Profitability comes in many forms, whether it’s managing the service mix you provide, the lab you use, specialty services you offer, or in concentrating on overseeing expenses. However, one area that often seems to come up in conversations with doctors is schedule management. It’s not usually the key point or focus of the conversation, but it turns there. For instance, a doctor will be inquiring about adding a specialty service to the practice, but unsure of how to build it into the schedule. We then begin talking about how their patients are scheduled, and it opens a Pandora’s box of crazy. I’ve talked to doctors at their wits-end because they never know what the day is going to bring them due to schedule variance, and usually, allowing someone else to dictate who is seen and when. Or, even worse, allowing a freely-open schedule to fill as patient demand dictates.
I will give you a breakdown of how schedule management works for me, and how it’s allowed me to grow a seven-figure practice while only working, on average, three days per week. Keep in mind, not all formulas work for every practice, but I would argue effective scheduling for any type of practice is vital to the bottom line…and usually, your sanity.
Create a template. Most EMR’s allow for a creation of a schedule template, which allows you to dictate the time between appointments, the appointment type, and what times the specific appointment type is allowed. What this permits in the back-end of administration time is the ability to predict what staff is needed, and when. For instance, if you have many glasses exams scheduled, you would ensure optical staff support is available. Conversely, in my office, if we are seeing specialty dry eye appointments, we need to ensure tech support is adequate for testing and delivery of the procedures, and can thus pare down on optical support staff at that time.
This also makes it easy for staff to know who to schedule and when. My EMR offers a look-up feature that allows staff to find the specific appointment type they need, and then offer several times and days to patients without having to toggle electronically between days and fumble through making an appointment. Additionally, our schedule ties in to an online schedule feature that allows patients to schedule their own appointments. We are not worried about them scheduling incorrectly because the availability is based on the template.
The best part of schedule template creation is the predictability and reduction of stress on both staff and doctors. You know what patients are coming, what they will likely need, and can prep yourself and office to smoothly deliver your services.
Pre-appoint, or pre-schedule. Many practices already employ some method of pre-appointing or pre-scheduling, but my point here is the management of that system. It does no good to pre-fill the schedule with appointments if there are no engagements with the patient to confirm those appointments. That will lead to many no-shows and possibly, confused patients. There are several key steps to pre-appointing:
Inform the patient you are doing so. I’ve been doing this for the 10 years my practice has been open, so my patients are used to our scheduling system. But a simple, "And we will put you on the schedule for your next year’s appointment around this same time, and let you know about that appointment about a month ahead of time," saves a lot of heartache and confusion. Add this phrase at the end of an exam. Patients will express if this is not what they prefer for scheduling, but I would say the majority of patients are very agreeable to our system. If this is new, don’t worry. Your patients will soon adjust.
Then, actually do it. One of the check-out tasks for my staff is to actually pre-appoint the patient for next year’s appointment. By simply putting them in approximately the same day and time a year from now, it makes it easy. When you wait to do so, you add several extra minutes of effort, as my EMR offers an easy way to pre-appoint within seconds. That staff time can add up, and the efforts to recall that "forgotten" patient can add even more staff time, and in some cases, disappointment by the patient. My patients have come to depend on us doing this to maintain their desired time for their exam, every year.
Make sure to confirm. We utilize an electronic confirmation system to confirm patients’ appointments. We first do this a month ahead of time. If the patient confirms, they then just get reminders of the appointment leading up to its time. If they don’t confirm, we try again two weeks prior to the appointment. If they still don’t confirm, we call and let them know they have 48 hours to confirm, or we will release their appointment slot. This ultimately results in 90% of our patients confirming or calling to reschedule, but not lose, their appointment.
What about those who didn’t come in? For those who didn’t make it to their pre-appointed eye exam, they filter into our "old-school" recall list. Meaning, they will be emailed and/or called to schedule an exam. If they totally opted out of the pre-appointing to begin with, they will also fall to this list.
What if demand is higher for certain days or times? We advise patients to keep their originally-scheduled time, but also offer a waiting list. In the event someone cancels, or even no-shows (which is rare), we can notify patients on this list of the desired slot that is now available. We have many grateful patients shift their appointments in this manner.
Remember, each patient who walks in the door is worth a certain dollar value each year. By maintaining a system of schedule management, having more predictable time intervals between patient visits, and effectively managing your staff’s time, you will build a more profitable practice. Take the following scenario as an example: If a patient comes to your office every 18 months because you are relying on them scheduling themselves once you remind them they are due vs. every 12 months via pre-appointing, they have a little more than three exams in a five-year time frame, rather than the expected five. That can add up to a loss of thousands of dollars for your practice over the course of time.
Although scheduling can come as a second thought to some, it is arguably one of the most important aspects of your day-to-day management. Doctor time is the most valuable time, so by managing the schedule, you can perhaps compress your schedule into fewer days, and still be just as (if not more) profitable. Or, see more patients in the same time frame if you so desire. Impart a system, allow your staff to embrace it, and your patients will, as well.
Gina M. Wesley OD, MS, FAAO owns and practices at Complete Eye Care in Medina, MN. Accolades include Minnesota's Young Optometrist of the Year in 2011 and the Early Professional Achievement Award from The Ohio State University College of Optometry in 2013. She is a member of the American Optometric Association, a fellow in the American Academy of Optometry and enjoys practicing, writing and lecturing in the industry. For questions or comments about this article, please contact firstname.lastname@example.org.