03.25.08
Posted in Uncategorized at 1:41 pm by amit
We’ve discussed scheduling problems in the past, pointing you to a few resources here and there, but we’ve never really provided a comprehensive approach for those scheduled appointments that go off the rails due to patients canceling, rescheduling, or simply not showing up at all.
Here are the exact strategies we’ve put in place over the last few years. If you’ve got something that works in your practice, leave a comment and share it with us.
Make Reminder Calls
We all forget things, and appointments (particularly those with a long lead time) are among the easiest things to lose track of. Appointment cards are helpful, but in the end, a phone call is your best bet. Email, text message and other automated solutions are starting to make some headway, but a good old-fashioned telephone call is still the most effective tool to combat schedule disintegration.
- Provide some lead time. Don’t make your calls the night before. Give patients at least 2-3 days notice.
- Don’t leave wiggle room. Saying, “Call us if you can’t make it,” is an invitation for people to reschedule.
I don’t think we started making these calls as early as we should have. When you’re not busy, it can feel like it doesn’t matter as much, but the truth is that it does matter. In fact, you could argue that it matters more - those cancellations are pretty painful in the early days.
Some practitioners argue that reminder calls encourage people to reschedule. I don’t buy it. Better to know, and take steps to deal with it, then have a sudden hole in your day.
Stay on Time
If you want patients to respect your time, then you need to start that process by respecting theirs. Make sure you stay on time. Don’t reschedule patients. Keep regular office hours.
Yes, emergencies crop up, but your clients will accept that if you explain it to them, apologize, and don’t let it happen regularly.
Book Tightly
What we’re really after here is teaching your patients to value their appointment. A large part of that is demonstrating that you’re busy and run a tight ship. Many practitioners tend to spread patients out over the course of a day, but for us the looser the schedule gets, the more reschedules we seem to encounter - patients figure they can get an appointment on just about any day, so what’s the big deal? It is a big deal, and it starts with effective scheduling.
Don’t Overbook
However, if you’re tempted to treat your appointment book like a discount charter flight and book it 120% full, you’re going to have problems. Overbooking to deal with last-minute scheduling changes is like treating symptoms instead of causes - it’s not getting to the root of the problem. In fact, just like running late, it’s probably creating more of them.
Book Acute Care Visits ASAP
Acute care visits are fertile ground for scheduling glitches. When patients call with an acute care issue, it’s because they want to be seen now. If you can’t see them soon, recognize the fact that they might get better or find someone else in the meantime. That increases the likelihood of a no-show or cancellation.
Follow the 1-2 Month Rule
When a patient wants to reschedule or cancel, remind them that they may not be able to get another visit for 1-2 months. Patients often reschedule simply for convenience, and this technique can often resurrect the appointment. You can read more on this approach here.
Deal With Repeat Offenders
You may discover that a large proportion of your problem appointments are with the same small group of patients.
We do have a no-show fee, but we use it with discretion. And while we don’t often charge people for missed appointments - unless they have some hard cost like custom formulated IV treatments - we do try to educate these people over time by explaining that someone else could have used their time slot.
Failing that, we follow a three-strike rule. After they bail a third time, we usually don’t hurry to call them back. If they call, we try to fit them in that day, or tell them to call back again another day when we might be able to provide same-day service.
Track Your Results
Although you may have a general sense of how well your appointment book holds together over the course of a month, nothing beats having some hard data. The easiest way is simply to have your staff track the numbers. This also lets you identify patterns that might crop up based on the time of day, week or year.
If your software doesn’t do this for you, it’s still easy to implement using pen and paper. Head to CalendarsThatWork.com, and print a lined version of their monthly calendar. Use the first line for reschedules, the second for cancellations (with no reschedule) and the third line for no-shows. Have your staff just put a tick on the appropriate line each time, then add them up at the end of the week/month. You can even enter your email address, and the site will send you the same calendar just before the start of each month.
Everyone has a role to play in keeping the schedule healthy -you, your staff, and your patients - and much of this is about teaching everyone involved about the value of a scheduled appointment. Consider yourself the Dean of the School of Appointment Value, and train your students accordingly.
We’ve noticed some dramatic improvements over time using these strategies - if you’ve got any other tips, we’d love to hear them!
Related posts:
- Reducing Cancellations and Reschedules
- Avoiding the Pitfalls of Advance Patient Scheduling
- Building a Busy CAM Practice By Acting Like One
- Why Your Practice Needs a Receptionist: Missed Calls
- How To Handle Free Advice-Seekers
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03.12.08
Posted in Uncategorized at 9:56 pm by amit
Medicare said Wednesday that it would continue to cover the use of an increasingly popular scanning procedure used to detect heart disease, despite the agency’s earlier misgivings over whether there was sufficient evidence to justify paying for the tests.
Reversing a proposed decision issued last December, Medicare said Wednesday that it would continue to leave payments for the scans — which can cost $600 or more — up to the local insurance carriers that the agency employs to oversee medical claims. Most of the local carriers have been covering the test.
Medicare paid for roughly 70,000 of these heart scans in 2006, according to the agency, at a cost of $40 million to $50 million. For people not yet eligible for Medicare, thousands of other such scans were paid for by commercial insurers or from patients’ own pockets, at prices sometimes close to $1,000. Firm data on the number of non-Medicare patients tested were not immediately available.
Because commercial insurers typically follow Medicare’s lead on what medical procedures they will pay for, Wednesday’s decision seemed likely to allow for continued growth in the number of scans. They are now widely advertised as a noninvasive alternative to tests like angiography — which requires the insertion of a catheter into the blood vessels.
Medicare’s initial proposal, which would have ended payment for the scans unless the patients were enrolled in studies to determine the technology’s effectiveness, had met with fierce resistance from the doctors who perform these scans and the companies that make the equipment. They strongly defended the use of these scans as an important alternative to traditional angiography.
“We found that the evidence is not black and white either way,” said Dr. Barry Straube, the chief medical officer for Medicare. Given the overwhelming criticism of the preliminary decision, the agency decided that it did not have enough reason to override the local carriers’ decision to cover the tests as medically necessary. “Before we make a significant change in policy, we need more evidence,” Dr. Straube said.
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Posted in Uncategorized at 7:48 pm by amit
WHEN the Columbus Children’s Hospital agreed to name a new lobby after two retail chains to thank their corporate parent for a $5 million donation, everyone was all smiles. The same was true when the Ohio hospital renamed itself Nationwide Children’s Hospital, to acknowledge a $50 million gift from Nationwide insurance, a large local company.
But a coalition of children’s advocates contends that the hospital went too far by agreeing to name a new emergency department and trauma center after another locally based retailer, Abercrombie & Fitch, in exchange for a $10 million donation.
The coalition, which includes the Campaign for a Commercial-Free Childhood, several pediatricians and Parents for Ethical Marketing, is asking the hospital to reconsider the decision made in June 2006 to accept the donation. The plea is being made now because ground is to be broken this year for the building to house the emergency and trauma facilities.
The 15 organizations and 80 individuals that compose the coalition contend that naming the new center after Abercrombie & Fitch — known for provocative advertising and revealing clothing — sends a grievously wrong message.
“It is troubling that a children’s hospital would name its emergency room after a company that routinely relies on highly sexualized marketing to target teens and preteens,” the members of the coalition wrote in a letter that was sent on Tuesday to the hospital’s office in Columbus, Ohio.
“The Abercrombie & Fitch Emergency Department and Trauma Center marries the Abercrombie brand to your reputation,” said the letter, addressed to five senior officers of the hospital. “A company with a long history of undermining children’s well-being is now linked with healing.”
The complaint is an example of negative reaction to the increasingly prevalent practice of naming public facilities after corporate sponsors, donors and supporters.
Opponents who complain about the growing commercialization of the American culture are upset that private companies are able to brand stadiums, parks, schools, school buses and hospitals.
About a dozen hospitals across the country bear corporate or sponsor names, including at least two other children’s hospitals: Mattel Children’s Hospital U.C.L.A. in Los Angeles and Hasbro Children’s Hospital, the pediatric division of Rhode Island Hospital in Providence.
Naming a facility for Abercrombie & Fitch “is more egregious,” said Susan Linn, the director of the Campaign for a Commercial-Free Childhood in Boston, because of the reputation of the retailer as “among the worst corporate predators” for “sexualizing and objectifying children.”
“Selling corporate naming rights is a slippery slope, and this is way down that slope,” said Ms. Linn, who is also the associate director at the media center at Judge Baker Children’s Center, an affiliate of the Harvard Medical School.
The sex-drenched images of toothsome young men and women that Abercrombie & Fitch has used for years to sell its own-brand apparel in ads, posters and catalogs have made the company and its chief executive, Michael S. Jeffries, billions of dollars — and countless enemies.
The opponents of the company’s campaigns, which are typically shot by the fashion photographer Bruce Weber, contend they cross the line by presenting undressed teenagers and 20-somethings in overly sexualized situations. The company describes its ads as playful and celebratory of the free spirit of today’s young Americans.
Last month, the police in Virginia Beach, Va., removed two large posters — part of the chain’s national campaign — from the windows of an Abercrombie store in a mall and charged the manager with an obscenity misdemeanor. One poster showed a woman with a breast mostly exposed and the other displayed three shirtless young men, one of whom was also revealing part of his backside.
The city of Virginia Beach subsequently decided against prosecuting the store manager.
Other times, however, the opponents of the Abercrombie approach have prevailed; in 2003, the company discontinued its popular magazine-style catalog, A.& F. Quarterly, because of mounting complaints from parents about its racy contents.
And a year later, the company, based in New Albany, Ohio, agreed to pay $50 million to settle a suit that accused it of discriminating against minority employees for promotions and cultivating a white-only image.
As for the coalition’s protests against the hospital naming, Tom Lennox, a spokesman at Abercrombie & Fitch, said on Tuesday, “We are proud of our longstanding relationship with the hospital and pleased to help secure its bright future.”
•
A call from a reporter to Nationwide Children’s Hospital for a response to the letter from the coalition was returned by Jon M. Fitzgerald, the president of the Nationwide Children’s Hospital Foundation.
“I like to focus on the philanthropy of it,” Mr. Fitzgerald said, adding, “I don’t feel comfortable addressing” any of the objections raised in the letter.
“Two years ago, Abercrombie & Fitch made a very significant philanthropic gift,” Mr. Fitzgerald said. “In honor of that gift, we chose to offer recognition of their tremendous support of our organization.”
Mr. Fitzgerald took issue with a contention in the letter that the hospital agreed to “sell naming rights” to Abercrombie & Fitch in exchange for the $10 million.
“We don’t sell naming rights,” Mr. Fitzgerald said. “We as a nonprofit accept gifts to support our mission. We’re looking for philanthropic support.”
The ground-breaking for the building in which the facilities are to be housed will probably take place in late fall, he added, with completion scheduled in 2012. The new lobby, to be named after the Limited Too and Justice retail chains owned by Tween Brands, also will be in the new building.
•
Abercrombie & Fitch has been a frequent target of criticism from organizations and activists like those that wrote the letter. They also include the National Institute on Media and the Family, Teachers Resisting Unhealthy Children’s Entertainment and Dr. Alvin F. Pouissant, the nationally known professor of psychiatry at the Harvard Medical School.
One school of thought holds that complaints from parents and the establishment only elevate the brand’s appeal with the target audience.
“There’s always a ‘forbidden fruit’ aspect to what adolescents do; that’s probably why they smoke,” said Dr. Victor Strasburger, professor of pediatrics at the University of New Mexico School of Medicine, who also signed the letter. A main goal of the letter is “trying to influence the decision-makers at children’s hospitals to act responsibly,” Dr. Strasburger said. “We’ve reached a point in our society where it seems there’s no such thing as bad publicity,” he added. “We have to pull back from that.”
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03.08.08
Posted in Uncategorized at 5:12 am by amit
ANCHORAGE — Eli Lilly, the drug maker, could and should have warned physicians as early as 1998 about the link between Zyprexa, its best-selling schizophrenia medicine, and diabetes, an expert witness told jurors Friday in a lawsuit that claims that Zyprexa has caused many mentally ill people to develop diabetes.
Instead, Lilly hid Zyprexa’s risks from doctors to protect the drug’s sales, according to the witness, Dr. John Gueriguian. Lilly waited until 2007 to add strong warnings to Zyprexa’s label to reflect the drug’s tendency to cause severe weight gain and blood sugar changes.
Lilly put “profit over concern of the consumer,” Dr. Gueriguian said Friday near the end of four hours of testimony.
Zyprexa, a drug for schizophrenia and bipolar disorder, is by far Lilly’s top-selling product, with worldwide sales of $4.8 billion last year.
The company has said it did nothing wrong and fully disclosed what it knew about Zyprexa to the Food and Drug Administration.
Dr. Gueriguian is testifying on behalf of the State of Alaska, which has sued Lilly to recover its costs for treating Medicaid patients who developed diabetes after taking Zyprexa. The trial is being heard in state court in downtown Anchorage before a jury of seven women and five men.
Dr. Gueriguian is a specialist on diabetes and was a medical reviewer for the Food and Drug Administration for 20 years before retiring in 1998.
At the F.D.A., he recommended against the approval of Rezulin, a diabetes drug that was later withdrawn for causing severe liver damage in patients.
Under examination by Tommy Fibich, a lawyer from Houston who is representing Alaska, Dr. Gueriguian methodically reviewed about a dozen documents in which Lilly scientists and executives discussed the potential links between Zyprexa and diabetes.
Zyprexa was introduced in September 1996 and hailed as a breakthrough medicine for the treatment of schizophrenia.
But doctors quickly began to report to Lilly that patients suffered severe weight gain, high blood sugar and even diabetes after taking the drug.
By the fall of 1998, the combination of adverse-event reports, clinical trial data that showed hyperglycemia and weight gain, and problems in animal studies should have been enough for Lilly to warn doctors about Zyprexa’s links to diabetes, Dr. Gueriguian said. Instead, the company did nothing.
Documents from 1999 and 2000 also showed that Lilly was accumulating evidence of Zyprexa’s risks but not sharing it with doctors, he testified.
And in 2002, only 10 months after Lilly began selling Zyprexa in Japan, medical regulators in that country required Lilly to warn doctors against using Zyprexa in diabetic patients.
But Lilly did not issue a similar advisory to doctors in the United States. Instead, the company advised its sales representatives not to discuss diabetes with doctors unless the doctors brought it up first, according to another document presented at the trial.
“We will NOT proactively address the diabetes concerns,” the document, an internal Lilly memorandum, said.
Court recessed on Friday before lawyers for Lilly could cross-examine Dr. Gueriguian. They will have the opportunity to do so on Monday.
A lawyer for Lilly said after Dr. Gueriguian’s testimony that the company had shared all it knew with the F.D.A. and that the question of the link between Zyprexa and diabetes was still a subject of scientific debate.
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03.07.08
Posted in Uncategorized at 5:32 pm by amit
The Online Nursing Degree Directory listed us in their Top 50 Alternative Medicine Blogs. Thanks to the ONDD!
The list is worth a gander from a practitioner perspective. It’s well categorized, with a few good sites I’d never seen. Head over and take a look.
Related posts:
- CAM Information Resources
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