Scheduling and the butterfly effect for higher clinic revenue | Amanda Olson, DPT

I have been a practicing physical therapist for seven years now. If I tack on three additional years for when I was in physical therapy school and rotating out on various clinical internships, than I have had ten years of experience documenting patient care in one realm or another. Within the seven years that I have held a physical therapy license, my husband and I have moved across state lines three times. Additionally, I changed my area of emphasis from pediatrics to pelvic health. All of these events lend to the fact that I have seen seven different clinical systems of documentation and patient scheduling.

Within the last ten years advances in technology, software, and gadgetry has grown exponentially. For example, five years ago my husband bought me a Garmin navigation system when we moved from Portland to Seattle. I was working in a pediatric home health care system at that time, and would have been lost every day without the use of the Garmin. I also scheduled my patients in pencil in a spiral bound paper calendar book and wrote SOAP notes in a Word document. These were then faxed by our front office to various physicians, and billing reimbursement turnaround from insurance took somewhere in the neighborhood of six months.

Fast forward five years to 2015. I sold the Garmin on ebay long ago, opting for the use of navigation applications on my cell phone. I have seen several different electronic medical record systems with scheduling software during geographical and career changes. I have seen tacky online scheduling programs that often experienced significant down time due to server issues. I have seen systems in which the front office staff had to enter a new patient into the scheduling and billing software system first, and then manually re-enter them into the separate electronic medical record and documentation system thus allowing for errors in transposition, wasting time, and draining efficiency from the clinic. And let’s be honest, efficiency has a dollar value in the business of healthcare in the year 2015.

It only makes sense that our patients should be scheduled, documented for treatment, and billed from one single software program. Wrapped snuggily in a package with a bow of checks and balances neatly tied around it, we should expect there to be no discrepancies between these three interrelated components of practice.

Ideally when a patient is scheduled into a software system, the expected benefits are clear and concise scheduling in which the patient and the therapist can clearly see the intended visits. There should be reminder calls and text messages to the patient to increase attendance rates, eliminate no-shows and decrease cancellations or misunderstandings. In turn, this should result in increased patient retention as the experience of the patient will be consistency in smooth check-ins and on-time appointments.

In bestPT I have found all of these things. In addition to all the aforementioned patient scheduling capabilities, there is a great deal more. Automated patient check in, and workflow automated task management are components that have created the experience of a finely tuned instrument.


An example of the how the schedule appears upon logging in for the day

With this scheduling system, patient name, appointment type (evaluation or follow-up appointment), outstanding balance, and check-in status is readily visible. Thus, when my 7:30 am patient walks in the door, the front office and I can both see the check-in status, money collection can take place if necessary, and treatment can begin on time. Furthermore, patients are readily searchable in the left upper hand corner, thus when a patient calls on the phone to schedule an appointment, office staff can quickly find the patient and get them scheduled.

Workflow xDocs

An Example of the Workflow

Workflow is made smooth with the use of an alert system that provides pertinent information regarding each individual patient. In a busy clinic staff can easily forget important tasks that must be done to remain compliant with insurance and billing. There are various intricacies involved in checking in patients (some more than others), and processing their paperwork. There are also important tasks that should be done with every patient that comes in the office that can easily be forgotten by both physical therapy and front office staff. For example, every patient should ideally have a future appointment scheduled prior to leaving the office. The alert system indicates when a patient has no-showed, and if they do not have a future appointment scheduled. This alert system is an example of the checks and balances in place so that each staff member in the office will be reminded of necessary patient tasks.

In physics, specifically in chaos theory, the notion of the butterfly effect comes to mind when analyzing the effects of something as simple as patient scheduling on the health of an entire physical therapy practice. The butterfly effect refers to the idea that the flutter of a butterfly’s wings might create small changes in the atmosphere that can ultimately alter the path of a tornado or delay, accelerate or prevent the occurrence of a tornado in a far off location.

The butterfly effect of this scheduling program on our practice has been tremendous. There is better office communication through the alert system, and daily errors in patient flow have been significantly reduced. My colleagues, office staff, and I feel less frazzled throughout the day because scheduling and check-ins occur smoothly lending to on time appointments, decreased stress on the patient, little to no scheduling errors, and less loose ends at the end of the day. This in turn has lead to better visit compliance from patients. The reminder calls and texts alert patients of upcoming visits and thus our no-show rate has decreased substantially. Thanks to the alert system I am now on time with progress notes resulting in compliance with insurance and billing. The system sends me a risk report with millions of rules calculated and checked against our practice’s actions in real time allowing for corrections to be made immediately. In the greater picture, this has lead to higher practice revenue, which is vital to the growth of our private practice.

For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

-Amanda Olson, DPT