Grand central scheduling: case history: a hospital radiology department gains physician satisfaction and treatment efficiency with a centralized scheduling solution

Health Management Technology, Oct, 2004

Busy physicians appreciate efficiency, especially when it comes to booking an outpatient screen or test. Having to call multiple departments or wait on hold for confirmation can eat away valuable time physicians could otherwise use to treat patients. A North Carolina medical center's radiology department was very familiar with this challenge--until it implemented a centralized scheduling solution.

Multiple Numbers, Long Wait Times

Alamance Regional Medical Center (ARMC) is a 238-bed medical complex in Burlington, N.C. Physicians who used ARMC's radiology services were frustrated with the scheduling process. Instead of calling one central number and talking to a designated scheduler, office staff had to call multiple numbers to book a procedure. The physician's office also encountered long wait times and often had to wait for a callback to confirm an appointment.

"The real disadvantage was to the doctor's office," says Connie Lawrence, R.N., clinical analyst and system manager at ARMC. "If the radiology department didn't have a clerk at the phone and the clinicians didn't answer, the physician had to leave a voice mail message. Then it was up to the radiology department to call the physician back to confirm the appointment details."

Radiology department staff and practitioners were frustrated, too. Clinicians often had to answer the telephone and log appointments into the radiology information system (NS), taking away from valuable time they needed to spend treating patients. Moreover, communication among the radiology areas was disjointed and often duplicated.

Once the patient arrived for a scheduled procedure, additional delays could ensue. The majority of medical necessity checks and insurance verification procedures were performed when the patient walked in for an exam. Neither patients nor staff had advance notice of potential problems or issues that needed resolving, and patients were sometimes surprised to find their insurance would not cover the scheduled procedures.

"It takes time to do all the necessary verifications. When the patient is sitting there, it's an unnecessary wait," Lawrence says. The revenue cycle was also delayed because the patient account was not created until the patient came in for the exam.

In addition to these internal challenges, a radiology facility that had opened across the street presented ARMC with strong competition.

More Streamlined Scheduling

ARMC's leaders knew the radiology department--and other areas of the hospital--needed to operate with maximum efficiency and stay ahead of the competition. A multidisciplinary performance improvement team was formed in the spring of 2001, and was tasked to research enterprise scheduling and account management solutions and to present a recommendation to administration for a centralized scheduling solution.

The team ultimately chose scheduling.com, by Los Gatos, Calif.-based SCI Systems, to provide the centralized scheduling solution. ARMC had already seen favorable results from decentralized versions of the scheduling.com application at each of its five outpatient rehabilitation clinics, so it made sense to integrate the technology into another department, Lawrence says.

In June 2003, ARMC rolled out scheduling.com in a newly formed centralized scheduling office. Staffed with six schedulers, ARMC began scheduling mammography, CT, MRI, diagnostics, nuclear medicine and ultrasound procedures for the radiology department. The medical center implemented a registration interface to connect the scheduling program to the Med-Series 4 account management program. A schedule interface was added to send appointments and patient information from scheduling.com to the IDX RIS. Prior to centralized scheduling, ARMC staff in each area of the department logged appointments and patient information directly into the RIS.

ARMC connects to the scheduling.com ASP via a virtual private network. The medical center can control the content of its own database, stored at the SCI facility. ARMC chose an ASP model because it was more economically feasible, Lawrence says. SCI maintains the hardware and provides database backup.

Operating with Maximum Efficiency

ARMC had a vision of providing "one-stop shopping" for patients and providers to schedule into the facility. Physician offices appreciate the fact that they can opt to call for patient appointments one at a time, or they can make one phone call to schedule multiple exams for multiple patients, Lawrence says.

With scheduling.com Account Management and Medical Necessity modules, ARMC centralized scheduling staff are completing preregistrations more efficiently. The hospital can now verify whether a procedure is medically necessary and verify insurance coverage when a patient books an appointment. If the test or exam is not covered, hospital staff can notify the patient ahead of time to resolve the issue.

"If we find that the patient's insurance will not pay or that the procedure isn't medically necessary, we have a few days to work on it before the patient comes in," Lawrence says. "That eliminates a lot of frustration for staff and patients, and helps to make our process more efficient." The revenue cycle begins earlier, too. A patient account is created the moment the appointment is scheduled.