"Doctors are no different from Starbucks or Wal-Mart"

[Nords]

Rich, has the doctor's "open-access office" caught on yet or is it still controversial?

http://www.businessweek.com/smallbiz...212_182930.htm

[Rich_by_the_Bay]

Sounds sensible, reminds me of a scheduling strategy called "wave scheduling" years ago. If you previously saw 3 patients an hour, you would instead book all 3 at the top of the hour. The theory is that one might not show, 1 would take more time than average and one would take less. All in all, no one waited more than about 1 appts duration in theory.

Problem was it systematically punished patients who always arrived on time and expected to be seen on time. Rarely possible under that plan.

I have always run on time in my practice, other than the usual unexpected urgencies. My patients over time learned that, and for the most part arrived on time. It worked well, though I had to become more and more flexible with it over the years.

If I were setting up a primary care practice today, I'd probably try to keep open scheduling with lots of patient education.

[ladelfina]

That's partially how it works in Italy. The public service doctors have posted office hours and you just show up and it's first-come first-served for primary care. People visibly bleeding or something can cut in line without protest among the other waitees. For specialists I think appointments are the norm, though.

We've only been a couple times but have never waited as long as in the US where it's been 45 min. normal minimum wait.

[Khan]

Quote:

Originally Posted by ladelfina That's partially how it works in Italy. The public service doctors have posted office hours and you just show up and it's first-come first-served for primary care. People visibly bleeding or something can cut in line without protest among the other waitees. For specialists I think appointments are the norm, though. We've only been a couple times but have never waited as long as in the US (45 min. normal minimum wait).

It was that way in in a small town in NY when I was yound (1950s and 60s).

[cute fuzzy bunny]

Quote:

Originally Posted by Rich_in_Tampa I have always run on time in my practice, other than the usual unexpected urgencies.

Ah, so YOU'RE the one!

So far I've never had a single doctors appointment occur on time. For my current doctor I generally add 20 minutes to the scheduled appt time and thats usually 5-10 minutes ahead of when he sees me. Considering my wife works with him, I'd think he could do a little better, but apparently thats no benefit.

I did have one doctor berate me thoroughly for being 5 minutes late to an appointment. That was pretty delicious at the next appointment when he didnt see me on time and I gave him his own speech back at him...

[JohnEyles]

I did walk up to the receptionist once after I'd been waiting for 45min
and demand my copay back (which was done) and state that I had
waited too long. It was a specialist I wasn't sure was doing anything
for me.

Has anyone ever tried mailing a doctor a bill for the time they spent in
the waiting room ? Especially someone who is a higly-paid hourly
worker, after deducting something a court might find reasonable, like
15min - it'd be fun to try !

The problem is, I like the people at my (regular) doctor's office VERY much,
especially the doctor himself. I just don't like their "practices" - stuff like
waiting time, ease of getting anything done over the phone (getting test
results, for example) etc. Seems like things changed a LOT for the worse
after they became part of some big "medical group". I've thought of
writing the doctor (the one I like) a personal letter ...

[Rich_by_the_Bay]

Quote:

Originally Posted by Cute Fuzzy Bunny Ah, so YOU'RE the one!

But if I knew you were my next patient, there might be a slight delay... we'll be right with you, sir, please have a seat next to the Readers Digest in the corner. Do you have insurance? There will be a $10 copay in advance. Please stop talking to the other patients, Mr. Bunny, and get your feet off the table. Sir, there is no smoking allowed in the waiting room... what is that you're rolling in that little paper...

[Jarhead*]

Quote:

Originally Posted by Rich_in_Tampa But if I knew you were my next patient, there might be a slight delay... we'll be right with you, sir, please have a seat next to the Readers Digest in the corner. Do you have insurance? There will be a $10 copay in advance. Please stop talking to the other patients, Mr. Bunny, and get your feet off the table. Sir, there is no smoking allowed in the waiting room... what is that you're rolling in that little paper...

Methinks you have had enough "board-time" to evaluate "Fuzzy".

By the way, Gene Woodling is another one.

[cute fuzzy bunny]

Methinks he wouldnt make me wait at all, but we'd be doing the prostate exam right off the bat.

[John Tuttle]

Quote:

Originally Posted by Rich_in_Tampa I have always run on time in my practice, other than the usual unexpected urgencies. My patients over time learned that, and for the most part arrived on time. It worked well, though I had to become more and more flexible with it over the years.

I took an elbow in the eye while playing basketball and started seeing flashing lights and white bubbles. I got an emergency appointment and had emergency surgery for a detached retina. It was a bad tear and I learned later from the surgeon I was fortunate not to lose sight in that eye. I try to get the first appointment of the day so I don't have to wait, but I never complain about waiting because I know I inconvienced a lot of other patients that day.

[Telly]

Quote:

Originally Posted by Cute Fuzzy Bunny Methinks he wouldnt make me wait at all, but we'd be doing the prostate exam right off the bat.

Like, with a Louisville Slugger? I'd leave immediately. Forget the copay!

[Rich_by_the_Bay]

Quote:

Originally Posted by Jarhead* By the way, Gene Woodling is another one.

Wow - just a faint memory - he left the NYY in 54. How about the Scooter? Or Elston Howard (if I didn't already mention him - great utility player: OF, C, 3B all well).

[SonnyJim]

I can't blame my doctor for having a line of patients. I recently had spinal surgery and the neurosurgeon billed Tricare for $8,600, their allowed fee was....get this........ a whopping $199. How else could he make any money except by volume.

[Rich_by_the_Bay]

Quote:

Originally Posted by SonnyJim I can't blame my doctor for having a line of patients. I recently had spinal surgery and the neurosurgeon billed Tricare for $8,600, their allowed fee was....get this........ a whopping $199. How else could he make any money except by volume.

I have rendered services to Medicaid patients where it cost me more than they reimbursed, literally.

No problem, really. I made it up on volume.

(Sorry, couldn't resist, but my opening sentence is true.)

[Meadbh]

The science of patient flow (all based on operations management) is becoming increasingly important in healthcare. For tons of information, check out www.ihi.org, the Institute of Healthcare Improvement website. I personally know several practices that have embraced the open access idea. The results are sometimes excellent, but are less predictable in healthcare than in manufacturing industry, because patients, being people, are less predictable than widgets, and sometimes want, and need, to have their (lengthy) stories heard. Or they come in with one simple complaint and, well, there's more to this than meets the eye. And there's the added complication that the doctor may be called away to, say, deliver a baby. These examples can throw a wrench in the best laid plans!!!

[Nords]

Quote:

Originally Posted by Rich_in_Tampa No problem, really. I made it up on volume.

You'll get us in on your IPO, right?

[Sandy]

There are really two kinds of waiting:

providers who routinely overschedule/underestimate how much time they will spend with each patient. Generally this is a problem with office management from poor communication with the physician, lack of understanding of each day's patients needs, etc. Some occaisional miscalculation is inevitable, but routine practice of overbooking is inexcusable. Having managed a clinic (albeit briefly) I have no patience for this approach and have walked out of offices and found another provider for routine care.

OTOH there is the delay due to true emergencies, surgery that took longer than expected, etc. Up to an hour might be ok, if the provider doesn't think the wait will continue to grow or they can catch up during the day. For an hour or longer, a good office manager should call YOU if things are backing up and let you know, giving you the chance to come in later or reschedule.

In large practices, many providers defer scheduling (and the assoicated headaches) to the clinic or practice manager, and are often baffled when patients are frustrated and angry. But since the practice of medicine is essentially a customer service profession, they should keep a pulse on this aspect of there practice.

[mykidslovedogs]

Quote:

Originally Posted by Rich_in_Tampa No problem, really. I made it up on volume.

....by volume of other Medicaid patients or by volume of privately insured patients? Is it possible that if you didn't have some privately insured patients in the mix to make up for the low Medicaid reimbursement you'd be operating below cost?

[Rich_by_the_Bay]

Quote:

Originally Posted by mykidslovedogs ....by volume of other Medicaid patients or by volume of privately insured patients? Is it possible that if you didn't have some privately insured patients in the mix to make up for the low Medicaid reimbursement you'd be operating below cost?

It was a joke - a takeoff on an old comedy routine about a guy who priced his merchandise below cost but bragged about how shrewd the plan was cause he'd make it up on volume.

Probably something the old timers would remember, mostly.

[REWahoo]

Quote:

Originally Posted by Rich_in_Tampa It was a joke - a takeoff on an old comedy routine about a guy who priced his merchandise below cost but bragged about how shrewd the plan was cause he'd make it up on volume. Probably something the old timers would remember, mostly.

Heck, the sales guys in my old company tried that line on me on a regular basis. Sadly, they weren't kidding.