Late patient policy

[JustPlainBill]

So --- haven't seen a thread on this in a while and had a recent situation which is prompting the question ---

Had a 90+ y/o new patient show up 15 minutes late to their appointment accompanied by family --

we typically require new patients to show up 30 minutes early to fill out paperwork etc. -- for an established patient, it's 15 minutes early to go over any insurance changes, etc.

then usually -- although it's physician specific -- we have a 15 minutes late policy -- you will be rescheduled ---

Now, I'm the new guy and building a practice -- slow day today -- had patients scheduled early (1pm) and then at 4:40 and 5pm -- last patient is taken at 6:40 ---

this patient shows up at 5:15 for a 5pm appointment -- had no one scheduled after that so ----

I wound up taking them although my front staff seems to accommodate anyone rather than risk getting yelled at by an irritated patient who wants to be seen when they show up, not when they are scheduled ---

how does everyone else deal with this one?

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[deleted87716]

If it's slow (or if I'm caught up), I'll typically see them anyway. Depending on the circumstances, however, they may be asked to reschedule. It's my call, not my staff's. I try to be as flexible as I can, within reason, and will always try to see them, if possible. However, if somebody shows up late and there are other patients who are on time, the late person gets seen when I can see them. They should be prepared to wait. I won't penalize other patients for somebody else's tardiness.

I get paid to see patients, so there's nothing to be gained from turning somebody away.

 

[cabinbuilder]

So --- haven't seen a thread on this in a while and had a recent situation which is prompting the question ---

Had a 90+ y/o new patient show up 15 minutes late to their appointment accompanied by family --

we typically require new patients to show up 30 minutes early to fill out paperwork etc. -- for an established patient, it's 15 minutes early to go over any insurance changes, etc.

then usually -- although it's physician specific -- we have a 15 minutes late policy -- you will be rescheduled ---

Now, I'm the new guy and building a practice -- slow day today -- had patients scheduled early (1pm) and then at 4:40 and 5pm -- last patient is taken at 6:40 ---

this patient shows up at 5:15 for a 5pm appointment -- had no one scheduled after that so ----

I wound up taking them although my front staff seems to accommodate anyone rather than risk getting yelled at by an irritated patient who wants to be seen when they show up, not when they are scheduled ---

how does everyone else deal with this one?

SO this is my take on this: it comes down to customer service in the end. Plus.... the 90 year old generally is at the mercy of who is picking them up, the shuttle service, how long in the bathroom, how mobile are they, etc etc etc. Lots of factors. I wouldn't want my grandmother turned away after all the effort it took to get there in the first place. It comes down to courtesy and common decency. You can take 15 extras minutes of your life and do the right thing.

Similarly if there is a young mom with a bunch of babies who is stuck taking the bus with strollers, etc. They are at the mercy of public transportation, I always see them too.

Now if it's some yahoo with a loud mouth, Rastafarian looks who reeks like cannabis and hasn't shaved or showered in the past month - forget that and reschedule.

 

[JustPlainBill]

SO this is my take on this: it comes down to customer service in the end. Plus.... the 90 year old generally is at the mercy of who is picking them up, the shuttle service, how long in the bathroom, how mobile are they, etc etc etc. Lots of factors. I wouldn't want my grandmother turned away after all the effort it took to get there in the first place. It comes down to courtesy and common decency. You can take 15 extras minutes of your life and do the right thing.

Similarly if there is a young mom with a bunch of babies who is stuck taking the bus with strollers, etc. They are at the mercy of public transportation, I always see them too.

Now if it's some yahoo with a loud mouth, Rastafarian looks who reeks like cannabis and hasn't shaved or showered in the past month - forget that and reschedule.

I hear you n the geriatric mobility or mommy with a lot of little ones --- This case in particular was the adult children who were picking mom up, were told to be there 30 minutes early for paperwork, were called by staff at the 15 minute late mark and responded,"Well, yep, it's ok, they're on their way now --" "Ma'am, they're 45 minutes late" "Oh, it's ok, they're on their way".... and it's the last patient of the day, staff was getting antsy to go home and a new patient --- we wound up staying close to an hour after close as she needed some stat labs to guide dosing recommendations ---

I guess I'm torn between "customer service" and that thing you and I have discussed ad infinitum -- being treated like a short order cook -- I guess society is just losing respect for common courtesy --- yesterday, I was running late for MY physician's appointment, called his office to say I was running late 15 minutes PRIOR to my appointment time -- walked in at my appointment time fully prepared to be told I had to reschedule ---- but that's me.....

Also had an established middle aged patient who showed up 20 minutes late, demanded to be seen, bitched and moaned in the waiting area rather loudly, demanding to be seen for a high fever/sickness -- moved him to an open slot which required him to wait 20 minutes -- and gets seen for a 100.3 with mild maxillary sinus tenderness ---

and so it goes ---

 

[cabinbuilder]

I agree that 45 minutes late is just plain rude and I would have rescheduled that. There is a no win situation on that one.

 

[VA Hopeful Dr]

I'm with BD, it all depends on the schedule for that day. Try to be accommodating but not at the expense of patients who show up on time.

 

[deleted480308]

If you have space in the schedule, treat it like a chance to build your business and be in customer service mode. I'd have staff mention that normally being that late would result in a missed appt but that the doctor was gracious enough to find a spot in the schedule.

If the schedule was legitimately packed, you have staff apologize and offer them a chance to wait until there is a spot (in a private practice, I would say my last appt is at 6:15....unless someone no-shows on me, you can be seen then if you wait here) or reschedule.

The trick to being hardcore about patient promptness is you better not get behind schedule yourself. I never made appts at my last FM doc's practice, I would just drop in when I needed to and ask to be slipped in during the next no-show, never had to wait more than an hour or so.

 

[Bacchus]

This is what our office "does." I often don't make a huge fuss because I have no control over the front staff and they're checkin procedures.

1) If you are 15 minutes late you are no-showed, unless you call that you're going to be late.
2) If you're pregnant and this is a PN appointment or OB complaint (I think I might be in labor (and doesn't require a trip to triage)) you are seen as soon as you're registered.
3) Children under ?2 yo are seen regardless.
4) If late, you are given the option to reschedule elsewhere into your provider's schedule.
5) If your provider doesn't have a slot, then you will be offered a spot in another provider's schedule.
6) You can outright reschedule.

I've met my magic "1650" last month so I'm not as "pressed" for patients 😉. I do try to be flexible and know my chronic patients most likely NEED TO BE SEEN. You're coming in for a backache and are 30? Have a sore throat and no suspicion of anything bad going on? Go to the urgent care or reschedule. I'm not going to be hard pressed at the end of the day to see you. The nicer you are to me, the nicer I am to you. I often ask our MAs to bring back the early 5:20 patient if the 5:00 just arrived or isn't even yet in the building and it's 5:00. It usually works out.

Where I sacrifice is this: I often have notes to do at the end of the day. Now that I've accepted dictating, I can get through my 15-20 charts in an hour (I take my computer into the room and type if appropriate).

Of course, I'm still a resident so I don't have much control over anything, but I do appreciate the minimal control I have over my schedule. It's nice because we can request 40 minute appointments and I will often utilize these for my more complicated patients until I become more proficient. Good news is, the office I'm going to has 20 min appointments and that's what I'm used to in residency 🙂.

 

[Doctor4Life1769]

This is what our office "does." I often don't make a huge fuss because I have no control over the front staff and they're checkin procedures.

1) If you are 15 minutes late you are no-showed, unless you call that you're going to be late.
2) If you're pregnant and this is a PN appointment or OB complaint (I think I might be in labor (and doesn't require a trip to triage)) you are seen as soon as you're registered.
3) Children under ?2 yo are seen regardless.
4) If late, you are given the option to reschedule elsewhere into your provider's schedule.
5) If your provider doesn't have a slot, then you will be offered a spot in another provider's schedule.
6) You can outright reschedule.

I've met my magic "1650" last month so I'm not as "pressed" for patients 😉. I do try to be flexible and know my chronic patients most likely NEED TO BE SEEN. You're coming in for a backache and are 30? Have a sore throat and no suspicion of anything bad going on? Go to the urgent care or reschedule. I'm not going to be hard pressed at the end of the day to see you. The nicer you are to me, the nicer I am to you. I often ask our MAs to bring back the early 5:20 patient if the 5:00 just arrived or isn't even yet in the building and it's 5:00. It usually works out.

Where I sacrifice is this: I often have notes to do at the end of the day. Now that I've accepted dictating, I can get through my 15-20 charts in an hour (I take my computer into the room and type if appropriate).

Of course, I'm still a resident so I don't have much control over anything, but I do appreciate the minimal control I have over my schedule. It's nice because we can request 40 minute appointments and I will often utilize these for my more complicated patients until I become more proficient. Good news is, the office I'm going to has 20 min appointments and that's what I'm used to in residency 🙂.

We only have 15 min for return/acute (unless acute is female issue related, then it is 30).
New pts, well childs, annuals are 30. Medicare annuals 45. Annual + pap technically is 45 but I make those 30.
If I have openings, I say bring 'em in. If I don't, then I tell them to re-schedule. Showing up 45 mins late at the end of the day = reschedule. No questions asked. That's my personal policy and it is kosher with my nurses.

1650 is impressive already. I have 1250 currently, but I only have had PGY-2/3 years. Our clinics go from 8:15-11:30 and then 1:15-4:15. We don't go beyond that. If on hospital medicine, then clinic is 8:45-11:30 or 1:45-4:15.

If I have a complicated patient, I request 30 mins. We don't have 20/40 min appts. The practices in the area are all 15/30 as well so it's good practice. One private practice said 15 mins for new and established, I said no thanks. All in all, you're pretty lucky.

 

[Doctor4Life1769]

If you have space in the schedule, treat it like a chance to build your business and be in customer service mode. I'd have staff mention that normally being that late would result in a missed appt but that the doctor was gracious enough to find a spot in the schedule.

If the schedule was legitimately packed, you have staff apologize and offer them a chance to wait until there is a spot (in a private practice, I would say my last appt is at 6:15....unless someone no-shows on me, you can be seen then if you wait here) or reschedule.

The trick to being hardcore about patient promptness is you better not get behind schedule yourself. I never made appts at my last FM doc's practice, I would just drop in when I needed to and ask to be slipped in during the next no-show, never had to wait more than an hour or so.

Why not schedule an appt?
In the off chance everyone showed up, you wasted your time and inevitably pissed off someone on my staff.

 

[deleted480308]

Why not schedule an appt?
In the off chance everyone showed up, you wasted your time and inevitably pissed off someone on my staff.

because my work life was such that I did not have great predictability over my schedule. I assumed the risk that I might someday not have found an empty slot but I never had to wait long and had they refused to let me try the "walk-in" method I simply would have found another doctor.

"Hey, I know I don't have an appt but does there happen to be a slot in the next hour or so that I might fill?"....it's not that crazy

 

[Doctor4Life1769]

because my work life was such that I did not have great predictability over my schedule. I assumed the risk that I might someday not have found an empty slot but I never had to wait long and had they refused to let me try the "walk-in" method I simply would have found another doctor.

"Hey, I know I don't have an appt but does there happen to be a slot in the next hour or so that I might fill?"....it's not that crazy

My PCP is usually cool with whenever I show up, as long as I had my name on the schedule book because she understands my busy schedule as a resident. I just have to be sure not to show up in the final 30 mins of clinic.

 

[deleted87716]

The trick to being hardcore about patient promptness is you better not get behind schedule yourself.

Not true. If I'm running behind, it's not my fault. I don't overbook or play stupid scheduling games. If I run behind, it's because one or more patients needed the extra time, and any whiners are reminded that the same courtesy will be (and probably already has been) extended to them, should the need arise. Given the choice between having a doctor who ALWAYS runs on time (e.g., "sorry, your 15 minutes are up...please schedule another appointment so we can address any remaining issues") vs. a doctor who will take the time to address your needs, I can't imagine anyone who would choose the former.

I never made appts at my last FM doc's practice, I would just drop in when I needed to and ask to be slipped in during the next no-show, never had to wait more than an hour or so.

Yeah, that's just odd. Basically, you're asking for a same-day appointment (which I offer), so just call and schedule a same-day appointment. Why would you want to waste time hanging around waiting for something to open up? If the office doesn't offer walk-in hours, don't expect to be able to just walk in.

 

[Doctor4Life1769]

Speaking of PCPs...

My current PCP is looking to transition out of insurance and go simply based on fee per service. She will start charging several hundred dollars per visit.

I will be looking elsewhere. Question is, would you consider having a co-resident friend be your PCP when we are both out in practice? Or would you look to join someone entirely random?

 

[deleted480308]

Speaking of PCPs...

My current PCP is looking to transition out of insurance and go simply based on fee per service. She will start charging several hundred dollars per visit.

I will be looking elsewhere. Question is, would you consider having a co-resident friend be your PCP when we are both out in practice? Or would you look to join someone entirely random?

Hundreds per visit? How many people are going to be willing to pay that for FM?

 

[deleted480308]

Not true. If I'm running behind, it's not my fault. I don't overbook or play stupid scheduling games. If I run behind, it's because one or more patients needed the extra time, and any whiners are reminded that the same courtesy will be (and probably already has been) extended to them, should the need arise. Given the choice between having a doctor who ALWAYS runs on time (e.g., "sorry, your 15 minutes are up...please schedule another appointment so we can address any remaining issues") vs. a doctor who will take the time to address your needs, I can't imagine anyone who would choose the former.



Yeah, that's just odd. Basically, you're asking for a same-day appointment (which I offer), so just call and schedule a same-day appointment. Why would you want to waste time hanging around waiting for something to open up? If the office doesn't offer walk-in hours, don't expect to be able to just walk in.

I'm young with no large issues. My visits are short. Were I a patient at a place that cancelled me if I was 15min late, I would expect them to be prompt too.

I didn't do appts because the nature of my work was unpredictable and full of last minute "crisis fixing". When I happened to be able to swing by I did...they were fine with it

 

[deleted87716]

Were I a patient at a place that cancelled me if I was 15min late, I would expect them to be prompt too.

You'd be one of those folks to whom I could only say, "Sorry we failed to meet your expectations."

 

[deleted480308]

You'd be one of those folks to whom I could only say, "Sorry we failed to meet your expectations."

That's cool, I went to a free schedule type of place. Different business models for different folks

 

[Doctor4Life1769]

Hundreds per visit? How many people are going to be willing to pay that for FM?

Yeah well, that's her personal business and not mine.

 

[deleted480308]

Yeah well, that's her personal business and not mine.

I'm not judging it. If she can make ends meet charging $5k/visit, more power to her. I'm curious about the business model and what area has enough patients willing to pay that for the model to work.

 

[VA Hopeful Dr]

Speaking of PCPs...

My current PCP is looking to transition out of insurance and go simply based on fee per service. She will start charging several hundred dollars per visit.

I will be looking elsewhere. Question is, would you consider having a co-resident friend be your PCP when we are both out in practice? Or would you look to join someone entirely random?

My current PCP was a year behind me in residency.

 

[styphon]

We have a 15 minute late restriction, but if we have an open spot the same day and the patient wants it, we MUST reschedule them (Indian health services policy on "open access"). My record so far is 3 no shows from the same pt, all within 6 hours.

If I don't have any slots, but someone comes in for something that is truly urgent, I will usually double book or see them during my "lunch". This includes chest pain, SOB, wound check, lacerations but does NOT include "sore throats" "flu", etc.