Steven Nemerson

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Health systems and hospitals often lack the capacity to align clinical schedules with the correct time estimates for many diagnoses and procedures. More specifically, provider practices in both inpatient and outpatient settings are usually based on crude schedules that assign generic time slots based on patient category-for example, new visit versus follow-up-or diagnosis. Even sophisticated systems used for electronic health records, scheduling, and billing don’t have the capacity to fully optimize physicians’ and advanced practice professionals’ schedules.

Inaccurate forecasting of the time needed with patients can result in many negative knock-on effects, starting with a basic inability to accommodate for individual patient variability. While the most obvious issue here might be inadequate time to complete individual patient encounters, there can also be empty time within individual patient encounters.
	
	While the patients themselves experience frustrating and unpredictable service delays and billing inequities as a result, health systems, physicians, and provider practices are all impacted. Inefficient scheduling not only affects the patient experience, but operationally, providers suffer lost volume and revenue through these mismatches in productivity and reimbursement. Moreover, it's nearly impossible to accurately analyze and compare provider performance and cultivate “best patient encounter practice” among a group of peers.

This is one area of healthcare where a data-based approach can make a world of difference. With a dynamic scheduling solution in place, using granular demographic, diagnostic, geographic (facility or office location), and provider data, health systems and medical practice groups can consistently and capably accommodate patient needs, capture the revenue they deserve, drive provider efficiency, and harness data to engage in performance improvement.

Understanding key healthcare concerns stemming from ineffective scheduling


	Along with lost revenue and negative patient experience, other serious problems often emerge from retaining an antiquated approach to scheduling and workflow, including:

: Constant pressure to see more patients, produce more relative value units (RVUs), and generate more revenue is a major source of burnout among providers. This pressure is magnified when physicians deliver care that is captured inaccurately or not documented in coordination with the encounter time, or when they perform services that could otherwise be capably handled by other staff-such as trained nurses, behavioral health technicians, diabetes counselors and care managers-operating at “top-of-license.”

: A lack of accurate information about the time needed to complete a specific diagnosis or procedure, as well as accounting for follow up and additional testing, makes it more difficult for a health system to gain internal insight and improve efficiency over time.

: Health systems leave time that could be used to diagnose and treat additional patients on the table, because most scheduling software averages the amount of time needed and assigns arbitrary slot lengths instead of making a more specific, data-informed time commitment. Patient access is reduced, providers are confronted with unproductive time, hospital and office flow is jeopardized, and daily schedules are extended.

Facility inadequacy and unnecessary space

: With improved scheduling comes increased patient turnover, with both better room utilization and facility management.  Not only office and inpatient unit flow can see benefit, but services such as housekeeping and patient transport can be optimized, while overall space requirements can be reduced.

A perverse disconnect between time spent and reimbursement

: When billing patient visits on codes with a recommended time-based component (including elements of counseling and coordination of care, prolonged services), reimbursement is often based on significant increments of time that may be measured in as short as 15 minutes and longer than 45 minutes. Without going into detail given the complexity of coding, this creates incentives for providers to spend extra time where it’s not necessarily mandatory.  It also creates situations where scheduled time slots may be longer than the code being billed, essentially imposing circumstances where the provider is delivering under-reimbursed care.

Why the move to dynamic, efficient scheduling makes a substantial impact


	Many health systems administrators and executives, as well as providers, already recognize that a significant issue exists with inefficient scheduling. The solution involves a number of new tactics for scheduling that improve accuracy, align schedules with more accurate projections of time spent with each individual patient, and distribute workloads.

Using demographic information, patient histories, comorbidities and other available sources of data, health system administrators can develop a more accurate predictive scheduling process that takes into account the unique needs of a patient, whether more or less time is forecasted. The predictive tools used as part of this approach can dynamically adjust schedules, allowing for continued improvement and accuracy as time goes on. Robust comparisons between different providers and offices can also be generated, allowing for insight into scheduling that can lead to additional positive adjustments and a greater understanding of the process.

This leads to more effective use of all professionals’ time and skills within a health system or specific office. With a deeper grasp of the individual needs of patients, health systems can utilize high-level providers like physicians in areas where only they can provide care, while nurses, technicians, counselors and other medical staff can be tapped to provide appropriate care and accurately capture and bill all interactions. Scheduling these interactions with other professionals allows physicians to keep their schedules on track. This is especially important in the context of providing access to in-demand primary care providers and specialists, reducing wait time, and increasing the number of patients they can diagnose and treat. With doctors having so little free time throughout the day, this benefit can easily prove to be one of the most important ones realized with the move to a more dynamic approach to scheduling.

A few easily avoided pitfalls that health system leaders must keep in mind


	Implemented correctly and managed competently, this scheduling strategy aligns resources with actual need, without reduction in quality of care or a negative impact on the patient experience. Health system administrators and leaders must remain aware of the potential for these consequences to occur. Scheduling should never be used, for example, as a weapon to force some providers to work more quickly, which can lead to burnout as well as the very issues with patient experience and care quality that this process is designed to address. Providers need to understand the reasons behind such a system being implemented as well as the implementation itself-including that it takes a more humane approach to scheduling valuable providers’ time, as much as optimizing patient volumes, flow, and revenue. Otherwise they may fear that a push to see more patients is the only reason for making the change.

Value-based care makes dynamic scheduling even more important


	In the world of value-based care, where quality and patient management will dictate profitability, improved scheduling has clear value. The continuing shift to the value-based care model means adopting dynamic scheduling that provides deep insight into individual patients and sets appointments better aligned to care needs will only become more valuable as time goes on. Because it intelligently uses many data sources to arrive at a more specific and accurate allocation of resources, the dynamic approach to scheduling can allow health system administrators to better understand the cost of care associated with each patient, as well as collectively for the entire population. It puts health systems in an exceptionally strong position to manage financial and outcome pressures, allowing them to adapt to industry changes and benefit now and far into the future.

John Marchisin is managing director and Steven Nemerson, MD, is a subject matter expert in the healthcare practice of AArete, a global consultancy specializing in data-informed performance improvement.

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Inaccurate forecasting of the time needed with patients can result in many negative effects, starting with a basic inability to accommodate for individual patient variability. 

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