The Ideal Dermatology Office Should Have No Waiting Room
It takes a new patient approximately 33 days to be seen by a US dermatologist.1 Inside physician offices, the average waiting time is 24 minutes.2 In a recent study of 394 dermatology offices, many patients identified the average in-office wait time as the crucial area that needs to improve for better patient satisfaction.3 Furthermore, a study by Press Ganey Associates, Inc. showed that the overall satisfaction declines from 93.1% with a 5 minute or less wait time to 80% after 30 minutes of waiting.4
First and foremost, healthcare providers should avoid designing spacious waiting rooms. This propagates the idea that it is the norm to wait before seeing the physician. The space can instead be used to make more exam rooms. The reception desk can be eliminated, and staff redirected to run the exam rooms more efficiently. Under this design, an assistant can escort patients directly to prepared exam rooms.
Thorough preparation for appointments by both staff and patients using appropriate appointment scheduling, in-advance paperwork completion and insurance verification can facilitate well-timed patient visits. Electronic medical record (EMR) systems with no preset requirements for appointment scheduling are superior and can be customized according to each clinicians work style or office flow.
It is advisable to book follow-up visits for new patients as they are leaving. As follow-up visits usually require less time, they can provide physicians with a buffer when spending more time with new patients. These buffer appointments can also be used by practices for unscheduled patients. Though gross underbooking should be avoided as it leads to excess physician free time, underbooking by 5% to 10% has been shown to result in the most efficient use of physician and patient time.5
Similarly, it is also important to determine how much time is needed for various types of visits based on patient conditions, levels of complexity and therefore varying time requirements. It is helpful if staff creates a chart of 3 categories of visits including short, medium and long visits. Then a time increment should be defined for each type of visit. Staff can then design different combinations of these categories, and intersperse shorter visits with longer ones.
Lastly, appointments should not be booked months in advance. Patients scheduled too far in advance often cancel or fail to show. Offices tend to counteract these cancellations by double booking their schedules. This may in fact lead to overbooking and significant delays if the patients do show up.
Having patients complete registration forms, medication lists and other paperwork in advance through a practice’s website can also speedup office visits considerably. Patient forms and other relevant information should be made available online. Patients should be encouraged to complete these forms before their scheduled visit. This can help avoid waiting room bottlenecks where there is a delay in moving patients to examination rooms.
Similarly, it is now expected that healthcare providers provide access via patient portals. The Department of Health and Human Services Stage 2 “meaningful use” mandate requires 5% of patients using online patient portals in order to receive incentives. Practice portals often coexist with patient portals as well. These are connected to the EMR and allow access to schedules, payments and messaging with healthcare providers.6
Insurance verification should be performed prior to patient visits by requesting insurance information at the time of appointment scheduling. This way when patients come in they only have to present the insurance card and their ID to a staff member or at a check-in computer system. This also gives offices sufficient time to verify the insurance information.
Similarly, labs should be completed in advance so that the physician has access to the results at time of the office visit. To ensure this, EMR systems or practice portals can be used to send e-mails or reminders to patients’ smart phones to complete their lab work approximately 1 or 2 weeks before their appointments.
In the setting of no waiting room and no reception desk, only 1 staff member is needed to work the hall and escort patients to their exam rooms. For technology savvy patients, self check-in via computer stations or portable tablets can be provided. The technology will direct patients through every step of the check-in process including insurance verification, completion of forms and collecting copayments.
Once inside the exam room, patients input their personal history using the computer system. An open access system should allow medical assistants to enter the room at any given time to obtain vitals, or help patients if logistical issues arise.
Physician and Patient Encounter
Open access systems also allow physicians to enter the room once the check-in process is complete. The physician should review labs prior to the patient encounter. Physicians can use the computer system or tablets to enter information about the encounter directly into the EMR. Instructions for the patient should be clearly outlined at the end of the EMR and ideally a copy should be given to the patient in print or electronically through e-mail or patient portals.
At the end of the visit, the patient can use the computer system to checkout and schedule further visits. Another option is to use an electronic smart phone or app. A designated checkout staff member should facilitate the process for patients who are not technologically versed.
Different dermatology practices may need to tailor this system according to their requirements. All practices should thoroughly analyze what systems and processes contribute to delays.
Satisfaction surveys designed to measure the success of the scheduling system should be implemented and feedback given to office personnel. These surveys can provide insight into patient perceptions of time spent in the office and can be a valuable tool for practices to identify strengths and weaknesses.
Check-in computer systems and portable devices can also help practices assess patient wait times by documenting when the patients signed in, when they were moved to the examination room and when they signed out. This data will help analyze and systematically evaluate the system.
Patient satisfaction, the efficiency of practices and the quality of dermatology care can be improved by reducing in-office wait time via various techniques. These include improving office setup, encouraging in-advance appointment preparation by patients and staff, effective appointment scheduling and continued self-evaluation surveys.
This new office model puts patient-centered medicine at the core of practice management as patients are empowered to assist in managing their own visit. Instead of focusing on making the waiting room experience pleasant for patients, healthcare providers should strive to instead eliminate the wait all together.
We want to hear from you? Should dermatologists eliminate the waiting room all together? Should patients check themselves in and out and do their personal histories?
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Ms. Giambrone is a medical student at Rutgers-Robert Wood Johnson Medical School in Somerset, NJ.
Dr. Alamgir Rao is with Aga Khan University in Pakistan.
Dr. Rao is with Rutgers-Robert Wood Johnson Medical School in Somerset, NJ, and Weill Cornell Medical College in New York, NY.
Disclosures: The authors report no relevant
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J Am Acad Dermatol. 2008;59(6)741-745.
2. Bleustein C, Rothschild DB, Valen A, Valatis E, Schweitzer L, Jones R. Wait times, patient satisfaction scores, and the perception of care. Am J Manag Care. 2014;20(5):393-400.
3. Press Ganey Associates, Inc. Medical practice pulse report: patient perspectives on American health care. http://www.pressganey.com/researchResources/medicalPractices/pulseReports.aspx. Accessed February 20, 2015.
4. Press Ganey Associates, Inc. Medical practice satisfaction: mean section score for “overall assessment” questions on the medical practice survey. National Quality Measures Clearinghouse (NQMC) measure submission form. 2011:21-24.
5. Penneys NS. A comparison of hourly block appointments with sequential patient scheduling in a dermatology practice. J Am Acad Dermatol. 2000;43(5 Pt 1):809-813.
6. CMS stage 2 final rule form 2012. Centers for Medicare and Medicaid Services website. http://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Stage_2.html. Accessed February 20, 2015.