Avoid rather than pay for delays

One of the latest debates in physician practice circles is whether doctors should compensate patients for excessive wait times in the office, as highlighted by a recent article from CNN and ensuing poll on the Huffington Post.

Time is, after all, money. For patients, it's money they'd like to be earning at work rather than sitting on a paper-lined exam table in a clockless room; money they'd rather not shell out to the babysitter for a longer-than-expected shift; and money a growing swath of healthcare consumers really can't afford to do without.

Understandably responsive to this concern, some physicians are willing to offset the expense. Featured patient Elaine Farstad told CNN that, to date, she's sent bills to six physicians who have seen her more than 30 minutes late, three of which have paid. Some physicians even volunteer cash to inconvenienced patients without being asked. For example, when Dr. Cyrus Peikari, an internist in Dallas, recently had to miss a day of work because of a family emergency, he gave the patients whose appointments he canceled $50 at their next appointment.

Although it's commendable for physicians to value patients' time, many practices' current financial struggles likely preclude them from handing out cash in the waiting room. A more reasonable customer-service approach may be for staff to notify patients of delays upfront and give them the option to reschedule, according to Charlene Burgett, MS-HCM, administrator of North Scottsdale (AZ) Family Medicine. "Patients still may not react favorably to this news," Burgett wrote in a recent blog post, but "they would much rather have the opportunity to make that decision."

Better yet, keep avoidable delays to an absolute minimum. Though it takes discipline and creativity, it is possible for practices to keep their office schedules on track. Just ask Paula M. Comm, MA, administrator of PRA Behavioral LLC, a 10-physician, three-location psychology practice in Schaumburg, IL.

"We put a huge emphasis on timeliness, especially when patients are coming in for their 15-minute follow up during lunch breaks," Comm said. "Being on time is crucial, and we are rarely more than 15 minutes late if that."

Comm credits part of her practice's scheduling success with MDs who are particularly good at monitoring their time, knowing when to make follow-up phone calls without getting bogged down, and so on. Some physicians, on the other hand, "need us to manage their time for them," she says.

To do so, Comm employs the following strategies:

  • For doctors who have trouble cutting off appointments with some patients, staff put forced breaks into their schedules, with lighthearted code names such as "ketch up."
  • To give some psychiatrists built-in time to conduct follow-up calls and dictation, schedulers block off one hour for every 45-minute new-patient consultation.
  • Comm, who holds a master's degree in clinical psychology, will see patients herself when psychiatric emergencies arise, allowing physicians to stick to their schedules.

Although the latter option may not be available to most practices, Comm agrees with Burgett that it is essential to maintain open lines of communication among physicians, employees, and patients. Not only do patients deserve to be forewarned of lengthy waits, but staff need to glean from patients what type (i.e., length) of appointment is truly required for their appointment.

Of trying to discern whether to schedule 15 or 30 minutes for a visit, Burgett, wrote: "We have heard many times, ‘It's none of your business' or ‘It's personal.' Patients need to understand that we need this information to help prevent delays and by making sure that the physician is prepared to deal with the problem (equipment or supplies) prior to the patient's arrival."

Practices can make these interactions smoother for front-desk staff and patients alike by providing education to patients and training employees to handle the often-intense interpersonal aspects of their work.

What are your views on respecting patients' time and keeping your practice schedule on track? Please share your ideas here or join the discussion on LinkedIn. - Deb

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