Homegrown appointment system reaps solid rewards

A multilocation practice designs its own software to allow patients to schedule their visits using the Internet.

By Tyler Chin, amednews staff. Oct. 28, 2002.

For years, patients and referring physicians would have to wait a long time on hold or try to get past a convoluted voice-mail system to talk to someone to set up an appointment with any of 60 physicians at Illinois Bone and Joint Institute.

It wasn't uncommon for patients to show up for their appointments at one of the orthopedic group's 11 Chicago-area locations only to discover that they had been assigned the wrong physician for their condition or gone to the wrong office.

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Upset with the problem and patients' frustration, Thomas Gleason, MD, and Wayne Goldstein, MD, both orthopedic surgeons, decided to develop scheduling software that would let patients make an appointment over the Internet without having to call the office. They hired programmers to write the software, which was installed at their two largest offices in April.

While other physician groups around the country let patients request appointments by e-mail, the system that the orthopedic group uses is unusual. Patients can go to a Web site and select an appointment date and time without having to wait for the office to call or e-mail back to finalize the appointment. Patients who aren't comfortable using the Internet or don't have access to it can still call the office to schedule appointments, and staff will access the scheduling software, Dr. Gleason said.

"This is a real-time system. It's not a system where you have to wait for a phone call back or anything of that nature," said Dr. Gleason, who came up with the idea in 1999.

Patients can set up appointments online, without waiting for the office to call back.

The decision to offer real-time scheduling "was driven partly by my frustration with my schedule and the schedulers," he said. For example, he would set aside slots for follow-up patients, but those slots would be filled with new patients, who require more time than follow-up patients. He would fall behind, aggravating both him and his patients.

That desire to improve patient service led him and about a half-dozen other IBJI physicians and their relatives to form a company, G&G.com Inc., and invest $1.3 million to develop and implement the software. The company and its owners hope to recoup their investment partly by selling the software, called the AppointmentSite, to other group practices for about $5,000 to $10,000 plus an annual maintenance fee of $1,000, Dr. Gleason said. The software can be customized for any type of practice, he said.

But even if nobody buys the software, Dr. Gleason said the investment he and his colleagues made will pay off because the software will make it easier for the group to attract and retain patients. "In the old system, I know that we lost patients because they couldn't reach the office," Dr. Gleason said.

Return on investment

To use the system, patients must first register online and set up a user ID and password. The system asks a series of questions and generates a list of physicians who specialize in treating the patient's particular condition. The patient clicks on the doctor's name to get a calendar and selects the date and time he or she wants to come in. If the time isn't available, the system gives three alternate times nearest the selected time.

Dr. Goldstein estimates that the group will see $22,750 per physician in annual revenue and savings based on the 19 doctors who work at the two offices using the software.

Specific savings and reimbursement estimates, per physician, are:

$2,500 in labor savings. Pre-software, one scheduler was needed for every three doctors in the group, Dr. Goldstein said. With the software, the practice believes that each scheduler will be able to handle an additional physician.
$3,750 in additional reimbursement from 50 office visits by patients who previously missed their appointments because they were assigned the wrong physician or went to the wrong office. That sum is based on an average reimbursement of $75 per visit and a conservative estimate that a single patient a week missed an appointment prior to the installation of the system, Dr. Goldstein said.
$7,500 in reimbursement from 100 additional patients annually. The group believes that physicians will be able to see an average of two additional patients a week for 50 weeks as a result of more efficient and accurate scheduling.
$9,000 in additional reimbursement for procedures that some of those 100 patients will require. The basis for this estimate is that 6% of the additional patients will require procedures averaging $1,500 each.

Those figures may be conservative, as some physicians at the group are already seeing one or two additional patients daily rather than weekly.

Although the group believes that the software will help increase patient revenue, they stress that their desire to improve service to patients, not money, motivated the project.

"It's more than dollars and cents," Dr. Gleason said. "My purpose for living is to try and provide good care, and I get great satisfaction out of that. How can you put a price on that? As long as you feed your children, you pay the mortgage, you educate your kids ... why not do something like this for your patients? It [also] makes it a lot more pleasant and pleasurable to go to work knowing my schedule is organized appropriately."

"The fact that we see one or two more patients a day is good, but it's definitely not the goal," added Mary Moran, MD, a rheumatologist at IBJI who is not part of the investor group or G&G.com Inc. "We try to serve as many people as we can, but we do not want to do anything that would sacrifice quality [of care]."

Dr. Moran said that, although she now sees 20 to 22 patients a day -- up from 18 to 20 -- she still spends the same amount of time with patients as she did before, because she sees only the patients whom she's supposed to see, instead of having to deal with patients who were misdirected because of scheduling snafus.

ADDITIONAL INFORMATION:

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The Illinois Bone and Joint Institute expects to make $22,750 per physician, per year, in extra revenue and savings from a self-designed program that allows patients to schedule their own appointments in real time over the Internet.

$2,500 in labor savings from not having to hire as many schedulers.
$3,750 in additional reimbursement from 50 patients who previously missed their appointments because they were assigned the wrong physician or went to the wrong office.
$7,500 in reimbursement from 100 additional patients annually -- more efficient scheduling will allow physicians to see two additional patients per week.
$9,000 in reimbursement from the estimated 6% of those 100 additional patients that will require a procedure.