Creative Scheduling (Full Version)

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jmattox -> Creative Scheduling (August 29, 2007 4:54:08 PM)

Hey there.  I'm interested if anyone has some helpful hints regarding scheduling patients.  Currently, I run a clinic with 3 PT's and 1 PTA.  We have 1 hour evals and 30 min. time slots for f/u's.  To counter our high cx/ns rate, I'm thinking of piggybacking another f/u or "walk-in" pt. on the last 15 min. of the eval.  What are others doing to offset their cancellation rate and shrinking reimbursements?  Your advice is greatly appreciated!

Jason Mattox, MPT, OCS



orthotherapist -> RE: Creative Scheduling (August 29, 2007 5:42:28 PM)

First of all I would try to address the no show/cancel rate.  What is your current cancel/no show rate?  What do you currently do to minimize this rate? 

I learned that tracking each therapists cancellation rate was helpful.  I found that some were being told by their patients that they would be unable to make their next appointment.  The therapist would "forget" to tell the front desk staff (in this case it was on purpose so that they would have more free time during the day). 

You can then learn from the therapist with the lowest rate what they are doing to minimize rates and piggyback off of that.

As always get staff input prior to making changes - get their buy in and let them know what may happen should the rate continue to be high. 



OAK -> RE: Creative Scheduling (August 29, 2007 8:20:44 PM)

We book 30 min for a new eval. and 15 per f/u.  It works pretty well.



jmattox -> RE: Creative Scheduling (September 2, 2007 12:04:13 AM)

Thanks for the input!  Our cancellation rate runs about 4-5/day.  We have a "wait list" usually, but may only be able to capture 1 from the list.  Getting staff to buy in is also a big challenge with any changes.
          



Kaden -> RE: Creative Scheduling (September 2, 2007 7:30:42 PM)

OAK,

How to you staff your clinic if doing 30 minute evals and 15 f/u.  Seems tough to do a quality eval in 30 unless you are not treating them as well on that day.  With 15min f/u I assume you are using aides or assitants to make this work.



FLAOrthoPT -> RE: Creative Scheduling (September 3, 2007 9:47:52 AM)

and no medicare



OAK -> RE: Creative Scheduling (September 3, 2007 11:14:42 AM)

quote:

ORIGINAL: Kaden

OAK,

How to you staff your clinic if doing 30 minute evals and 15 f/u.  Seems tough to do a quality eval in 30 unless you are not treating them as well on that day.  With 15min f/u I assume you are using aides or assitants to make this work.




Treatment and assessment are always done in one session, no aides or assistants used.  This question has been brought up with me before on this board.  I have always booked this schedule as do all other clinics in my area.  For me, 30 min is more than enough time, I don't believe I would be able to take up 60 for an assessment if I tried.

Quality of treatment should not be measured by how long the patient is in the clinic.



Kaden -> RE: Creative Scheduling (September 3, 2007 5:56:54 PM)

Everyone evals at different speeds but I would argue there is no way you are providing a patient with a complete eval PLUS intervention if only using 30 minutes. 

Evals aside, how can you possibly effectively treat a patient in 15 minutes for subsequent f/u's if not using aides or assistants.  I would assume you are treating managing multiple patients at a time and not treating medicare.

This is not meant to be an attack on your scheduling or treatment style - I really am just curious how you pull it off b/c obviously for revenue and absorbing cancel and NS your system would be much better.



OAK -> RE: Creative Scheduling (September 3, 2007 7:24:31 PM)

quote:

ORIGINAL: Kaden

Everyone evals at different speeds but I would argue there is no way you are providing a patient with a complete eval PLUS intervention if only using 30 minutes. 

Evals aside, how can you possibly effectively treat a patient in 15 minutes for subsequent f/u's if not using aides or assistants.  I would assume you are treating managing multiple patients at a time and not treating medicare.

This is not meant to be an attack on your scheduling or treatment style - I really am just curious how you pull it off b/c obviously for revenue and absorbing cancel and NS your system would be much better.


First of all, I'm from Canada so no medicare.  A patient will spend an hour in our clinic on average, so yes I am managing multiple patients, usually 4 or 5 at once.  While I'm doing one to one with a patient, the remaining patients are on modalities or are doing exercise.  I average about 30 pts per day in an 8 hour booking day, we rarely have N/S, maybe 1 or 2 at most per day.  If a complicated patient attends our clinic that needs alot of one on one they will be refered out, however this rarely happens.  The majority of patients attend our clinic through word of mouth, so I know we are providing quality treatment. 



Sebastian Asselbergs -> RE: Creative Scheduling (September 3, 2007 9:07:14 PM)

OAK, I am with you with regards to assessments. Almost NEVER need to book more than 30 minutes. History is BIG, very few tests (for red flags and such).
My treatments are mostly education, education and some manual work (from neurodynamic to postional to the rare manip). Patients generally rebook for review, retest and modify home work.  2 or 3 times. Occasionally use acupuncture as well.  Have about 15-18 new ones a week. This includes about 30% chronic pain patients - even they don`t get more than 30 minute evals.  Or more than one visit per one or two week follow up...
BTW, I am doing MANY 15 minute sessions for follow-up.   remember that my caseload is kind of self-selecting by now: I don`t do worker`s comp, many elite athletes  (don`t need me to supervise their gym work-out and exercises), many chronic pain folks, and many spinal pain conditions. 
This works really fine and the word keeps getting around - after 13 years in this clinic (and 21 years in this town), my new patient load is as heavy as it has ever been.  But much fewer sessions than 13 years ago.... I am happy with a busy day of 24-26 patients (including 2-6 half hour assessments).

Less than 2 cancellations a week.

BTW - I am also in Canada.



jlharris -> RE: Creative Scheduling (September 3, 2007 10:41:57 PM)

Maybe as I gain experience I'll change, but right now I'm uncomfortable having 3-4 pt's wait for me to make the circuit back to them as I'm working with another.  Sure they can do their exercises, but if they don't need me to watch them, then why should they be in my clinic paying me to help someone else on their time?  I think I'm the exception though.  Most PT's I work with don't express much problem in seeing multiple pt's at the same time and charge them for the time that they don't have with them one-on-one. 

Although it seems like it, I haven't made a judgement on what I think about the ethics of this.  Again, I need more time I think.



Sebastian Asselbergs -> RE: Creative Scheduling (September 4, 2007 6:24:52 AM)

Jason, the patients I spoke about who "don`t need me to supervise their gym work-out and exercises" - are actually doing these in their fitness club or at their home. I wasn't clear on that - my bad.  I have NO gym at the clinic - just space for me and my patient to work in if we need to. Always one-on-one. Always. No assistants - no aide. 
I agree with you with regards to the multiple patients issue.  My patients pay for 15 minutes with ME. Any additional time spent at the clinic (at the front desk, "can I use the balls/bodyblade/tubing"?, or the mats for stretches or other) is NOT charged extra for.



jlharris -> RE: Creative Scheduling (September 4, 2007 6:47:20 PM)

Thank you for the clarification Sebastian.  I still think (in the US) I tend to be in the minority with my concerns (right or wrong, unsure at this point).



alodato -> RE: Creative Scheduling (September 5, 2007 12:34:33 AM)

Have your front desk do confirmation calls the day before their appointment, that might help with the reduction in NS and cancels.  Also (hate to say it), but patients will show up if they feel you are helping them.  If you have lots of NS and cancels, maybe the quality of care should be looked at and see if there is a problem on that end....



SJBird55 -> RE: Creative Scheduling (September 5, 2007 6:43:09 AM)

Jason, you probably could treat 3 or 4 patients effectively with one support person.  I did it years ago and I'll admit, it is a lot of fun - it takes planning and knowing your mix of patients and knowing who needs what, but when it pieces together, it is fun.  It's just that since the late 90's with the clear definition of 1 on 1 and a code for group, it is not financially in our best interest to be providing anything except 1 on 1 (IF a PT is using CPT codes appropriately based on definition).   I believe in the U.S. we have been completely stripped of our professional freedoms and are stuck in a system where we have to watch the time and document, document, document. 

Something kind of interesting... I divided my outcomes from years ago into categories:  category 1 represented patients that were definitely treated 1 on 1 and category 2 represented patients that were potentially treated in non 1 on 1 situations.  I did use the group code for billing during the group situations.  When comparing effect size between the categories to determine outcome, the patients that had low back or lower extremity problems had better effect sizes in the group situation.  Patients that had cervical or shoulder problems had better effect sizes in the 1 on 1 situation.  In reflecting on that, I tend to think that the reason the group situation is helpful for those with low back pain or lower extremity problems is because patients give each other positive feedback and do notice improvements amongst each other - they also tended to encourage each other a bit more (because it is really easy to observe improvements in that population) as compared to someone with a neck or shoulder problem.  It's almost as if there is an additional boost of placebo in the group situation for those patients. 

The other thing, Jason... it is quite difficult to do much about patients being charged for one on one services when the patient is actually receiving group services.  Unless the percentage of patients is quite close to 100% Medicare, then it's like hitting a brick wall to have change occur AND the money isn't there for anyone to enforce the rules.  It's kind of sad actually.... we'd all be in an uproar if we went to the store and bought butter over margarine because butter is always more expensive and truly from a cow and then we found out that the "butter" we bought wasn't real butter but some fake whatever being sold as butter.  I think that if patients knew the definition of codes and knew what they were being charged for a one on one service that was upcoded from a group code (and a group code has a very low reimbursement value), I think patients would be pissed.



jmattox -> RE: Creative Scheduling (September 5, 2007 11:38:01 PM)

Many thanks to those of you who posted responses!  I appreciate your input and find it interesting to see the different ways of doing things for different parts of the country and Canada.
    -Jason



Soleman -> RE: Creative Scheduling (September 11, 2007 9:27:04 PM)

Charge a fee for no shows and cancels with less than 24 hr notice 



BillW -> RE: Creative Scheduling (November 3, 2007 12:47:33 PM)

 I have worked in settings that gave 30 minute treatments, settings where I saw 30 patients a day with 15 minute time slots, and settings where time slots were 30 minutes apart, but patients overlapped.

I do not believe that a thourough eval on a back or neck can be done in a 30 minute period.  You have to be leaving certain things out.  Obviously you do not believe they are important, but I would have to disagree.  Our thourough evals is part of what sets us apart from MD's.  When I worked in a clinic with pt's every 15 minutes, I believe that I gave good care, but people waited much longer for me, and I was not able to give the attention that I give now, or at times, the attention they should have had.  Anymore than 2-4 pts at at time is unreasonable for good quality care.

I do not beleive a good treatment can be done in 30 minutes.  Very few injuries can have the proper treamtnest applied in that time period.  When I worked in a clinic with this time period, I always felt like I was leaving stuff out. 

I currently have total control over my schedule.  I schedule people every 30 minutes, but people are there for 45 -90 minutes.  I try to keep it to 2-3 people at a time.  This way, everyone gets 20-30 mintues of hands on, and I can still pay close attention to their form on ex, as I believe there is doing things correctly, and thenthere is just going through the motions if form is not very specific.  If I have someone that needs a private room, or if they are so low level that they need me physically with them, I schedule them for an hour as the first pt of the day, or right after lunch, so no one else is there.  I wil make an exception if someone very independent with good form already will be there at the same time.  Seeing more than one pt at a time canbe done well with very good quality.  Also, if you stand over the top of the pt all the time, they will lack independence in their program by the time they are done.  I have seen that happen many times.

It is a difficult question.  You really can not give an adequate treatment in under 45 minutes to an hour, but you also can not be financially viable if you see 1 person an hour.  I beleive that seeing people every 30 minutes with a few over lapping can be done very well, and is the best combination.  30 minutes is too little, more than 5 people at a time is too many.  Do 1 hour treatments with 2-3 over lapping.  They will all get adequate manual time, and you should be able to see their ex form well.  Also, peole really like the socialism that accompanies having more than one peron in isolated treatment.

To address the actual question.  I do not think your problem is with scheduling.  What are doing with a waiting list, and well properly scheduled times is the way to go.  you need to work on the cancellation rate itself.  That rate is a pretty avg rate in a clinic where it is not addressed, but can be cut in half with some work. 



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