Learn how to be appointment-book savvy with the four T’s of scheduling

Probably no other procedure at the front desk is more important to the growth and success of a practice than making appointments. New, established, reactivated, and rescheduled patients are all critical to the bottom line of business. Without patient appointments, there is no business.

Timing. The first step in a smooth-running office is scheduling appropriate times for patients. Understanding how long a new patient will take, how much time doctors require for a report of findings, or even how long a routine adjustment will take, makes the difference between flow and chaos.

New patients take the most time, but not all new patient times are created equally. Generally speaking, a new patient will require time for paperwork, consultation (10–15 minutes of initially talking to the doctor), new-patient videos, the examination, possible x-rays, and in some offices the treatment.

A new patient may require anywhere from 45 minutes in some offices, to 2 hours in another. The important thing to learn is how much time is required in your individual office. What is your doctor’s normal routine? Does he usually take x-rays? Does she adjust or do therapy on the first visit? Is your doctor so experienced and competent in his own timing and procedures that the exam is thorough, yet quick? Or is your doctor a relatively new practitioner who requires a long time to complete the evaluation?

What is important for the front desk to know is how much time should be blocked off for a new patient’s schedule so that patients do not get interrupted by pulling doctors away to see other patients during the visit. Nothing is worse for new patients than an interrupted service. Sometimes, doctors may be able to go and quickly adjust another patient while the new patient is changing into a gown, or perhaps a chiropractic technician is taking x-rays, but doctors should never be called out of a room with the new patient to see another one. This is rude and totally unprofessional behavior. It is paramount to saying to them, excuse me for a moment, someone else is more important than you are. While exceptions may arise, scheduling should always be done to avoid this type of interruption.

Technique. Scheduling appointments is more than blocking off specific times for new patients and knowing how to double book established patients. Scheduling for success takes finesse in handling not only the doctor’s required times, but also each individual patient’s idiosyncrasies. Some patients habitually run late. Some patients love to talk and visit with doctors, throwing them off schedule. Some patients require more time because they are older, or more severely injured. Some patients drop in without an appointment or come earlier than their scheduled time. Each little upset can play havoc in a smooth schedule.

The experienced front desk CA knows these little issues and quirks and when they can squeeze another patient in or when to block off more time for a certain patient. It takes skill to make scheduling look easy.

If doctors take 15 minutes to see an established patient, the front desk should schedule only four patients per hour. However, knowing that one patient will run late, another may reschedule, or a patient will take less time, the CA will allow for six to eight patients to be scheduled. Some offices actually schedule a patient every 5 minutes—three in a 15-minute time slot, or 12 per hour.

This type of scheduling usually occurs the first or last hour of the day, knowing that spill will occur prior to opening and after closing. A word of caution: While doctors may think they can handle this type of schedule, patients do not like to wait. Having patients wait longer than it takes them to be treated is a sign of poor scheduling. In other words, patients will not mind waiting 5 or 10 minutes for a 20-minute treatment. However, they will start to complain about a 20-minute wait for a 5-minute treatment.

An appointment book should be used to create an easy flow of existing patients and allow room for growth with new patients. You should always have an appointment time to accommodate emergency patients.

Proper planning is the key. Plan to see new patients at specific times during the day. Some offices book new patients in blocks, meaning that they only accept new patient appointments during a certain time of day, usually midmorning and again midafternoon. New patients are not seen at the same time as regular treatment time patients are scheduled. This helps avoid the interruptions of the doctor and keeps the focus on the new patient.

The downside of this type of scheduling is twofold: 1) if there are no new patients scheduled during the blocked time, it becomes down or dead time; and 2) blocking does limit how many new patients an office can schedule in 1 day. Two to four seems to be the limit since the blocking is normally set at 1 1¼2 hours twice a day.

Some offices see new patients only on specific days, for example Tuesday and Thursday, leaving Monday, Wednesday, and Friday open for regular scheduling. Of course the downside to this type of scheduling is that new patients might not be able to come those 2 days. New patients normally want to be seen right away resulting in losing them to another office that will accommodate their wishes.

Troubleshooting. Your appointment book tells a story: who is always late, never schedules, walks in, continually misses appointments, is supposed to be on a treatment plan (and therefore, a set appointment schedule), is scheduled to be reexamined or x-rayed, is reactivated, or rescheduled. The appointment book is a road map of where your office is going, and a look back at why it is going in that direction.

Whether your appointment book is on your computer or in a paper book, your office should be able to track trouble. If one of your patients has rescheduled his last three appointments, something is wrong. Either, a) he is out of pain, and therefore does not think he needs to come in; b) his schedule has changed at work or home, and he failed to correlate that with his chiropractic care; or c) his financial situation has changed, and he does not think he can afford care.

One of these three issues is always at the heart of a rescheduling patient. Before the patient drops out, the front-desk CA should make the office aware of the patient’s rescheduling habits. The doctor needs to educate the patient on why he needs to continue with care once pain is gone, the office manager needs to discuss financial options with the patient, or the front-desk CA needs to make appointments around a new work schedule.

A patient who never schedules an appointment (a walk-in) is one who does not follow orders or directions. This type is also one who fails to pay their bill. If you are reading your appointment book properly, you will know which patients to collect money from—never allow a nonscheduler to pay you later.

Some patients who like to chat tend to want to look at the appointment book and schedule their next appointment during a time when there are not a lot of other patients scheduled. They want quantity time with the doctor, not quality time. Either schedule these people just before lunch or right at the end of the day (and then make the excuse that the doctor has an appointment or meeting they must get to right away).

If there are patients who are habitually late, tell them that the appointment time is 15 to 30 minutes prior to the time you actually write their name in the appointment book. If you expect to see them by 11 am, tell them their appointment is 10:45. This allows you to properly schedule another patient at 10:45 and not throw off the rhythm of other patients or the doctor.

Once you know how to interpret your appointment book, you will realize that it tells you why your office is not meeting goals of growth and collections and when more time should be spent on educating patients, proper reports of findings, financial consult, and even front-desk training.

Tips. One tip I found most useful (other than a good appointment book) was color-coding by using highlighters to offset time for new patients or report-of-findings times and using colored pencils to immediately indicate something special about a patient.

For example, a patient's name is written in pencil, unless there is something unusual about the visit, then the patient’s name was written in the appointment book using colored pencils and highlights:

• red is monthly, maintenance patients
• blue is for walk-ins
• purple is for unconfirmed times
• green are recalls patients
• yellow highlighted boxes are new patients
• pink highlighted boxes are report- of-findings patients

When more than one doctor practices in the same office at the same time, colored pencils can also be used to designate which doctor the patient is seeing.

Other tips of the trade include:

• Everyone, including the doctor, should know how to read the appointment book. A system should be in place that would allow for anyone in the office to follow procedure and not have to ask a lot of questions.

• The appointment book must be kept neatly and accurately. Do not write in ink, erase, or use correction fluid. It should never look crowded. Keep it big enough to allow growth. It should be an organized road map of where the office is going, how fast, and with what bottlenecks.

• Do not leave the appointment book exposed to patients. It is not advisable to let the patients view your schedule; many times they can misread the blocked areas as openings and try to come in then to take advantage of the doctors’ time.

• Never turn a patient away. Preplan a buffer period in the morning and afternoon to accept emergencies, walk-ins, or delays. The standard buffer is approximately 20–30 minutes.

• Patient control is the secret of any office’s success. Time can be wasted if the appointment book has holes. Avoid scattering appointment times. Time lost between patients is lost forever. Make the most of your day by creating productive time. Group or block patients based on your doctor’s normal adjusting time. Remember that new patients and reports take longer than an adjustment. Plan accordingly, as to not rush the procedure. Usually, the two most important visits for patient retention are the first and second visit.

• Call missed appointments as soon as you realize the patient is running late—usually 15 minutes after the scheduled time. Keep trying until the patient is reached. If you talk to another family member or coworker or are leaving a message on an answering machine, remember to be discreet. Simply leave your name and number and ask that they call back. Do not say that they have missed an appointment. Never assume that because you have left a message, the patient got it. If you do not hear back within 24 hours, call again.

Ces Soyring, CA, is cofounder of the National Academy of Chiropractic Assistants (www.naca-online.com) and a chiropractic consultant. She can be reached via email: naca_csoyring@yahoo.com.