OPEN DOOR FAMILY MEDICAL CENTERS, INC. POLICY AND PROCEDURE. Appointment Scheduling RESPONSIBLE DIRECTOR: Chief Operations Officer

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1 OPEN DOOR FAMILY MEDICAL CENTERS, INC. POLICY AND PROCEDURE TOPIC: RESPONSIBLE DIRECTOR: AFFECTED DEPARTMENTS: AUTHORIZED BY: Appointment Scheduling Chief Operations Officer Patient Services, Nursing, Providers President & CEO APPROVED BY: Chief Operations Officer EFFECTIVE DATE: 12/23/97 POLICY NUMBER: V1-2-PC UPDATED (date and initials): 05/11/98 10/27/00 10/05/01 04/02/04 06/22/06 09/26/06 03/07/07 08/01/08 07/01/09 1. Statement and Purpose: The Center s goal is to provide a patient centered medical home for all primary care patients registered with Open Door Family Medical Center. All primary care patients are assigned a primary care provider (PCP) who is responsible for the care of the patient and together with his/her care team provides continuity of care. This model provides an on going relationship with a personal physician. The physician leads a team that collectively takes responsibility for the on-going care of the patient. The personal physician and team coordinate the patients health needs through all stages acute, chronic, preventive, and end of life. Care is coordinated and integrated across the health care continuum. Open Door has recognized that care coordination is enhanced by having same day appointment access, expanded hours, and ease of communication between patients and their physicians and care team. II. Significant Principles - Medical: When establishing provider templates the following guidelines are followed: 1. Appointment slots are assigned in 15 minute segments; some may require 2 segments - 30minutes, etc because of the visit type or procedure length required. 2. Every appointment should have a reason for the visit in the Reason section of eclinicalworks. 1

2 Formatted: Font: 3. The Center strives to schedule 28 patients per provider per day to ensure a minimum patient volume of 21 visits per doctor per day. This ratio is adjusted based upon specialty and show-rates by provider. 4. The following are marked or blocked out on the appointment template: All regularly scheduled provider meetings Lunch schedule for each provider Hospital rounds when applicable Any time the provider is scheduled to be off III. Procedure: Scheduled Appointments: 1. When scheduling patients, the staff member will request preferred day and time from the patient or will advise the patient of the next available appointment slots jjtieirrimcarefor thcir provider, All patients are encouraged to be seen by their PCP whenever possible but at least annually 2. In most cases, the number of PE, pap, immigration physicals, and new patient appointments per session will be limited to three per provider in the morning and three per provider in the afternoon. This can be adjusted at the provider s request or after consultation with the CMO. 3. New patients are asked to come in 20 minutes early to allow time for registration. 4. When scheduling an appointment, the following standards are followed: Patients seeking emergency care are transferred immediately to a registered nurse or provider if a same day appointment is not immediately available. Emergency care needs are defined by the patient. The nurse or provider will determine if the patient will be seen today at any Open Door site, scheduled for a future date or referred to the emergency department. Urgent medical or behavioral problems are seen within 24 hours. The same day appointments can be used for these requests, The staff will tfollow 4he guidelines from our same day appointment policy which have the following criteria: Formatted: Highlight Aria! Formatted: Font: Aria! 1. Non- urgent/routine a. Blood pressure or other screenings b. Chronic health problems such as controlled hypertension, controlled diabetes, arthritis 2. Urgent a. Reaction to food or medicine which causes swelling or itching b. Animal bites c. Domestic violence d. Sexual abuse e. Chest pain f. Trauma with swelling g. Bleeding from any cause h. Severe pain

3 i. Fever over 102 degrees j. Repeated vomiting and or diarrhea 3. Emergency a. Drug overdose b. Seizures c. Poison injury d. Heart attack or inability to breath 4. Guidelines for appointments: Emergency care- immediate care Non- Urgent sick visits- within 48 hours Routine, non urgent or preventive care visits- within 2 weeks Adult base line and routine physical within 4 weeks Initial visits for newborns to the PCP within 2 days of hospital discharge Initial family planning visits within 2 weeks Family planning visits for birth control, and Emergency Contraception are same day visit Non-urgent sick visits are seen within 48 hours Routine, non-urgent or preventative care visits are seen within 2 weeks. Initial prenatal visits are seen within the first trimester. If the patient enrolls during the second trimester the initial prenatal visit is given at the next available appointment time, but not to exceed two days after the positive pregnancy test Initial visit for newborns are seen by a primary care provider within one week after hospital discharge. Newborns shall receive priority scheduling to avoid excessive exposure to other patients in the facility. Patients seeking a medical clearance for pre-op should be scheduled 7 to 14 days prior to surgery. Hospital follow up visits should be scheduled within 7 days from hospital discharge. Initial family planning visits take place within two weeks, New mental health intake visits are scheduled by a provider or staff member and the reason for referral/visit documented in the appointment. The Department only accepts patients with self pay, Medicaid, Hudson Health Plan, and Medicare as their insurances. Mental health referrals from hospital discharges will not be accepted _unless the referral is screened by one of the mental health providers or _Director of Behavioral Health prior to an appointment being given. All managed care patients who cannot be accommodated within these _standards must be offered an alternative appointment with another -provider. 5. Calls to patients to confirm appointments the day before are made electronically using PhoneTree. Patients have the right to request no home contact or to

4 request a reminder call from a staff member in lieu of an electronic message. This request must be documented in ecw to avoid home contact. 6. Staff members must advise patients to bring their insurance card along with proof of income in order to be offered our sliding fee scale. Staff shall remind the patient that: Payment is expected at time of service The patient will be charged the full fee if the patient does not bring proof of income to substantiate sliding fee assignment. However, the patient may sign an attestation statement and be seen today The patient must be prepared to pay any outstanding balances at the next visit The patient will be informed of the Center s policies governing insurance _plans, including insurance forms, co-insurance and co-pays requirements 7. Patients canceling appointments are encouraged to reschedule at the time of cancellation. Cancellations are documented in ecw. The cancellation is noted in the patient encounters, and the Patient Recruitment and Retention Representative follows up as assigned. Same-day Access: 1. Each provider will have same-day slots on their schedule daily. These will be adjusted periodically based on no-show rates and seasonal demand. These slots are booked by phone on the day of the request, or when a walk in arrives at the facility. 2. Once all sameday appointment slots are filled, all additional requests for same-day sick visits require clinical judgment either from the provider or nurse in the unit. General Guidelines for appointments: Emergency care- immediate care Non- Urgent sick visits- within 48 hours Routine, non urgent or preventive care visits- within 2 weeks Adult base line and routine physical within 4 weeks Initial visits for newborns to the PCP within 2 days of discharge Initial family planning visits within 2 weeks Family planning visits for birth control, and Emergency Contraception same day visit Specialty Services: Women s Health Department 1. Routine gynecology, pap smears, menstrual complaints, sexually transmitted diseases, pregnancy testing and birth control visits are referred to the women s health providers. 2. Abnormal pap smears, surgical consultations, and gynecology procedures are scheduled by appointment with the gynecologist. 3. Prenatal visits are scheduled with the midwives, while prenatal intake is scheduled with the Patient Care Technician?. 4

5 HIV Testing Services High risk HIV patients are seen by the HIV Counseling and Testing staff. 2. Low risk HIV patients are seen by their POP. Podiatry Services 1. New patients and follow up podiatry appointments will be scheduled for a 15 minute slot unless noted by the provider. 2. Double booking one slot per hour is acceptable to accommodate demand and recognize no shows. Ortometry Services 1. Annual and new optometry patients are given 30 minute appointments. Insured patients may only schedule one annual exam per year. 2. Follow-up optometry visits should be 15 minutes in length. 3. Patients with eye injuries or foreign body in the eye should be sent directly to optometry for same day evaluation. Mental Health 1. A new patient to Behavioral Health Department should be scheduled for new intakes with a social worker and given a 30 minute initial appointment. 2. Initial psychiatric evaluation/assessment appointments may only be scheduled by a social worker following the psychosocial assessment. A patient may not utilize psychiatric services without ongoing treatment with a staff social worker 3. Follow-up behavior health appointments should be scheduled for 30 minutes and should be scheduled with the same provider each time. 4. Follow-up behavior health appointments may be 60 minutes in length, but only at the request of the provider. Dermatology 1. New patients and follow up appointments will be scheduled for a 15 minute slot unless noted by the provider. 2. A dermatology procedure should be scheduled using a 30 minute appointment. 3. Do not double book dermatology slots. Nutrition Services 1. Diabetic patients should receive two 30 minute visits two weeks apart unless otherwise specified by the nutritionist. 2. All other nutrition visits should be 30 minutes in length unless specified otherwise by the nutritionist. IV. Distribution: Administrative Manual V. Evaluation: This policy will be evaluated by the COO annually for compliance with the policy and procedure. VI. Review/Revise: This policy and procedure will be reviewed annually by the COO. Any revisions or updates will be based upon professional organizational standards, operating guidelines, and recommendations of provider staff or oversight agency.