Department of Medicine Scheduling Guidelines Version 2.0 Created: January 15, 2009 Approved by: Edward Abraham M.D. Nancy Dunlap, M.D., Ph.D, MBA 1
Appointment Availability Emergent Care same day if indicated, but within 24 hours of request for new and return patients. Emergent care and treatment options should be coordinated through the attending physician and should not be delegated to support staff. Priority Care within 72 hours if indicated. If the referral is made through another physician, the attending physician should notify the referring physician of the steps taken in caring for the patient. Likewise, if a UAB physician is requesting a referral from another UAB physician, the referring physician should make contact with the consultant. Routine Care within 15 working days/21 calendar days Each practice pod or clinic will define criteria for determining emergent/urgent and routine care to assist staff in proper triage. Each section/specialty will have an attending physician available to see patients in clinic for urgent/emergent outpatient care Monday-Friday from 8AM-12PM and 1PM-5PM. Each division/department will have a single telephone number for appointments, hospital admissions and consults. To ensure that insurer s referral process is followed correctly, staff will verify insurance plan and referral requirements at the time of appointment scheduling. The MSO will provide staff with training and updated materials to verify that the correct referral process is being followed for the patients health plans. A Medical Director will be designated for each ambulatory and in-patient clinical unit who will be accountable for compliance with access standards, efficiency, and quality of care given at each practice site. 2
Scheduling Guidelines: DOM Practice Standards In order to improve patient access, guidelines to manage and utilize the provider schedules have been established. The purpose is to provide efficient scheduling processes, increase patient volumes; decrease days to appointment wait times and reduce scheduling errors. Provider Sessions A minimum of 8.5 appointments should be scheduled per session. Provider schedules should be defined with specific protocols that reflect the provider s current scheduling patterns. However, the schedules should provide flexibility to allow more appointment type choices within 72 hours of the appointment date. Open slots on the provider schedule should be filled rather than frozen or closed to prevent additional appointments from being scheduled. Physicians Closing/Cancelling Clinics (resulting in Bumped Patients) Physicians should cancel a clinic as far ahead of the date as possible to minimize rescheduling appointments. The minimal acceptable lead time for closing or cancelling a clinic will be 30 days. A physician will be allowed to cancel x % of scheduled clinics without providing a make up clinic each year. Exceeding the allowed % of canceled clinics without make up clinics will be reported to the Medical Director and the Division Director. A regular report will be provided to the Chair of the Department. This information will be considered in a physician s performance appraisal. A rescheduling fee for clinics closed with less than 30 days notice may also be considered by the division. Clinic may not be closed/cancelled with less than the required notice except for emergencies (illness, death in family, etc). If clinic is cancelled, it is expected that the provider will have a make-up clinic within 2 weeks of the original appointment date (either before or after the closed appointment date). Clinic closings/cancellations and violations of this policy will be tracked and reported routinely by the Clinic Director to the appropriate levels of physician management (Medical Director, Division Director, Chair of the Department). 3
Scheduling Activity Scheduling activity will be performed by trained staff in the Department of Medicine Scheduling Office or by clinic staff. Activity includes but is not limited to: scheduling new and return appointments, medical record tracking, rescheduling appointments from the Wait List, mailing new patient letters, reminder calls to patients, follow up on no-show appointments, rescheduling of bumped appointments. Support staff located in the clinic or in the academic office will have view only access to the physician schedules. Freezing Slots/Clinics Frozen slots are acceptable on a provider schedule in order to: 1) Place a hold on a day that may need to be closed/cancelled. Freezing the clinic will prevent additional patients from being added to the schedule and possibly being rescheduled. Clinics frozen for this purpose will be set to release/open within 14 days of the appointment date. This will prevent frozen clinics from being overlooked and under booked. 2) Save a slot or two for work-in patients or same day appointments. The intent is that all frozen slots will be booked with an appointment. Frozen slots for this purpose will be set to release the day before the appointment date. Overbooking Policies Appointments may only be overbooked with the direct approval by the physician, nurse or secretary. The scheduler must receive the approval for overbooking in writing (email accepted) from the physician, nurse or secretary or the scheduler will confirm the approval to overbook to the physician, nurse or secretary in writing. Documentation regarding the approval to overbook will be noted on the appointment in the GE/IDX Scheduling system. Documentation will also be kept on file for reference. 4
Scheduling Open Slots Clinic schedulers will have the ability to fill any open slot prior to the appointment date. Notification of appointments scheduled with less than 24 hours notice or for the next day, will be emailed to the secretary so that appropriate forms can be prepared and charts can be pulled. Same day appointments will be approved by physician, nurse or secretary only. Appointment Slot Gaps Clinic schedulers will review physician s schedules after the ClientTel reports have been reviewed and appointments have been cancelled (typically 72 hrs prior to the appointment date). If time slot gaps are present on the schedule, the schedulers will attempt to fill these slots using the following options: Contacting patients on the Wait List to fill the slot Adjusting the schedule to make room for additional new patient appts if appropriate. Wait List Schedulers will make every attempt to fill open slots with appointments on the Wait List. The guidelines for scheduling appointments from the Wait List will be followed. Adjusting the Schedule to Avoid Gaps If open slots are not able to be filled with appointments from the Wait List, the schedulers will attempt to close gaps by adjusting patients to a different slot, making room for a new patient slot. Reminder Calls Every clinic will perform reminder calls to patients prior to the appointment date. These calls can be automated using the ClientTel system or they can be performed manually. Automated Calls - If the automated system is used to perform reminder calls, the following process will be followed to manage the call results: 1) The results report will be reviewed by a clinic scheduler the day after the calls are performed. 5
2) Patients that selected the CANCEL option will be called to confirm the cancellation of the appointment and to offer the patient the option to reschedule. If a voice mail/answering machine is reached, the clinic scheduler will leave a message informing the patient that per their response during the auto call process, the appointment has been canceled. The clinic scheduler will document the cancellation in IDX and cancel the appointment. 3) Appointments that had a response of DISCONNECTED, NO ANSWER, etc will be called again by the clinic scheduler to confirm the appointment. The clinic scheduler will record the result of the follow up attempt on the results report. Manual Calls If the clinic chooses not to use the automated call reminder system, then manual reminder calls must be made. 1) Calls should be made consistently for appointment types using a print out of a current provider schedule 2) Calls should be documented on the provider schedule After the call reminder reports have been completed, the clinic scheduler should try to fill any open slots created by cancellations by contacting patients who are on the Wait List (see Appointment Slot Gaps) Reminder Appointments Follow-up appointments requested by the physician at the time of service should be scheduled as a reminder appointment if the follow-up period is more than 6 months in the future. Reminder appointments are not actually scheduled to a particular date/time but are placed on a list for a particular return period. Patients will be notified 1-3 months before the follow-up period that they need to schedule an appointment. Using reminder appointments rather than scheduling actual appointments 6 or more months in the future, will reduce the number of bumped appointments that occur when a provider changes the master schedule or a daily schedule. Reminder appointments may also reduce the number of patient cancellations as appointments would be scheduled closer to the actual appointment date rather than 6 or months in advance. 6