Do you control your schedule, or does your schedule control you? The appointment schedule is one of the most important tools in your office, but too often it's created haphazardly and left to chance. A poorly scheduled office is frustrating for patients and staff alike, and has a negative effect on your bottom line. With the advent of computerized scheduling, it is easy to have a more organized and efficient schedule.

I noticed two years ago that it was difficult for patients to schedule an annual eye exam for glasses or contact lenses. For the first time, there were no appointments available for several weeks in advance — the appointment book was just too full. The schedule was randomly filled every 15 minutes with any type of appointment. Contact lens checks, IOP checks, post-op visits, and everything else were scattered throughout the day, leaving little time for "routine" eye care. At the end of the day the staff and myself were worn out, but many times we felt like we'd accomplished nothing.

Family eye care was the lifeblood of my practice, and I could see that limiting patient access to comprehensive annual exams was jeopardizing our continued growth. While medical treatment is a large part of our office, the fact remains that 52% of our revenue is derived from our dispensary, so I wanted to generate eyeglass prescriptions. I also wanted to continue our growth in contact lens fitting and services. Telling a patient he must have his annual exam before renewing his contact lens prescription, and then informing him that there are no appointments available, is a good way not to build a practice.

Schedule by template

We decided to implement template scheduling. It has allowed us to "work smarter, not harder." Template scheduling allocates certain time slots for specific appointment types. We reserve enough slots for routine

eye care so most people can be scheduled within a few days. The remaining slots are allocated for contact lens checks, IOP checks, cataract post-ops, etc., and are grouped in several blocks throughout the day. Each office is different and has specific scheduling needs, but all can benefit with a logically-designed schedule. To start, I recommend reviewing the prior year's services. Count how many "short" visits you performed, including things such as IOP checks, contact lens checks, red eyes, etc. Double that number and have at least that many slots available on your schedule, broken down into three or four blocks each day. Use the remaining times for "long" visits such as routine eye exams and contact lens fittings.

Let's go through an example. The sidebar, "Quantifying Your Office Visits," shows the services a typical office might pro

vide in a year. This model assumes forty-nine five-day workweeks, allowing three weeks for holidays and vacation. You can see that our schedule must provide slots for at least 10.3 short visits, and 28.3 long visits per week. In this example we allow thirty-minute slots for long visits; all others visits are allotted 15 minutes.

Schedule short blocks

Our sample schedule demonstrates one configuration that will easily accommodate our needs. Having "short" blocks each morning and afternoon allows plenty of choices for contact lens checks and makes slots available for patients that must be seen that day. There will be some emergency patients that need to be worked in immediately, but in most cases patients can be scheduled at a designated appointment time. Also note the separate blocks for cataract post-ops Wednesday morning, and vision therapy Friday afternoon. Grouping similar patients at the same time is usually more efficient and can be correlated with staff schedules.

Also important to note is that we schedule multiple patients for the same exact time in our short blocks. For example, on Monday we have two appointments scheduled for 8:00 a.m., two at 2:00 p.m. and two at 4:00 p.m. Wednesday we have four scheduled at 8:00 a.m. Don't panic! The actual arrival time or complexity of the case dictates the order in which patients are seen. These short visits rarely require the same amount of time. For example, you might have a person who is returning for dilation and one who presents with a subconjunctival hemorrhage. It makes sense to see the hemorrhage patient while your assistant is dilating the other. Evaluate the number of patients (and their needs) scheduled in a given block of time and treat them in the most efficient manner possible.

High-tech advantages

Take advantage of your computer to maintain strict adherence to your scheduling rules. Our computer software prohibits the user from assigning the wrong appointment type to a given slot. One must first enter the reason for an appointment, and the computer searches for

the next available time that matches. Only certain employees are given the clearance to "over-ride," and that's only after a warning message is displayed. By setting up your template scheduler properly, it is possible for new employees to make appointments correctly.

Don't be afraid to save the "best spots" for your most profitable patients. Place your poorest-paying managed care plans and those prone to "no shows" in time slots that least restrict your ability to see cash patients. Don't forget it's your schedule and you should control it. Begin using your schedule, but realize that it is a work in progress. If you find yourself constantly adding work-ins or you have insufficient slots for certain appointment types, don't despair, simply change your template. If you have a well-designed template and you are still booked up weeks or months in advance, then you need to step back and reevaluate. It may be time to increase delegation, add staff or doctors, or perhaps drop some undesirable vision plans.

More than a schedule

Switching to a template-based schedule has allowed us to see more patients in the same amount of time, thus increasing profitability. Staff morale has improved since we are out on time for lunch and at closing time. Most importantly, patients receive their care in a timely and efficient manner. They appreciate that, and become enthusiastic referral sources for us.  And guess what?  We have appointments available!

Dr. Scibal is in private practice. E-mail him at johnscibal@cartervision.com.