March 29, 2019

Appointment Efficiency

The most important metric, in my opinion, to determine the health of your practice is appointment efficiency. It’s a direct and straightforward test that can indicate the performance of your scheduling staff, the need to recruit more Providers, and it can even indicate how you manage your visits overall. Unfortunately, this metric is hard to generate in most EMR’s, and thus it’s been forgotten. In fact, I’ve yet to work with a practice that is already using this test, but it soon becomes gospel. The metric goes by many names, and some would argue that the title alludes to other parameters – regardless, this one seems to indicate the core of them all.

Here’s the equation: Provider Units Consumed / Provider Units AvailableA unit can be any amount of time in the context of an appointment. Most Providers use 15 minutes to define a unit because they believe they should spend no less than 15 minutes with a patient. If you specify a unit to be 15 minutes, then make sure your EMR is displaying at 15-minute intervals. A sick visit may only take 15 minutes. Therefore, it’s value is one unit; whereas an annual appointment may take 30 minutes, thus, it’s value is two units. Once you define your unit value, you must remain consistent thereafter.Provider Units Available (PUA) are how much time the Provider has allocated for patient care that day. It does not include non-billable time such as completing the charts at the end of the day or working with administrative staff. Office the schedule template allocation within your EMR is the same. A Provider may be willing to work from 9:00 am to 5:00 pm (32 units) with a 1-hour lunch break (4 units) for a total of 28 units.Provider Units Consumed (PUC) are how many appointments or 15-minute units are consumed during the time they allocated to the practice. If a Provides spends two units on a 1 unit appointment, you still count it as 1 unit as it was scheduled. Staying consistent with the examples above, let’s assume the Provider has 28 PUA’s, and on their schedule today they’re going to see five annual visits (10 units) and nine sick visits (9 units); the total PUC would be 19. Therefore their Appointment Efficiency was 19 divided by 28 or 67.8%.Now that you can calculate the Appointment Efficiency for the practice you’ll need to start analyzing the data. One of the first conclusions you need to compile your data are benchmarks for the practice as a whole and the Providers. You can use this information to identify ‘bright spots’ in your practice and hold everyone accountable to the same standard which founded on their ability. Take the following example:

  • Provider A Appointment Efficiency = 210%
  • Provider B Appointment Efficiency = 130%
  • Provider C Appointment Efficiency = 80%
  • Thus, the average practice Appointment Efficiency = 140%

Here’s how you may use this example data to manage the practice:

  • Provider A has been with the practice for a long-time and has many patients of his/her own. Are the patient satisfaction scores indicating that this patient throughput is acceptable? Is this Provider too busy and should give some of their appointments to Provider’s B & C? Does Provider A need to allocate more time to the practice given the high demand for appointments?
  • Provider B has been with the practice for a year but reschedules appointments frequently and refuses to see a few visit types. Should this Provider work one less day per week until the Appointment Efficiency increased? Does this Provider work a schedule that overlaps with Provider A? Does this Provider run late because the time allocated to each appointment type is beyond their capability? Since Provider B is a shareholder, it might be just as advantageous to give that Provider a percentage of your daily volume to increase your quality of life without giving up income.
  • Provider C is a Nurse Practitioner and has recently joined the practice. Practices may expect mid-level Providers to have a lower expected Appointment Efficiency due to the different rate of time and overhead. 80% in this context might mean Provider C should be measured independently of Provider A & B who’s average would be 170% otherwise.

You can use Appointment Efficiency to determine the health of many aspects of your practice. For instance:

  1. When should you recruit another Provider to your practice? Perhaps when you’ve maintained an appointment efficiency with all Providers above 200% per day for two weeks is a good sign that it’s time.
  2. Combine this information with your average reimbursement per visit to determine the profit associated with each Providers Appointment Efficiency. Let them know that they need to maintain an Appointment Efficiency of at least 120% before they qualify for a Productivity bonus.
  3. Use this information to adjust your schedules. Is Provider B at 400% appointment volume on Tuesdays because Provider A is in Surgery and Provider C has the day off? Is there an opportunity to extend office hours on Monday and Friday to reduce congestion?
  4. Consider if the operational workflow of your clinic staff is supportive of an improved Appointment Efficiency. Often there’s a bottleneck which inhibits the pace of the Provider indirectly.
  5. Is your scheduling staff restricted by poor schedule template design in the EMR or by poor placement of appointments? Should you reconsider the blocks in your schedule for emergency or sick visits? Should you stagger lunchtimes, so the demand is mitigated? Reward scheduling staff for crafting an agenda with the Scheduled Units / Available Units achieving 100% for the practice per day.
  6. Maybe you’re interested in opening a second location; this information can help you determine the potential of spreading your present Appointment Efficiency to another location/Provider. You might be able to increase your Appointment Efficiency by letting your Billing Staff work from home and converting their office into an exam room instead.
  7. So your Appointment Efficiency is at a number you’d like to see it across the board, now what? I suggest finding ways to make the value generated from each appointment better. Perhaps 1 Physician should off-load their general appointments to 3 Physician Assistants with the hopes of consuming units in the Operating Room primarily.

Everything within the practice correlates to your ability to conduct patient encounters. Your practice doesn’t treat patients by spending an hour in a meeting in the middle of the day, it doesn’t increase your bottom line arguing about website content, and it certainly isn’t helping when you’re focused on bookkeeping. All of those ancillary time consumers are essential, but that’s secondary to maintaining a proper Appointment Efficiency benchmark. Your practice consumes one precious fuel which is Provider time, and everyone employed by the practice is there to make the consumption rate of that fuel more efficient. There is limited fuel on this Earth so be sure you’re consuming it practically. Provider Appointment Efficiency isn’t the burden of the Provider alone; it’s an indication of the health of the entire system.

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