6 Office Flow
Abstract
The flow of patients in your office is dictated by three processes: check-in, the exam visit itself, and check-out. Understanding each step of check-in can help you streamline how much time patients spend in the waiting room or filling out paperwork. It is essential that check-in occurs as quickly as possible so that patients can spend the majority of their time in your office interacting with you as their provider. Since check-in and check-out are where the transactional portion of your business occurs, it is important to ensure this is done discretely but also effectively so that copayments, balances, and deductibles are collected. Taken together, the elements of office flow can impact the quality of a patient visit by making your office appear coordinated and professional.
Top 10 Things You Need to Know
Understand the intricate processes involved in check-in and check-out, as these are two areas where office flow efficiency can be maximized.
A single receptionist at a single desk in the middle of a waiting room can be beautiful and aesthetically pleasing, but is not efficient as he or she is bound by the Health Insurance Portability and Accountability Act (HIPAA) legislation with regard to the tasks they can carry out that may be overheard in the waiting area.
Ensure the person checking in patients is not burdened by answering phone calls or other questions and can focus on the patient in front of them, so as to process their information and start the office visit as quickly as possible.
Try to direct all patients into filling out paperwork online at all times.
Separate surgical procedure visits in time, and preferably space, from general medical dermatology. Similarly do so with cosmetic patients.
Position check-out and check-in spaces in separate areas.
Choose the type of assistant you want in the room with you.
Evaluate how you practice in terms of time you spend in the room for different types of visits to maximize your schedule.
A separate nursing schedule which can run alongside you is an efficient way to manage tasks such as suture removals and patch test placement.
Craft your templates with great care as “new patients only” over the course of an hour will not flow as efficiently as a mixture of established and new patients. Attempting to spread out skin checks and new patients will ultimately lead to better flow dynamics.
6.1 Introduction
Whether you are building your office space from the ground up or inheriting someone else’s design, it is important to think about your flow of patients throughout the day. Although the concept of bringing someone from the waiting room to the examination room seems straightforward, there actually exist multiple processes along the way that can gum up the works. The result can be the difference between the patient having a good experience in your office versus a bad one—little of which has to do with the quality of care you delivered in the room. And while it is true that physicians in a small private practice may have more say over the flow of patients, do not let the confines of an academic institution or a large group practice dissuade you from influencing office flow. The best way to think of this process is to break it down into the following three components: check-in, rooming, and check-out.
6.2 Check-in
Although the title seems obvious, “checking in” to a doctor’s office is far from easy. If you have more than one physician schedule running at a time, it may be worth considering having either a separate check-in desk for each provider or several check-in staff working as a team. The check-in process directly influences how many patients are present in the waiting area which can impact their perception of how chaotic the practice is. If the check-in process backs up, the schedule tends to fall apart. For this reason, check-in is where the first decisions from a practice flow standpoint should be made. This is what I recommend considering:
6.2.1 Receptionist
The first observation a patient makes when he or she walks into the office is the waiting area and that includes how many receptionists are behind the welcome desk. (Note the use of the word “welcome” and not “check-in.”)
Behind the Glass or Not?
The ideal image of a dermatology practice is a beautiful desk behind which sits a receptionist who welcomes the patient. While this setting conveys luxury, it is not always practical due to space limitations. Keep in mind that HIPAA privacy laws are immediately in effect as soon as a patient enters the office. Therefore, if the people present in the waiting room can overhear a private conversation, there can be an issue. So, if you have one person in an open desk arrangement, bear in mind that this receptionist will need to understand HIPAA carefully and may not be able to perform the same number of functions as someone who sits behind a glass window that can slide shut.
6.2.2 Sign-in Sheet
Many physicians use sign-in sheets for their patients. The HIPAA Privacy Rule explicity permits the incidental disclosures that may result from this practice, so long as the information disclosed is appropriately limited. For example, patients may hear the name of another patient being called but should not see on a sign-in sheet the reason for the patient’s visit. Depending on the type of practice you have, the recognition of a patient’s name may not ensure their privacy adequately. In my office I use patient sign-in label forms. When a patient signs in, the sticker of the signature line is pulled off and kept by the receptionist so no patient is missed and other patients cannot see the names of others in the waiting room.
6.2.3 New Patients
New patients to a practice often have paperwork to fill out. In the age of electronic medical records, it is best to provide patients access to their portal at the time of scheduling out forms, so that they can fill this out ahead of out forms. Remember that one of the measures of the merit-based incentive payment system (MIPS) is to have these portals open within four days of new patients making appointments. Keeping in mind that patients may still not utilize their portal to fill out history and pertinent medical information prior to the visit, patient kiosks in the waiting room can decrease the time needed to manually enter information. These kiosks should be compatible with your electronic medical record to transfer information seamlessly. We use our patient kiosks for patients to fill out all Allergies, Medications, Past Medical and Surgical History and to sign practice forms such as Financial Guarantee of Payment. The final option (and I truly mean the last) is to hand patients actual paperwork on a clipboard with a pen. While as a practice owner you understand that patients can take anywhere from 5 to 30 minutes to fill out paperwork and then that paperwork must be hand transcribed into your EMR, this is rarely taken into account when the patient themselves thinks about wait time. As a result, in our office, we have implemented a laminated sheet that acts as the cover sheet for all paperwork given out on a clipboard. It simply states “Welcome to Mariwalla Dermatology. We would like you to fill out the following paperwork, so that we can understand your medical history better in order to help you with your skin. From the time this paperwork is completed and handed back to the receptionist the wait time should be no more than 25 minutes, as we have to also enter this information into the computer. Thank you for your understanding.”
Although having physical paperwork is important for those who do not feel comfortable on the computer, every effort should be made to steer away from it because it is incredibly inefficient for your staff and also your schedule. A new patient scheduled at 3:00 pm who shows up at 3:05 pm and then has to do all of their intake paperwork manually may not actually be ready to come back to the examination room until 3:45 or 4:00 pm The patient thinks they have waited an hour to see you and, in fact, they have. But from your perspective, they took an hour just to check in, thus upending your schedule. In the end, the patient’s perception is the only one that matters and, in their mind, they have already been in your office for an hour.
The other option you have (depending on number of patients) is to dedicate a resource to calling patients who have not done the paperwork online. If for some reason, patients are not willing to log on to their portal, having an area of your website where patients can download forms and fill them out at home is also quite helpful.
6.2.4 Established Patients
For established patients, the check-in process should be streamlined. They should be able to sign in and go through the rest of check-in quickly. It is important to remind your staff that patients who have not been seen in three years are technically new patients to the practice and may need to update their records.
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