The landscape of health care is continually changing and there is no part of the health-care system, including all providers that is not impacted by these changes. This impact extends to all patients, as they are facing larger out-of-pocket medical costs than ever before. They are having to make choices about which appointments to schedule, which medications to buy, and which medical recommendations to follow. Large institutions and small practices are seeing changes in reimbursement. Changes in reimbursement force health-care providers to reduce operating expenses. Third-party payers are being challenged by shifting regulations at both state and federal levels, and government payers have more subscribers than ever before, in part due to the changing demographics of society, but also due to the impact of the Affordable Care Act.
Much of these changes are coupled to changes in reimbursement, something that affects large institutions and small practices. These changes in reimbursement cause institutions and health-care providers to focus on reducing the cost of operating expenses in order to assure the margin necessary to remain viable. All of these changes in health care directly impact audiology practices, regardless of setting.
Make Sound Business Decisions
Audiologists are finding it necessary to focus more and more on strategic business plans in an effort to optimize reimbursement and reduce expenses due to financial uncertainty. Increasingly, many business decisions in the medical organizations, particularly large institutions such as hospitals, are made by business professionals, often without looking to the clinicians to discuss the clinical implications of the decision.
Conversely, audiologists can offer business solutions that improve the operating margin without sacrificing patient care. A cooperative approach to decision making can result in better decisions for both the practice and the patient. One way audiology practices can improve the bottom line is to focus on the daily operations and look for creative ways to increase revenue and/or decrease expenses.
One daily operation worth examining is the scheduling practice, particularly to understand how it impacts revenue. It is quite easy to assume that one’s current scheduling system is effective, particularly if the process has been in place for many years and everyone is comfortable with the process. However, having a scheduling model that is ineffective may create unneeded delays in patients accessing services, decreased patient satisfaction, and missing out on additional revenue.
Start with Scheduling
The scheduling for audiology appointments at Cincinnati Children’s Hospital Medical Center (CCHMC) had historically required that a provider appointment slot be tied to a resource within the facility. In this context, a “resource” was a room, such as a booth, hearing aid programming room, vestibular lab, etc. This had the effect of tying up the sound booths or treatment rooms whether or not they were being used by the provider during the visit. For example, the sound booth may have been used for 15 minutes out of an hour-long appointment, but the resource was effectively tied up for the full hour within the scheduling system.
By uncoupling these two requirements, we were able to revise the scheduling system to make it more efficient, thereby increasing the number of appointments available for patients. The increase in available appointments decreased the waiting time for access to the audiology clinic. We were able to accomplish changes without increasing expenses.
FIGURE 1 shows the fill rate of our appointments over the past 16 months. The new schedule was implemented in October 2016 and, as can be seen, the fill rate increased from approximately 60 percent to approximately 70 percent. By altering the clinic model at our center and focusing on patient access, we have created a positive shift in clinic fill rates and access to appointments.
Understand Patient Demographics
Another key component to optimizing schedules is to understand the patient demographics, particularly with regard to the location of services and/or socioeconomic status of patients. These two factors combined will have an impact on the percentage of patients who arrive later or do not show for scheduled appointments. Certainly, reminder calls, texts, and transportation options help with this issue, however, there are many social circumstances that will impact a patient’s ability to make their appointment.
In our case, we began to work closely with our schedulers to identify when, where, and why we had higher no-show rates, particularly at certain locations. Our investigations identified that one factor was the length of time between scheduling the appointment and the actual date of the appointment. Our studies show that patients are more likely to not show for appointments that are scheduled several weeks out. The sooner the appointment after the patient called to schedule, the higher the show rate.
Consistent with our hospital’s strategic plan, we needed to adjust our scheduling paradigm to ensure that patients have access to timely care in order to improve the percentage of patients showing for appointments. In the examples noted earlier, our adjustment of the schedule to improve the fill rate, coupled with reducing the no-show rate, has resulted in seeing more patients in the same time, and seeing them quicker, which results in higher patient satisfaction rates. We continue to implement the changes across our locations and now note changes in fill rate by location.
Challenging conventional and historical business operations can lead to improvement of the bottom line and to improved patient satisfaction. Sometimes the solutions are simple and easy to implement, such as our uncoupling of the provider from the resource. The difficult aspect of making these changes are first identifying where change can occur, and the extent to which a change will result in improvement. By shifting our scheduling process, we are focused on increasing our patient satisfaction while achieving a better bottom line.