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Using a modified wave system leaves time at the end of the hour to accommodate emergency or walk-in patients or to enable the physician to catch up on documentation.Couresty of Thinkstock

AAOS Now

Published 2/1/2012
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Steven E. Fisher, MBA

Don’t Drown: Ride the (Modified) Wave!

Scheduling system improves patient flow, reduces physician down time

How much do you know about the way appointment scheduling really works in your practice? Many orthopaedic surgeons are simply content to have a steady stream of patients whenever they are in the office. However, failing to implement a structured appointment scheduling system can result in both dissatisfied patients and lost revenue.

Many medical offices use the “wave” method to schedule appointments. For example, an office might schedule six patients at the top of every hour, or two patients on the hour, two more at 20 minutes after the hour, and two more at 40 minutes after the hour.

Obviously, the exact number of patients a doctor might see per hour depends on his or her specialty and the number of allied health professionals (AHPs) in the practice. However, the basic concept of “cramming” (that is, filling all available slots) remained the same for years. The only differentiation was that some practices allocated a longer period of time for new patients than for returning patients, always a wise course of action.

Unfortunately, this method of scheduling does not take into account “no-shows” or patients who might need to be seen on an emergency basis. With regard to emergency patients, practices typically follow one of two courses of action: (a) they insert emergent patients at the beginning or in the middle of an already full schedule, or (b) they make the patients wait until the first opening, which in many cases might be as long as a month in the future.

Both of these courses of action are problematic. Inserting patients in a full schedule almost always means that the schedule will back-up later, causing the doctor to run late and patients to wait for an unacceptably long time, which may compromise quality of care. Furthermore, patients who are in extremis are likely to end up seeing a physician in another practice who can meet their needs on a more timely basis.

Even so, many practices cling to the traditional way of appointment scheduling because they do not know how to do it differently. The result is stressed office staff, lost revenue, and angry patients.

A modified wave
An alternative to the steady stream and the pure wave methods of scheduling patients is “modified wave” appointment scheduling. With this approach, more than one patient is scheduled at the beginning of each hour and the end of the hour is left open, enabling the physician to catch up, if necessary.

Before implementing such a system, the practice first needs to look back at how many patients the doctor has seen in the office over the past few months and how many hours he or she spent in the office seeing them. The practice also needs to monitor how many patients, on average, canceled and how often patients called needing to be seen at short notice. Finally, the amount of time the doctor spends documenting care needs to be tracked, whether this documentation is done in the exam room or at the end of the day.

Collecting this information is not an easy task. However, the data do not need to be completely accurate; an approximation will serve quite well, and the practice can fine-tune the system over time.

Once this information has been gathered, office staff can develop a schedule for the doctor that “plays the odds.” For example, if the doctor averages seeing six patients per hour, and if on average there is one no-show and one walk-in per half-day, then that doctor’s schedule can be filled completely, with the walk-in canceling the no-show.

If, however, the doctor has two walk-ins and just one cancellation per half-day, then at least one slot needs to be left open. (The example assumes no AHPs assist the physician but it can easily be “tweaked” to the extent they do.) This approach will not work every day, but statistically speaking, it will work more often than not.

Offices may wish to create two types of walk-in appointment slots: one for visits from either new or return patients with new problems and one for follow-up visits that may just last only a few minutes.

Without question, some days will have no cancellations and more walk-ins than have been allowed for in the schedule. This is certainly less than ideal. However, under the traditional “wave” approach, where patients are bunched up and there are no breaks, the situation would be much worse—very long patient waits and a much longer day for the doctor. With the modified wave approach, however, if no one calls in needing to be seen on a given half-day and someone cancels, the doctor can finish his or her administrative work and perhaps even leave the office before the usual time.

Many practice management systems have appointment scheduling modules that allow for modified wave scheduling. Orthopaedists should look into the feasibility of moving in this direction for their own benefit and that of their patients.

By implementing modified wave scheduling, orthopaedic practices will significantly improve patient flow, improve revenue, reduce doctor and staff stress levels, and increase patient satisfaction.

Steven E. Fisher, MBA, was manager of the AAOS practice management group until his retirement in December 2011.