers@orthone.com
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