Scheduling, Staffing, and Task Assignment
It goes without saying that the world of oncology has grown more complex through the years. In addition, certain nuances (eg, multiple locations, large hematology volume, space inefficiencies, treating referred-in nononcology infusion patients, utilization of nonphysician providers, clinical research in the office setting, etc) complicate the comparison of one practice with another. As a consequence, uniform industry dashboards or benchmarks are difficult to find.
To follow are recommendations to consider in your of fice setting regarding scheduling, staffing, and task assignment with the hopeful intent, if implemented, to improve your practice’s operations. In addition, many of the hospital benchmarks discussed by Guidi (see pages 10-11) can be used in the practice setting as well.
Except for fine-tuned, hardwired procedures for the revenue cycle processes, appropriate scheduling is the most important aspect for a wellrun, efficient oncology practice.
1. Consider each billable event as a revenue-generating resource, and maximize revenue by scheduling each step in the patient’s process as a separate appointment. These include lab draws and lab work, doctor’s appointment, che motherapy, injection, etc. Direct intervention should occur when the patient is in the phlebotomy chair, examination room, or chemotherapy chair. Patients should be in a waiting room or subwaiting area when intervention is not occurring.
2. Make each appointment for the amount of time the intervention takes, and build into your system a method to accommodate the maximum number of patients. For example, if a lab draw takes 5 minutes and you have 1 lab technician, the template should be built for 1 patient scheduled every 5 minutes. Don’t schedule 5 lab draws at 8 AM if the technician can draw only one at that exact time. If the doctor needs 20 minutes to see a patient, review imaging and lab results, write orders, and dictate, don’t schedule patients every 15 minutes.
3. Build each chemotherapy chair into the scheduling system as a resource, ensuring that all the chairs can be viewed on the computer screen. Each patient should be assigned to a chair. Develop scheduling guidelines for the scheduler, and include time to start the intravenous or port access, give premedications, and mix and give chemotherapy. Utilize appointments throughout the day, with shorter treatments after noon.
4. Leave one or more chairs open as a swing chair(s), depending on your average number of sick walk-ins and add-ons. This allows add-ons to be assigned to a chair. This also allows for fewer bottlenecks if a patient has a reaction, because an open chair is available for the next scheduled patient.
5. Consider assigning one nurse to do all injections, port access (non-chemotherapy), and, if possible, have this chair/room near the lab. Build the schedule template with 10- or 15-minute slots for this service.
6. Schedule new cancer patient appointment (unless an emergency) within 5 business days or less. Schedule new asymptomatic benign hematology patients within 3 weeks. Symptomatic benign hematology patients, however, should be scheduled within 5 to 7 business days.
7. Reserve slots in the schedule for new patients according to provider’s preferences. Most pro viders prefer the last slot (11 AM to 12 NOON) before lunch and/or the last slots for the day (3 PM and/or 4 PM).
Multiple sources (proprietary and purchased data) are used to gather data to benchmark the practice production and compare it with other medical oncology practices. As stated previously, it can be difficult, at times, to compare apples with apples. As a guide, the number of full-time equivalents (FTEs) per fulltime medical oncologist includes:
- Front desk 2.4 FTE
- Medical records 0.6 FTE
- Phlebotomy and lab 1.0 FTE
- Chemotherapy nurses (mix and administer) 2.2 FTE
- Clinic support 1.0 FTE
- Insurance/billing 1.2 FTE.
As practices grow, tasks can be assigned to specific staff members and, over time, these tasks become that person’s responsibilities. It is very important that the right person performs each task, with the duty falling within his or her respective scope. For example, nurses should perform duties that require a registered nurse (RN) license. RNs should not be performing charge capture, charge entry, or scheduling. Coders should perform charge capture and charge entry. Front office staff should perform all scheduling. Training and accurate, up-to-date job descriptions are imperative.
In summary, as outside forces continue to impact the bottom line for oncology practices, it is imperative to operate as efficiently as possible. Hopefully, some of these recommendations will impact and improve your operations. Elaine Kloos is a Senior Consultant with the Oncology Management Consulting Group, where she specializes in service line development and strategic planning.