Policy AD-103 Medical Appointment Scheduling Policy 2018-05-18

Purpose:

To provide the access needed to allow patients to schedule appointments for routine and urgent care with their primary medical provider.

Policy:

Westside Family Healthcare strives to consistently meet the medical needs of our patients by providing appropriate access to health care. Continuity of care is an important consideration when scheduling patients.  The Scheduling Department’s search for a medical appointment will begin with the patient’s Usual Provider and then extend to their Usual Provider’s team, the home facility, and lastly, any available qualified medical provider in a location convenient to the patient.  

Specifics regarding the matching of appointment types, lengths and ailments will be further defined in the Scheduling Manual.

Scope:

This policy covers medical visits. Dental visits are not included in the scope of this policy.

Definitions:

New Patient:  Anyone who has never been seen by a provider at a Westside Family Healthcare facility, or a patient who has not been seen within the past 3 years.  People meeting these criteria must be initially scheduled in a designated “New Patient” appointment.  Patients who have only received Title X services and wish to establish as medical care patients must transition to full medical care through a New Patient Appointment.

Newborn New Patient:  Newborns within 10 days of birth who have not been seen by a Westside provider in a Westside facility.

Title X Patient:  A Title X patient may receive only Title X related and reportable services including: family planning, birth control, STI testing and treatment (including partner treatment), and infertility care.

Medical Care Patient (also referred to as an Established Patient):  A patient who:

1. has been established through a new patient appointment, a well newborn appointment, or transitioned from Title X care via a new patient appointment

AND

1. has had a visit with a primary care medical provider within the past three (3) years.  

Routine Appointment:  A visit with a medical provider that, based on condition or illness, requires that the patient be seen within no set time requirement

Priority Appointment: A visit with a medical provider that, based on condition or illness, requires that the patient be seen within 7 days.

Urgent Appointment: A visit with a medical provider that, based on condition or illness, requires that the patient be seen within 24 hours.

Same-Day Appointment: Appointment scheduled for the same day of the patient’s request.

Pre-Scheduled Appointment: Appointment scheduled for any day after the day of the patient’s request.

Usual Provider: A Westside medical provider (clinician) whom the patient considers their primary medical care provider.

Preceptor Provider:  A physician who oversees the care provided by a Christiana Care Health System Resident Physician during assigned sessions.

Patient Portal Request:  An appointment request initiated through Westside’s patient medical record portal (Follow My Health).

Procedure:

Patients may schedule appointments through any of the following processes:

• 1. Calls routed to the Scheduling Department

  2. Appointment request submitted via the patient portal

  3. Follow-up appointment scheduled by Medical Receptionist

  4. Urgent or Priority Appointment scheduled by nurse

  5. Providers may email the scheduling pools for completion by Scheduling at a later date

Provider selection process for returning patients:  To allow for continuity of care, Westside will, whenever appropriate, schedule patients with their Usual Provider.  If the Usual Provider is not available, the search will extend to the Usual Provider’s team members, then to any provider in the same location, and lastly to any provider in any location convenient to the patient. Appointments with the Resident Physicians can be offered at any point after the Usual Provider has been excluded as an option or may be offered instead of an appointment with the Preceptor Provider if the Preceptor Provider is the patient’s Usual Provider.

Scheduling staff are provided reference tools that direct them to select specific providers and/or specific time periods for appointment availability.  Generally, appointments fall into three categories:

• 1. Urgent - patient is to be seen within 24 hours

  2. Priority - patient is to be seen within 7 days

  3. Routine - patient is to be seen but there is no required timeframe

During the request for an appointment, patients may describe medical conditions that require immediate action.  Westside has an “Urgent Calls” list that details the conditions/complaints that are to be immediately transferred to a nurse for triage.  Nurses may schedule patients into same-day “urgent” appointment slots as they deem appropriate.

Although the majority of appointment scheduling is completed by the members of the Scheduling team, the following groups may also schedule appointments:

• 1. Behavioral Health providers – typically schedule their own follow-up appointments.

  2. Nutrition providers – typically schedule their own follow-up appointments.

  3. Nurses – typically schedule medication pick-up, follow-up treatment or education, and blood pressure checks. Routinely schedule urgent appointments and hospital/emergency department follow-up visits.

  4. Medical Receptionists – typically schedule follow-up visits related to recent care received but can also include other services such as nutrition, MA visits, and social services, as needed.

The above list is not intended to exclude work groups or individuals from scheduling appointments.  As business needs dictate and user training allows, others not listed above may be involved in scheduling appointments.  

Provider Call-outs

• 1. When a provider with scheduled appointments calls out of work, the Scheduling team uses the Allscripts PM “Bump Appointment” process which moves scheduled patients to “bumped” status.

  2. Schedulers attempt to contact patients who have been bumped in order to reschedule the appointment.

  3. Depending on the category of the appointment, the scheduler will attempt to reschedule the appointment.

Message Pools

• 1. Message pools exist in the Allscripts system which providers, nurses, and others may send requests to schedule patient appointments.  

  2. Schedulers are assigned to work each pool to ensure that patients are contacted to schedule appointments.

  3. Schedulers will message any appointment requestor to notify them of an inability to contact the patient or if the patient refused an attempt to schedule an appointment.  

New Patient Appointments – the number of available new patient appointments is in part determined by the number of providers available and the size of each provider’s patient panel.  

• 1. Newborn new patient appointments are never limited and can be scheduled with any qualified provider in an appropriate length appointment slot.

  2. Anyone who has never been seen by a Westside Provider or a patient who has not been seen within the past 3 years is considered a new patient and must be scheduled in a designated “New Patient” appointment slot.

  3. Patients who have only received Title X services and wish to transition to medical care patients require a New Patient Appointment.

  4. Schedulers must advise anyone who is scheduled for a New Patient appointment that they will not receive a prescription for an opioid pain medication during their first visit.

  5. OR Clearance many not be scheduled in a New Patient appointment

  6. A “Complete Physical” appointment type may not be used for patients who have not established as medical patients of Westside.

References: