Watch Those BAs, CAs, and Es
Broken appointments (BAs), cancelled appointments (CAs), and emergency appointments (Es) create multiple problems in keeping the appointment schedule on time and finishing treatment on time.
If an effort is made to fit the BAs and CAs into the schedule soon or to take care of the emergencies immediately, which is the ideal solution, the schedule will become crowded, run late, create stress for the doctor and the staff, and keep people waiting. There will not be enough time to complete the work for every patient that was intended to be accomplished, necessitating extra appointments and prolonged treatment time. Keeping people waiting and prolonged treatment are two major causes of patient dissatisfaction.
If BAs and CAs are reappointed several weeks later "at the convenience of the practice", and if the Es are only made comfortable and reappointed for a treatment visit several weeks later, total treatment time is usually extended.
What is the answer to this apparent dilemma? It lies in monitoring these types of appointments, getting them down to manageable levels, and arranging the daily schedule to include a consideration for them.
Step One is to take your appointment book for the past year and total up the BAs and CAs. If they average 10% of your appointments in a fairly even pattern, that appears to be the usual experience. If they are much higher than 10%, try to find out why. One good possibility is that the office has too rigid a policy on appointments, and forces appointments on patients that they really don't expect to keep, but accept because they feel powerless to do otherwise.
Step Two is to total up your emergency appointments for the previous year. There is disagreement about how to do this and about what is an acceptable amount. Some base their figure on a percentage of chair time, and believe that 20% is acceptable. Others base their figure on percentage of appointments and usually find 10% acceptable. I believe that 20% of chair time is much too much, and, while 10% of appointments may be acceptable, 5% is an achievable goal.
Emergencies should be monitored to find out how to prevent future emergencies, rather than to assign blame to the patient, the assistant, or the appliance. Sometimes the treatment is the problem, such as placing a wire or a bracket that interferes with the occlusion. Sometimes the technique may be the cause, such as leaving a sharp end sticking out. Sometimes the assistant may need additional training in certain techniques. Sometimes the patient may be breaking the rules on maintaining the appliances and may need reeducation. By monitoring emergencies, it should be possible to see patterns of causes, and it should be possible to correct some of them readily.
If the average daily number of BAs and CAs were 10% and the average number of emergency appointments were also 10%, they would appear to balance one another and provide a perfect solution to the scheduling problem. The only remaining problem is where to put the reappointments for the BAs and CAs. Since this is a fairly constant need, overbooking is not a good solution to the problem. It would practically guarantee that the practice would spend a great deal of time behind schedule. Practices that are aware that they have 10% BAs and CAs and overbook 10% are taking care of the BA and CA problem, but overlooking the emergency appointments.
If the object is to get the BAs and CAs in as soon as possible and to reduce the prolongation of treatment, there needs to be 10-15% of open time in the daily schedule to accommodate them. This can be strategically placed, based on past experience.
There are good economic reasons for organizing the BAs, CAs, and Es to smooth out each day's schedule, to see that patients are kept waiting a minimum amount of time, and that treatment is completed according to the estimated time. When patients are kept waiting and the practice is always rushed and behind schedule, it wouldn't even occur to those patients that you want or need more patients. They wouldn't even think of referring new patients to your practice. When treatment is prolonged, profit per patient decreases. As you accumulate more and more patients whose payment is completed, but whose treatment remains to be completed, your costs for office space, personnel, equipment, supplies, and utilities increase to accommodate the larger number.
There are also good management reasons for keeping a smooth schedule. It makes for a happy, less stressed staff and doctor, and that attitude is contagious. It transfers to the patients. In addition, work that is done under less harried conditions is likely to include fewer potentials for emergencies.
Finally, and most important, the practice must not get into the if-you-don't-care-we-don't-care game- "If you don't care enough to keep your appointments and keep your appliances in good condition, we don't care. It's your mouth, your appearance, your future health and well-being". The practice that rigidly refuses to reappoint a BA, CA, or E sooner than four to six weeks later may also be playing another game. It's called crime and punishment. It is exactly the wrong way to handle this problem. It tells patients that you really don't care, but it also prolongs treatment time, which is in no one's best interest.
If we truly believe we are in a caring practice, one excellent way to show it is in the proper handling of BAs, CAs, and Es.
