Provider flexibility has trade-offs with scheduling costs and complexity

12 Nov The Only 3 Ways to Address Patient Scheduling Errors

REMOVING ERRORS MAY REQUIRE TOUGH CHOICES

 

Patient scheduling has always been difficult. During COVID it became a real nightmare for some, as changing scheduling practices led to confusion, increased scheduling errors, and no shows at a time when providers are trying to get accustomed to new technology and a new way of handling visits. From a high-level, there are 3 strategies to scheduling that determine how likely errors are to occur. The tactics that each provider organization takes will depend on those strategies.

 

The law of scheduling

 

Getting scheduling right comes down to decisions on how to balance scheduling complexity. On one side, there are the differences between providers and the flexibility they have in determining their own schedules, visit requirements, and methods of practice. On the other side sits the expense of longer training times for scheduling staff and the errors that arise from trying to consistently get complex scheduling right. Whatever choices your organization makes, these two side must balance. It is a law of scheduling nature.

 

The law of scheduling flexibility/complexity – the flexibility given to providers must be offset with costs of complexity on the part of schedulers. Greater flexibility means greater complexity. Less complexity means less flexibility.

 

There are natural costs to complex scheduling that cannot be avoided. They must be managed or automated.

 

There are three, and only three, ways of addressing this dilemma:

1

 

Spend the costs necessary to support scheduling flexibility and provider variability

 

      1.  

2

 

Standardize scheduling to reduce costs, at the expense of provider flexibility

 

 

3

 

Invest in scheduling automation that reduces scheduling costs and errors while maximizing provider flexibility

 

Scheduling complexity can easily grow exponentially

A Schedule’s complexity is driven by the number of items that must be considered when scheduling an appointment. The more items to consider in a schedule, the more complex it is.

Some items that tend to influence a schedule’s complexity may be:

 

  • Varied or inconsistent provider scheduling preferences
  • Varied or inconsistent scheduling workflows across visit reasons
  • Different scheduling workflows for new or existing patients
  • Prioritization of certain providers for a visit’s reason

Scheduling is more complex than it first appearsHere are a few examples:

 

  • Some physicians prefer to only see Male or Female patients
  • Some physicians only see adult patients
  • Annual checkup appointments must be scheduled at least 365 days since the last annual
  • New patient appointments are 20 minutes in length while existing patient appointments are 15 minutes long
  • A physician only wants to perform physicals from 9-11 AM on Fridays
  • New physicians should be preferred when scheduling new patient appointments
  • Prioritize high acuity and high profit visit reasons for short term appointments, while scheduling low acuity and low-profit visit reasons further out.

These are just the tip of the iceberg. All these examples are of the variability you get with a single provider or a single appointment type.

 

Multiply this complexity across all an organization’s single-appointment types.

 

Then there are the multi-resource schedules that involve perhaps a machine and a technician or a provider and an anesthetist. Multiple requirements must be taken into account for these.

 

Then there are sequential schedules with rules on the sequences, and the variability between providers on how these are handled.

 

Then there are the complex schedules that combine these. For example, the patient may first need a pre-op visit with intake and an anesthetist. Within a specified window of time, a scan is scheduled where multiple resources, including equipment and radiologist are available, followed by a recovery room and then a post-op visit with a provider. Sometimes these might be specified as being same-day or next day.

 

Take one mental health practice as an example. They have 72 primary diagnosis and 73 secondary diagnosis possibilities that combined determined the visit type. In addition, they have 4 service types, different rules for established vs new patients, and 160 provider preferences to account for. The total individual combinations is nearly 7 million!

 

It is no wonder that schedulers are forced to rely on reference materials for scheduling. It is very common to have books, or PDF documents, or even a SharePoint site dedicated to maintaining scheduling criteria across all visit types, all physicians, and most insurance types. The scheduler is then navigating unwieldy documents that are 50-100 pages long in the middle of the scheduling process.

 

complexity drives costs

Training - It takes weeks of training time to get schedulers up to speed on this complexity. The rule of thumb we’ve seen is that 10-15 pages of documentation equates to a week of training. That means that many practices are training their schedulers for 2, 4 or even 6 weeks before they can let them handle live requests.

 

Recurring overhead - This training is not a one-time expense. Scheduling is a high-turnover field and every new provider or new piece of equipment has the potential for adding more variables. This means documentation must be maintained, training must be maintained, and QA practices continually reinforced or expanded.

 

Cost of errors - The other expense is the scheduling disruption due to delays. Due to the complexity of scheduling, schedulers always make mistakes for weeks and months afterward until they have a chance to internalize most of these detailed rules. This results in schedules that need to be reviewed, patients that need to be called, scheduling gaps that cannot be filled, and increased no-shows as a result of errors or communication.

 

Other expensive problems associated with scheduling complexity:

  • Reduced predictability of scheduling
  • Increased burnout of schedulers. The average industry turnover rate for schedulers is more than double the average for all US occupations

benefits of Provider scheduling flexibility 

While these costs are tremendous, the benefits for maintaining a flexible schedule are also tremendous. Providers gain the following benefits for having the flexibility to determine their own schedules:

 

  • Providers shape their own schedules.
      • Less burnout by providers
      • Better recruitment
      • Increased engagement
      • Improved provider satisfaction

You may notice that the problems and the benefits accrue to different individuals. The benefits of flexible scheduling are experienced by providers. Increased appointments filing schedule gaps, etc all benefit the provider.

 

The problems are experienced by those managing the provider’s schedule. The extra time, costs, and effort in making corrections are born by operations, practice managers, and their non-clinical schedulers.

 

resolving the scheduling challenge

There are 3 choices for balancing scheduling flexibility and complexity:

1

 

Reduce the complexity and standardize

If the costs of scheduling are just too much for your organization, you may have to suffer the hit to provider satisfaction and burnout in order to reduce the costs and overhead.

2

 

Embrace provider flexibility

If you cannot risk provider satisfaction, then you need to address the costs to supporting flexibility in order to maximize provider recruitment and satisfaction.

3

 

Support provider flexibility by automating the complexity

For a fraction of the costs of complexity, provider organizations can setup Intelligent Scheduling, to encode the complexity into software without putting the burden on schedulers.

 

1. reduce the complexity and standardize

StandardizeStandardizing scheduling reduces the burden and overhead. It removes provider choice in order to reduce errors and expenses. To start the standardization work, the organization typically forms a panel whose responsibility is to define the following

 

  • Set a standard weekly schedules
  • Reduce the number of appointment types
  • Standardize visit lengths across all appointment types, visit reasons, providers, and patients. Use either a single visit length across all appointments or use two visit lengths and split your visits into “short” and “long” appointments
  • Reduce or eliminate scheduling preferences by visit reason or provider

The benefits of doing this are that fewer staff are needed to maintain documentation, to QA schedules, and training can be drastically reduced. Scheduling consistency means fewer errors and gaps in the schedule.

 

The problems with this are that individual providers lose their flexibility. Provider engagement decreases and burnout increases. This has its own impact on the revenue and provider retention.

 

2. support provider flexibility with full schedules

Flexible & full schedules add costsOf the costs for flexibility, the ones most important are those that impact the schedule. The goal here is usually to allow for provider self-determination while keeping the calendar full. This requires:

 

  • Clearly document provider and visit reason preferences in an easily searchable and shareable document. Keep this maintained and updated every month
  • Employ quality assurance (QA) staff to validate scheduled appointments and resolve scheduling errors. Errors need to be corrected as quickly as possible by reaching out to patients. Despite their best efforts, some scheduling gaps will invariably be created. A process should be established that works with schedulers to quickly fill these gaps with new appointments or have the QA staff reach out to other patients to offer to move their appointments earlier into the newly emptied slots
  • Establish continuous coaching on an individual level to review scheduling rates, scheduling errors, and areas for improvement
  • Setup a periodic training/retraining schedule to keep the entire team updated and to decrease the frequency of errors

The benefits of this approach are that a process exists for encapsulating practice and provider requirements. This process delivers these requirements to the schedulers, updated regularly, with a QA process that ensures the provider the calendar is filled.

 

The costs of this approach can be substantial. There is overhead in maintaining the documentation, overhead in employing the QA personnel, and overhead in the ongoing training and retraining. Because of this, there is almost always ongoing tension as the providers want the benefits without the burden of the full costs. The law of scheduling complexity states that the costs WILL be paid somewhere, and if the overhead is too expensive, then the impact will be felt in the provider’s schedule.

 

3. embrace flexibility without complexity using automation

Scheduling automation removes complexity and cost

By letting an application handle the complexity, you remove the perceived complication by the schedulers. The automation uses advanced logic to handle huge combinations in conjunction with your practice management system. Practice management systems provide scheduling support, but do not provide this automation.

 

  • Utilize Intelligent Scheduling integrated with your practice management system which lets you automate your scheduling workflows and preferences
  • Specify your scheduling workflows, visit reasons, and preferences within the intelligent scheduling solution
  • Migrate schedulers to the intelligent scheduling solution. Due to reduced complexity and automation, a scheduler can be trained in a fraction of the time

Complexity is greatly reduced on the behalf of schedulers, since preferences, scheduling workflows, differences between new and established patients are all factors that are automated by the software.

 

Training is slashed to a quarter or a third of the time. This allows other roles besides schedulers to also be training in scheduling, giving your organization options during high call volumes and reducing the costs of scheduling. Errors are avoided. Even after training, schedulers always make mistakes for weeks or months after landing on the floor. With intelligent scheduling, most of those errors disappear, since the complexity is guided by the software. No full-time QA is needed for calling patients or checking for errors.

 

Add Patient Self-Scheduling to filling empty schedules automatically with wait lists, letting patients schedule themselves, reschedule themselves across your entire calendar

 

Breaking Down Silos with Automation

Once scheduling is automated, it is so simple that other roles can be trained. Our clients train other non-clinical and even nurse roles in scheduling. This improves patient satisfaction, as they are no longer being forwarded to someone new whenever they need to schedule. This improves operations as the organization has overflow options. Crucially, it also serves to cross-train others and break down silos, which is a critical step in developing a mature telehealth practice.

 

you can't change the laws of scheduling

The trade-offs that exist between a provider’s choices and the expenses born by schedulers is not something that can be changed. There is a balance that is part of the nature of complexity. This trade-off can be used to justify hiring that full-time QA role to check for errors and keep the schedule full or perhaps to begin to standardize all providers' schedules, or perhaps invest in intelligent scheduling tools to make it all easier.


Posted by Stephen Dean

Stephen Dean
Stephen first built his career in information technology. He left his philosophy major to work as a developer for Hewlett-Packard and then moved on to 3 consecutive startups, one of which grew to 150 employees before acquisition. Stephen received his MBA from the Duke University School of Business before co-founding Keona Health. At Keona Health, he directed all facets of finance, marketing and operations.

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