Advancements in Scheduling:
Centralizing, Outsourcing and Self-Scheduling
Hans P. Morefield, SVP Strategic Partnerships, SCI Solutions
The first scheduling call ever placed was answered on the first ring. The next caller was placed on hold.
Back in the 1990s, this was the essence of the scheduling experience at U.S. hospitals. Scheduling was mostly manual and decentralized, and customers had a 50/50 chance of having a good experience.
With the increasing competition and financial challenges facing hospitals, the need to do scheduling better became increasingly clear. More recently, progressive health systems have determined they need to do more than make their scheduling better; they want to make scheduling great.
In this article we'll explore how hospitals and health systems can be great at scheduling.
Scheduling is a vital hospital function for many reasons, including:
- Scheduling brings in outpatient revenue
- Scheduling determines whether a service line is profitable (largely driven by the productivity of the resources)
- Scheduling initiates the clinical and revenue cycle processes
- Scheduling is a customer's first impression of a healthcare facility
Centralized Scheduling
The first scheduling issue hospitals began to address was the many different phone numbers a customer might need to call depending on the service required. Decentralized scheduling not only is confusing, but also increases the frequency of busy signals, lengthens hold time, and leads to scheduling inefficiency. The easy answer was to bring all schedulers together in one area, provide customers with one number to call and train the staff to schedule any type of service requested by the caller.
Identifying the value of centralized scheduling was easy—achieving it is much harder. Individual departments within a hospital are resistant to giving up their control of scheduling to a centralized department. They have a simple reason for this reluctance; they believe, rightly, that healthcare scheduling is too complex for a scheduler to know all the questions, rules, details, preferences and other considerations that dictate how an appointment must be booked. The departments are sure centralized schedulers, if left to schedule based on their training alone, would undoubtedly make frequent errors, disrupting the operations of the department and driving customers away.
Centralized scheduling could only work if the hospital were to have a more capable scheduling system than the early, “dummy” scheduling systems employed by most hospitals. If schedulers were going to schedule all the services of the typical hospital, they would need a system that would help them manage the complexity.
These second-generation “Helpful” scheduling systems entered the market in the mid-to-late 1990s and enabled many hospitals to centralize scheduling. However, larger, more complex environments, such as academic medical centers, children’s hospitals and multi-hospital health systems, still couldn’t centralize scheduling. Why? Because compared to a typical hospital, an academic/children’s hospital, with their hundreds of specialist physicians seeing patients in clinics in addition to their large volume of hospital-based services, is magnitudes more complex. A “Helpful” scheduling system wasn’t good enough. Increasing complexity required an even smarter scheduling system—the next-generation “Expert*” scheduling system.
For all the challenges and costs associated with achieving centralized scheduling, many case studies have demonstrated the value. McLeod Health in Florence, S.C. centralized scheduling across three hospitals, along with pre-registration and insurance verification, and measured the following benefits:
- 24% increase in physician satisfaction
- Volume increase, including 90% in one department
- 40% reduction in outpatient denied claims
Yet, for all the cases of hospitals making scheduling better, not enough are making it great. In today’s highly competitive environment and given the importance of scheduling to the clinical and financial success of a hospital, the increasing is for great scheduling.
Option #1 for Achieving Great Scheduling: Better Call-Handling
Many hospitals term their centralized scheduling department a call center, but usually they fail by a wide margin to meet the standards of the advanced call centers we encounter when we call a bank, airline or catalog company. The characteristics of a true Call Center include:
- Defined service levels, for example: 85% of calls answered within 30 seconds
- Abandonment rate below 3%
- Call center performance data tracked daily
- Schedulers hired based on their fit for the job
- Calls regularly monitored by supervisors
- Schedulers given scorecards on their performance
- Continuous training and improvement program
If a hospital’s centralized scheduling department doesn’t match at least four of the above characteristics, it is not a true call center and the service is likely sub-optimal and almost certainly, not great.
To operate a true call center requires: good people, particularly a strong call center manager and agents with excellent customer service, call-handling skills; a continuous training program where agents are trained, regularly (daily, at least weekly) monitored, given feedback on positive and negative actions, and re-trained as necessary; and the technology to support an effective call center, particularly an automatic call distribution (ACD) system with call-recording and call-monitoring capabilities.
Outsourcing
If a hospital or health system wants to improve its call-handling to deliver great service, but can’t afford the associated costs or lacks the personnel to implement and maintain a call center, then outsourcing the call-handling is an increasingly common option. For a flat, per-minute fee, a healthcare-only call center will answer a hospital’s scheduling calls as if they were hospital employees. The call center guarantees to provide the staffing and the service to meet a contracted service level for speed-to-answer (average time a caller waits for a call to be answered) and abandonment rate (percentage of callers that hang up while waiting to speak with agent). With the experience from other healthcare customers and a singular focus on call-handling, an outsourced call center can be a very attractive option for a health system. The cost of an internal vs. outsourced call center can be fairly close.
That said, if one considers the challenges of getting internal buy-in with centralized scheduling within a hospital, getting the Radiology director to accept having calls answered by non-employees in a call center a thousand miles away can be hard to imagine. In this situation, the Radiology director will not be satisfied that the call center agent has a helpful scheduling system; the only conditions under which an outsourced call center would be acceptable is if the external schedulers are using an expert scheduling system and the Radiology department can define the rules that will guide (and limit) the schedulers appropriately.
| Internal Call Center | Outsourced Call Center |
10 Schedulers = $400,000 / yr $516,000 / yr Does not include technology, utilities, hiring costs, training costs and more. |
175,000 calls $525,000 / yr |
Option #2 for Achieving Great Scheduling: Self-Scheduling
Many hospitals and health systems are moving to a new model—instead of handling calls better, they’re offering their customers the ability to schedule online via the internet. Referring physician offices can schedule all the same tests they normally book by phone, and patients can schedule physician visits, self-referred tests, such as screening mammograms, and classes, as well as cancel or reschedule any appointment online.
The issue hospitals face in offering this capability is that it nearly always requires a new scheduling system—only expert scheduling systems have enough built-in intelligence to enable these untrained users (the portal needs to be self-evident) to schedule potentially complex tests and procedures without ever making an error. Hospitals and health systems must decide whether to be first in their market with self-scheduling or wait until a competitor offers the capability before making the investment themselves.
While waiting for a competitor can seem prudent, an interesting case study from a competitive market in the Southeast shows the costs associated with being second. About 18 months ago, a hospital noticed that referrals for radiology tests had stopped coming from two key physician offices in the community. When they sent a liaison to the offices to find out why, they discovered that their competitor had deployed a self-scheduling portal and the staff at these two offices, which normally split their referrals between the two facilities, liked the portal so much they had stopped calling the hospital without self-scheduling.
Within four months, the hospital that was losing business had gotten internal approval to find a new scheduling system with self-scheduling capabilities. The selection process took more than six months and it will be another few months before they will roll out their self-scheduling portal to their community. By allowing their competitor to be first, they will end up almost 20 months behind. Hospitals must decide if they can afford this; self-scheduling will likely be an option in every community within three to five years.
Self-scheduling makes operational sense, too. With the baby boomers poised to hit 65 and the increasing movement of services from inpatient to outpatient delivery, hospitals and health systems will see more and more patients each year. Without self-service, hospitals will simply add more and more schedulers to handle the volume. Self-scheduling will limit this expense.
In summary, scheduling is too important these days not to be done very, very well.
Consider the following steps to greatness ...
1. Centralize scheduling, if you haven’t already
For tremendous customer service and revenue cycle benefits
2. Define and achieve great call-handling
Consider outsourcing firms if internal effort is not possible
3. Recognize you will have to offer self-scheduling at some point
Will you be first in your market or a follower?
… and be Great! Do Scheduling Great!
*Expert Scheduling System—an application with an embedded rules engine that captures and automates all the rules associated with scheduling, so the scheduler only has to follow the application’s prompts. The scheduler can even be an untrained patient or referring physician office.
client quote:
“With SCI we reduced our lab monthly denials from $23,000 to 0, and increased utilization from 400 average orders a month to 3,230, as well as improved patient, physician and staff satisfaction.”
Eisenhower Medical Center
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