Imaging / Visual Field Appointment Scheduling

Tue, 24 Feb 2015 19:34:19 GMT

UNC has always performed same day imaging and visual field testing. As we are always looking for ways to improve overall clinic flow, scheduling imaging tests and visual fields has come up. Do any of your clinics schedule separate appointments for imaging and/or visual fields? If so, are the appointments still for the same day as the appointment with the physician or do you do them on a different day?

I appreciate your feedback on this.

Sarah

Tue, 24 Feb 2015 19:54:06 GMT

The Ophthalmic Diagnostic Center, in conjunction with the Department of Ophthalmology Lions Eye Clinic, DOES schedule their diagnostic tests. Many of our patients come from out of town. The physician completes an ODC referral form and requests the tests. Whenever possible, we schedule tests to be done prior to their clinic visit. In addition, the ODC has many private physician clients for whom we are doing testing all day long. Most of our tests are schedule, making for a manageable day. However, the nature of our work demands flexibility. Our glaucoma protocols for visual field testing CAN take up to one hour per patient and we must allow for that. We have a reasonable, logical schedule- no overbooking, to allow for accomodation of necessary add ons.

In my opinion, one gets into trouble by overbooking to begin with, or unreasonable scheduling slots, resulting in chronic overbooking of patients or underestimation of time needed. The end result is stress right out of the gate as you look out onto the landscape of the day, knowing you are already two hours behind. We all have those days occasionally, but to build it into your scheduling protocols is a set up for chronic stress and resulting inflammation. Spend a month looking at your ebbs and tides and doing a bit of documentation of what your reality is. Then adjust your schedule accordingly. This has worked very well for us.

We all find situations where the physician wants tests that are in conflict ( billing wise ) with each other. Here, in a teaching setting, we have a bit more lattitude for that. We can perform conflicting tests without worry of loss of revenue stream. In cases where you cannot do two procedures in the same day ( Slit Lamp photography and AS-OCT might be an example) one then has to make the decision to have the patient come back ( a headache for everyone) not do the conflicting test, or do it without charging for it. At the ODC, we do the tests, and put the unchargables into a "STATS catagory. Thus, we get the credit for doing the number of procedures without triggering an audit by charging for things we will never be reimbursed for. This takes some savvy in biling and coding, and a system, to pull off.

Hope this helps
Denice Barsness
Technical Director- ODC

Tue, 24 Feb 2015 19:54:23 GMT

We do both, same day imaging and scheduled appts. for Imaging. The scheduled Imaging appts. are for different days. These are called "PreMD Orders" because they are ordered by the providers at the conclusion of the patients' visits and the imaging is prior to seeing the MD at the next visit.

I would say the ratio is about 50/50 now with the Pre orders gaining ground quickly. MD's and patients bother like it

Bob

Wed, 25 Feb 2015 01:42:16 GMT

We try to fit all the tests on the same day. We dont have the billing issues as you describe and typically do whatever is required on the same day as physician visit. (except ERGs which tend to be booked in advance of the physician visit).

Wed, 25 Feb 2015 21:52:16 GMT

Thanks Denice, Bob and Cynthia. I love that you have examples of each way of managing this: scheduled, not scheduled and a 50/50 mix. While not all of our patients travel to us from a distance, many of them do come from hours away and the idea of scheduling on different days for these patients would not work well.

A few follow up questions:
Denice- For the patients that are scheduled on the same day as their appointment, do they receive multiple appointment reminders? Are you able to schedule the diagnostic appointment and the appointment with the physician so there isn't a large wait time between services? If testing requires dilation and the physician needs parts of the exam to happen before dilation, how do you manage that?

Bob- We've discussed doing a blend and this makes me so nervous! Are you finding that you don't have enough staff to cover the imaging of both the scheduled and the same day patients? If this happens, which patients get priority? Are you doing PreMD Orders for all testing? It seems silly to do this for a fast OCT, but like it makes sense for tests that take more time.

Cynthia- We do schedule our ERGs, but only on Fridays (when the physician who requests most of them works) so we can do them ahead of her appointments (when the stars align), but not for most of our other physicians.

Thu, 26 Feb 2015 18:36:58 GMT

We also have about a 50/50 ratio, and see more scheduled patients in the morning, with time for same day after (or sometimes during) the office visit. in the afternoon. We are trying to fit in a departmental lunch break, but are finding we juggle the lunch times
Denise is absolutely right when advising not to overbook before the day has even started...
Libba

Thu, 26 Feb 2015 19:17:45 GMT

Sarah-all patients requiring imaging, either PreMD's or On-Demand roll through the imaging dept., we just take them as they come. There is no priority for one type of patient vs. the other they are taken in the order they arrive in ADI (advanced diagnostic imaging). There is also no special staff assigned to either imaging modality. It's all one big imaging pool here.

I don't find this stressful at all. I like seeing a schedule and knowing how my the day for my dept. looks. I also find this easier for scheduling my admin responsibilities.

bob

Fri, 27 Feb 2015 18:48:10 GMT

We do imaging only when being seen for an appt with the MD., it can be requested at the time of the patients follow up appt, and first thing, before the exam, but, never when MD isn't here.
The f/u schedule may have written, FA/ICG PRN Lucentis 0.5 OS. or may say OCT and OPTOS, PRN Avastin OD, and then we all know what to do, test first, in the room second, evaluate is 3rd, and then if active, consent and give drops. Don't have any VF devices here.
Also, during a scheduled exam, MD may say, I need an OCT now, and then the chart is brought into a Testing Chart Rack, and it's time dependent, earliest appointment goes up top, as they've probably been waiting the longest.
Lastly, although we usually can get the gist of why a NEW retina patient is showing up in our office, we've been asked NOT to pre-scan any pt before the MD exam, despite what we know about their previous hx from the referring doc's office, and the general Ophthalmologists around here are usually pretty good.
J