As the old saying goes, “Organization is a virtue.” Okay, maybe that’s not how it goes, but that doesn’t mean it’s not true. It’s impossible to overstate the value of being organized, especially if you’re a busy clinic owner or office manager. And you probably know that the ability to keep yourself—and your schedule—well-organized is crucial. But for some folks, the constant ebb and flow of cancellations, no-shows, last-minute appointments, and documentation demands is enough to make their heads spin. With that in mind, I took to the streets—er, the web—and got some scheduling hacks directly from the clinical frontlines. Here’s what I found out:
How much buffer time do you have in between appointments?
It was eye-opening to learn how many clinics leave zero buffer time between appointments. However, when you consider the immense financial pressure most practices are facing, it isn’t exactly surprising. Many private practices—particularly ones that rely on ever-shrinking payer reimbursements—have adapted to that pressure by figuring out ways to fit as many patients as possible into a ten-hour work day. And this kind of system doesn’t always leave room for unexpected speed bumps—let alone a moment to enjoy a cup of coffee between appointments. To combat this, Jamie Simnitt, clinic manager at Functional Physical Therapy Center, suggests putting some of the responsibility back on the patients. While the clinic doesn’t schedule buffer time, according to Simnitt, “In practice, patients are usually 5-10 minutes early for their appointments, or they’re 15 minutes early because it’s their initial eval.” If your practice sets the expectation that patients should arrive early, it can help keep everyone’s day in order. After all, one late patient early in the day can throw a therapist’s entire schedule out of whack, and trying to catch up can negatively impact his or her ability to give all patients the focus they deserve.
If your practice employs this strategy, then it’s important to reinforce the desired behavior. For example, if a patient arrives early, the therapist should try to start the appointment as soon as possible. Not only will this encourage patients to continue arriving early, but it will also give providers a little leeway to address any additional patient concerns. It can even create wiggle room between afternoon appointments—which therapists can use to catch up on documentation (or to enjoy that cup of coffee).
How do you use assistants and techs to help you manage your daily workload?
As I explained in a previous post, reliable therapist assistants and therapy techs/aides can be a big help when it comes to organizing your workload. Melissa Swinehart, director of business and compliance operations at 6 Hands Physical Therapy and Wellness, says aides and assistants help make her practice operate efficiently. “Techs prep rooms and equipment/supplies,” she explained. “PTAs perform treatments, while PTs perform evals and some treatments.”
At Dynamic Physical Therapy, the team has developed a mutually beneficial program that leverages help from local high school students. As physical therapist and practice owner Jessica Super explained,“We partner with the local high school Health Academy. We take two to five seniors each school year and teach them the basics. They get an internship and great learning experience for their resume, and we get an extra set of hands in the clinic. It's worked really well for us for seven years now!” Super says her practice also uses therapy aides to help keep the schedule fluid. “We have it scheduled so your next patient is warming up as your current patient is finishing,” she explained.
Do you have a wait list or some kind of system for accepting last-minute appointments?
In many practices, it’s common practice to squeeze in last-minute patients. As Swinehart tells it, “Our clinic owner/therapist will usually work early or late to fit [extra patients] in when possible.” This certainly jibes with the “roll up the sleeves” mentality so many rehab therapists possess. But some clinics have developed systems for prioritizing and keeping track of those patients. According to Super, “We utilize a cancellation list which has been helpful in maintaining a full schedule.” Patient wait lists can also help practices avoid the last-minute scramble to fill empty appointment slots when patients cancel.
When do you complete documentation?
Of course, every provider has a different strategy for fitting in documentation time. It all boils down to what works best for the individual therapist and his or her workflow. Victoria Wimbish, office manager for Lori A Lehri, MS LCPC, says therapists in her practice typically document new evaluations “during the session” and complete daily notes between patients. This approach definitely works if you allow buffer time between patients, but what if your schedule is jam-packed?
“[I complete] subjective [information]—and sometimes objective—during the session,” explained Jennifer Rai, physical therapist at Rehab Specialists, Inc. “Then [I finish] during my lunch, a cancellation, or after work.”
Super suggests documenting during patient warm-ups and exercises. She did admit, however, that sometimes “it gets stuck at the end of the day.”
Do you have any additional suggestions for maximizing your schedule efficiency?
Swinehart offers some choice advice for those in offices where space is at a premium. “We’ve [started scheduling] by room first, [and] then [we] assign the therapist accordingly at the start of each day,” she said. Because her clinic has a small staff, patients will always see one of three therapists. But, she says, “We try to keep the same patient with a therapist throughout the duration of treatment when possible.”
Other commenters suggested bringing in an extra set of hands to keep things running smoothly. “Use of aides helps keep us stocked,” said Rai. “[That way], any bits of downtime can be used for bathroom breaks, snacks, or documenting.”
According to Super, it pays to plan ahead. “I always look ahead at my schedule and have our office assistant move people around in advance to avoid last minute shuffling,” she said, noting that doing so allows her to use the space on the schedule more efficiently.
Billing manager Annette Knight from Schultz Physical Therapy has a fantastic way of keeping track of active patients who might not be on the schedule. “Our front office exports [the] active patient list to Excel weekly, and documents why each patient isn’t scheduled,” she said. They also indicate whether the patient is on vacation, pending discharge, or on hold.
While no two practices are exactly alike, one thing remains true no matter where you work: better workflow equals better cash flow. And these tips not only support your practice’s financial health, but also can help improve your patients’ health. Do you have any scheduling and workflow tips? Let us know what’s worked for your practice in the comment section below.