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Reimbursement and Practice Management

Patient Access: Physician Delays

Unexpected provider delays or physician emergencies do arise.  They should truly be the exception and not the rule. When scheduled patients cannot be seen at the scheduled time, there are good and bad ways to deliver the news.

This article will provide information on ways to communicate with patients during unexpected provider delays and provide tips on medical office efficiency related to patient access.

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Unexpected physician delays or emergencies do arise. They should truly be the exception and not the rule. When scheduled patients cannot be seen at the scheduled time, there are good and bad ways to deliver the news. Follow these steps to keep the office on track.

  • A delayed physician should notify the office immediately.  And have a plan to make sure the news gets passed on. The front office endures the most of patients' frustration, so it's vital to keep those employees in the loop. Sometimes a nurse takes a call from a physician about a delay, then gets busy and forgets — or simply does not think to let the front office staff know. Set a policy to avoid communication gaps.
  • When possible, have a member of the clinical team go to the reception area and tell the waiting patients that the physician is delayed. Don't offer details about the situation (that would violate the patient's privacy), but do provide an explanation to garner the understanding of those who are waiting. If a nurse is not available, a receptionist can make the same announcement. Keep in mind, though, that patients often perceive the nurse or clinical person as a spokesperson for the physician. Yet the receptionist may be perceived as a gatekeeper.
  • Immediately give delayed patients the option to reschedule or wait. Simply having a choice will make patients feel less inconvenienced. Typically, if the delay is not extensive, patients will wait. If necessary, bring an extra employee to the front office to help with rescheduling.
  • If the delay is expected to be lengthy, the receptionist should inform scheduled patients who have not yet arrived. Give them the opportunity to reschedule or indicate that there will be a wait.
  • When the physician arrives, have them take a few minutes to stop by the reception area, apologize for the delay, thank patients for waiting, and indicate they will be with them as soon as possible.

With appropriate communication, clinic offices can effectively alleviate patients' frustration with unexpected schedule delays and maintain a level of patient satisfaction.

Pearl: Productivity

Naturally a clinic needs to make sure employees are as busy as possible. And assure they are doing the work that is appropriate for their positions. Well-staffed medical groups sometimes lose physician productivity because the staff is not working to capacity. This scenario can be the worst of both worlds — high overhead and low productivity. Don't just count bodies, measure productivity. One way to do this is to track employee hours per patient visit over time. Account for the total effort that employees commit to patients: billing, clinical work, referrals, telephone calls, scheduling, and reception. In general, practices find this number to be anywhere from 30 minutes to two hours per patient visit. Another staffing ratio is employee hours per work RVU. Measuring staff productivity over time may help determine the total amount of time invested in serving each patient.

Pearl: Cross-Training

Although everyone on staff should have a "measurable" role for which they are hired and held accountable, cross-training is essential in today's busy medical practice. By rotating roles periodically, employees with different perspectives can offer one another suggestions and tips related to the steps and processes of getting the work done.  If staff — from a nurse to a receptionist — knows that someone else will be responsible for their job tomorrow, it's a subtle way of optimizing performance. When employees resist the idea of another person doing their jobs, alarm bells go off.  It might mean that they think someone else could do a better job.

Pearl: Problem Solved

Review the lines of authority in the practice. Physicians like to make the final decisions about what occurs in their practices. That's good — but don't let that become an excuse for employees to keep doing things the "old" way. Doctors are too busy with patients to oversee every practice detail. Make sure employees (and perhaps even physician colleagues) feel empowered and know how to solve a problem.  This is easier if the employees are problem solvers, not merely chronic complainers.

Pearl: Expectations

Setting expectations for employees is a critical step to ensure a productive workforce. Put the job description in writing and present it to each person who applies for the position. During interviews with candidates, describe the position, as well as the practice, and encourage them to ask questions. A job opening is a great time to review and update the job description. Establishing written expectations about the job won't ensure results, but it will give the candidate a better understanding of the job's core responsibilities. It will provide a basis for discussing an improvement initiative if expectations aren't being met.

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