visit times result in a physician having less opportunity to see
more patients. While long session lengths may be appealing to
both doctors and patients, they will adversely impact productivity and financial performance.
In the ideal, patient visit lengths should be based on the
reason for the visit and as close to uniform as possible across
the organization or, at a minimum, within a particular practice
or specialty. Such decisions should be made jointly by management and relevant physician leadership.
The Number of Open and Same-Day Visits: Management
and physician leadership need to clarify, collaborate, and standardize same-day clinical appointments available for booking.
Practices with a large number of day-of-visit slots risk leaving
the openings unbooked and impacting productivity.
Poor Access to Care: While seen as a badge of honor by
some physicians, long wait times for appointments are highly
problematic for practices and adversely impact productivity
and the patient experience—not to mention the risk for denying patients needed clinical services. Patients may simply go
elsewhere or fail to seek or receive care. Open access models
may go a long way to both reducing patient backlogs and preventing their recurrence.
Causation includes an inadequate number of providers,
poor adherence to scheduling standards and required contact
hours, or providers who may not be seen as desirable choices,
either to the public or referring physicians.
Productivity Impacts Mostly
Under Physician Control
Physician-Directed Cancellations: While unanticipated
urgencies and emergencies do occur, there are times when
providers make last-minute schedule changes for less noble
reasons. Their direction to staff to “cancel my clinical session,”
often with short or same-day notice, disrupts the patient’s
need for timely care. While there are almost always good
intentions to rebook these visits, many simply never happen.
In addition, there is a significant and adverse impact on the
time of staff who are required to undertake such re-booking.
Denying Care to Late Arrivers: Patients arrive late, some
due to circumstances beyond their control, others due to
poor planning. Physicians who are rigid about providing care
to such patients, and avoid fitting them into their schedule,
not only deny potentially needed care but also adversely
impact their own productivity. Organization standards for such
patients are useful.
“Blocked Slots,” “Dummy” Patients: While relatively uncommon, these can represent insidious actions, often covert, which
become baked into a physician’s schedule. On the surface, all
appears well and that the provider is conforming to organizational requirements for patient booking, as well as available to
fill all schedule hours. Close inspection may reveal that this is
not always so. Surreptitiously, the physician has instructed the
booking staff to block slots on their schedules, often verbalized
as “catch-up time.” In more extreme cases, where physicians
have access to their schedules electronically or otherwise,
“dummy” patient names are sometimes observed.
The booking staff knows all about these games, routines,
and habits but are reluctant to call out physicians to senior
staff or the medical director.
Coding: Physicians are generally responsible for coding their
medical records (Levels I-V). Chronic under-coding is typically
seen as an issue for which the physician is mostly responsible,
particularly if there has been adequate auditing, organizational training, refresher programs, etc.
Annual coding audits should be routine for all providers,
particularly for new providers and certainly for those with significant coding variation compared to national norms. Reasons
for under-coding can be multiple (e.g., lack of training, fear of
over-coding, its attendant consequences, etc.).
Over-coding should not be ignored, as it presents a risk to
both the organization and the physician.
Unbilled Services: This can be perceived as a subset of
under-coding, but should be audited and monitored separately.
Physicians and the organization must be diligent to assure that
billing and coding take place for all services and procedures.