A structured appointment scheduling system can go a long way toward improving revenue and increasing patient satisfaction in a medical practice. The article, “Don’t Drown: Ride the (Modified) Wave!” in last month’s issue of AAOS Now explained the modified wave approach to scheduling patients as an alternative to the steady stream and the pure wave methods. 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.

To make the most of your practice’s appointment scheduling system, modified wave or not, keep in mind the following:

1. Every office, regardless of size, needs to set a metric for the number of days, on average, patients can wait to be seen. Doctors must agree on how many hours per week they want to see patients in the office. This will dictate how many doctors and clinical staff the practice needs to employ.
2. New patients should not be double booked unless allied health professionals (AHPs) are available in the office who can manage them before the doctor enters the exam room. Double-booking is problematic because the time required for new patients (and established patients with new problems) is unpredictable.
3. In a larger office, modified wave scheduling works best when a specific person is responsible for scheduling a subset of practice doctors. If several people are generally responsible for scheduling all practice doctors, modified wave becomes unmanageable because staff will find it difficult to keep physician preferences in mind.
4. Many large offices use one or two key appointment schedulers who look at the schedules of all the physicians and office from a “birds-eye” perspective. They look at which doctors in each subspecialty are available on what days, which ones appear to be over-booked (despite modified wave), and act as air-traffic controllers for urgent appointments.
5. If a doctor sees multiple types of patients, consider grouping them on a specific day. For example, workers compensation patients may be asked to come in on a Wednesday afternoon and independent medical examinations might be scheduled on Fridays.
6. To the extent that similar patients will have similar needs (in addition to being seen by the doctor and/or an AHP), their appointments can be scheduled at the same time. The doctor can then see one patient while the other one is having a radiograph or being screened for osteoporosis.
7. Immediately before and after a doctor has any extended time out of the office, reduce the number of routine follow-up appointments. The time should be reserved for new patients and returning patients with new problems. This will reduce the chaos that all doctors feel on the point of departure and upon their return.
8. Instructions for appointment scheduling need to be established by the doctors, set forth in writing, and clearly communicated to the staff who do the scheduling. Staff must understand which patients need to be seen immediately and which do not. This will require collaboration between clinical and nonclinical staff.
9. New patients, difficult patients, or patients with complicated problems should not be double booked at the beginning of the hour. Instead, their visits should be interspersed with others that are likely to take less time.
10. If a doctor will be seeing patients in an office for a full day, morning and afternoon hours should be clearly demarcated. Doctors need to arrive in the office on time and begin seeing patients immediately when they arrive. When these simple practices are not followed, there is invariably an adverse impact on patient flow for the rest of the patient day.

In addition, no one in the office should respond snidely or sarcastically to any patient. This applies to all staff members, not just those who schedule appointments. For the most part, patients are rude or abrupt because they are either in great pain, are dissatisfied with the way they are being treated, or both.

Staff must bear in mind that revenue from patients pays their salaries and act accordingly. They should attempt to defuse the patient’s anger and resolve the issue, rather than “up the ante” to have the last word. Angry patients are much more likely to file professional liability lawsuits. At the very least, patients who feel ignored and/or treated disrespectfully are likely to transfer their care to other doctors and to tell their friends about their experiences.

Steven E. Fisher, MBA, recently retired as manager of the AAOS practice management group.