Capacity, Creating and Managing

Understand Your Scheduling Horizon

Data show that the farther out an appointment is scheduled, the more likely the patient will not show up or cancel. Rework is the rate at which appointments are rescheduled due to patient cancellations, patient no-shows or PICs. In general, appointments booked 3 months out or more result in at least 50% rework rate.

• Use IPORT reporting to identify appointments that result in a 50% or higher rework rate.
• Do a deep analysis for trends by provider or visit type to understand any variations or outliers.
• Identify the types of visits that are regularly scheduled beyond the horizon.

Leverage JIT Scheduling

• Understand the current mix of appointment categories (e.g., new, follow-up).
• Use Blocks in the system to ensure that enough space is held for Recalls patients.
  • Consider making blocked time available a fixed number of days or weeks prior to the appointment date.
  • Consider using time-release Blocks that allow a particular slot to be used for any visit type during a fixed number of days prior to an unfilled appointment date.

Implement the MGPO Provider-Initiated Cancellation (PIC) Policy

PICs negatively impact the patient experience and consume practice resources. On average, it takes 5 to 7 minutes to rework each PIC, and in a high-volume practice, this can amount to many hours a week.

Per the MGPO PIC Policy:

• Non-emergent PICs will be submitted to the practice manager or appropriate practice representative, who will make suitable changes to the provider’s schedule.
• Schedulers will work with the provider to offer appointments ideally within 14 days, but no more than 30 days after the original appointment date.
• Practice managers will minimize overbooking to accommodate patients.

The transition to JIT scheduling can be used in conjunction with the PIC policy to ensure that the schedule is aligned with the policy. In addition:

• Develop strategies for rescheduling patients.
• Empower staff to offer service recovery to patients.

Utilize Cadence Wait List

Leveraging the Cadence Wait List offers multiple benefits: staff are prompted to go to the Wait List when an appointment is cancelled, and patients are automatically removed from the Wait List once their original appointment date has passed.

Once you understand your pending new patient volume and average pending wait days, and develop a strategy for using the Wait List that prioritizes new patients and those with urgent needs:

• Train staff on procedures to add patients to the Wait List and how to run the Wait List.
• Explore FastPass, an Epic tool that automates the Wait List.
• Review the Wait List Tip Sheet.

Increase Arrival Rate

Approximately half of scheduled appointments are “not arrived.” It is important to increase the arrival rate to both reduce rework and maintain full provider schedules. Once you have reviewed and understand no-show, same-day cancellation, and fill-rate trends and outliers:

• Use IPORT reporting to identify cancellation trends.
• Implement TeleVox to automate reminder calls and texts, and actively monitor associated reporting.

Lengthen Follow-up Visit Intervals

Once you understand follow-up visit intervals and trends, develop condition-based recommendations. Consider lengthening follow-up intervals to open appointment slots for new and urgent patients. For example, if a provider regularly asks patients to return for 3-month follow-ups, consider moving them to 4- or 5-month follow-ups if clinically appropriate.

Offer eConsults

Providers often need to consult with a specialist to determine next steps related to patient diagnosis and care. eConsults are requested electronically via Epic to enable referring providers to discuss a patient’s care with a specialist without the patient being seen, freeing up capacity in the specialty practice for more clinically appropriate patients.

Once you have determined the types of referrals that may be appropriate for an eConsult and which physicians can respond to an eConsult request, leverage the Population Health Management team to discuss implementing an eConsult program.

Utilize Virtual Visits

For practices where demand exceeds physical capacity, virtual visits may be an alternative way to see patients in a non-clinic space rather than in an exam room. See the Virtual Visit Toolkit.

Reduce No-Shows

A no-show is a patient who does not show up for a scheduled appointment. No-shows should be properly noted in Cadence. Prior-day and same-day cancellations should not be treated as no-shows.

• Aim for a no-show target rate of <3%.
  • To calculate your no-show rate, divide the number of no-shows by the number of all booked appointments.
• To reduce no-shows:
  • Send appointment reminders 3 days in advance via TeleVox phone call, text message or personal call.
  • Conduct a monthly review of your no-show and late cancellation reports to identify trends and chronic no-shows.
  • Conduct a monthly review of PIC reports.