What Can I Expect From My Primary Care Clinic When Scheduling An Appointment?

by Tiernan O’Neill

WHAT CAN I EXPECT FROM MY PRIMARY CARE CLINIC WHEN SCHEDULING AN

One of the most common concerns of both patients and doctors alike seems to be what can they both reasonably expect when an appointment is made at their clinic. As premiums and deductibles rise for patients there can be greater frustration when they don’t believe their money has been sufficiently spent. And for clinics and providers as workload, administrative burden and lastly patient expectations become more and more cumbersome they too wish to find a happy balance between desire and reality. This article is meant to address scheduling, problems covered, financial responsibilities and follow-up and how each directly affects patients as well as providers.

SCHEDULING

A patient should expect timely access to their primary care provider, and rightfully so. This generally means a routine acute or chronic condition appointment availability within 24-48 hours (business days). Access is one of the main reason patients will or won’t establish themselves with a primary care physician over utilizing urgent care services instead. As an established patient at a clinic, that clinic holds detailed historical information on a patient that can expedite and ease scheduling. Now from the clinic’s perspective, a timely appointment is typically determined by three major components and each of them is heavily influenced by reasonable expectations. There actually has to be an opening on the schedule. No clinic can or should schedule a patient quickly thereby inconveniencing other patients who have had the foresight and organization to plan ahead. Additionally, patients need to be flexible. Should you be unwilling to budge from a specific day or time you need to understand that availability on the schedule could be problematic through no fault of the clinic; as well it is typically not the best way to work with the scheduler so they work with you. Finally, the nature and range of issues wished to discuss within that appointment should be reasonable and practical to fit within the confines and limitations of the clinic’s schedule. Specialty appointments (new patients, physicals, procedures) tend to take more time on the schedule and thus they have limited availability and tend to book out farther in the future.

PROBLEMS COVERED

A patient should expect to cover the issues they have been scheduled for. When a patient is clear and detailed in the problems they wish to cover in an appointment, every reasonable effort should be made by the clinic and provider to meet those expectations. Within the appointment itself, it is incumbent on the patient to be organized and satisfied with the care they receive. It is often helpful to have your thoughts, issues and possible refills written down to reference throughout the appointment. It does little good other than scheduling a second appointment to call back later and say you forgot something. I would also highly recommend when you are dealing with a new issue, a health issue that is potentially life changing that you bring a friend or family member along with you to the appointment. Many people are often surprised what a second set of ears can hear when your mind is racing with possible implications of news you are receiving. From the provider side, you often hear clinics complain about the “oh by the way” factor. Patients will often add issues within their appointments, which can be the main cause of primary clinics running behind from their pre-set schedule. To this, I generally respond by saying “tough.” Primary care has been, is and always will be affected by these issues. It is the nature of the beast. When these issues present themselves a clinic should have a schedule or method allotted to handle this problem. Now, since primary care clinics have vast histories and tendencies of their patients they should also have a system to recognize, deal with and deter patients who chronically abuse this accommodation on purpose. Ultimately a patient, within reason, can expect to have their concerns and issues covered.

A second issue that is worth discussing within this topic is what a patient can expect to get out of their annual physical. A routine physical is for screening purposes only. While it is possibly intended to find health problems that are not normally obvious, it is not designed to coincide with acute issues, known chronic problems, or the possibility of abnormal findings. While some offices will allow patients to coincide annual physicals or preventative visits with diagnostic appointments, patients need to be aware this will add, specifically to the cost, of the encounter. Many people misunderstood the inception of free yearly physicals as a chance to address all of their health problems in one visit without charges. Billing guidelines set forth by the American Medical Association and endorsed by every insurance company clearly allow for clinics to bill for a diagnostic visit (and procedures) along with the physical charges as well.

FINANCIAL RESPONSIBILITIES

A patient should rightfully expect to satisfy their financial responsibilities in a manner as dictated by the guidelines of the clinic. This is probably an issue or a stance most patients don’t want to hear. But if a clinic is clear and consistent with their guidelines, patients need to follow them. It has been extremely unfortunate the business of health care has for so long and continues to be viewed as a credit industry. Whereby patients or really in fact consumers believe they should receive services and pay at a later date when it feels appropriate to them. You would never imagine a scenario where you buy food at your local grocery store now a days and simply say bill me later. In response to ever escalating costs and collections, many clinics have countered by collecting charges, coinsurances, and deductibles at time of service. Additionally, there has become a greater trend lately to keep patient financial credit cards on file for money collecting purposes after insurance determinations.Rather than arguing or even refusing to make such payments, you are best advised to find either an insurance plan or clinic where you can feel most comfortable with your financial responsibilities at time of service.

FOLLOW-UP

A patient should rightfully expect for timely and complete follow-up from their appointment. Test results, medication refills, and answers to your questions close the loop and should be considered an integral part of the appointment yourself. Providers have a reasonable expectation for their method of choice in delivery to such components to be respected and valued by their patients. Clinics will use a wide array of methods from lower staff relaying information to electronic portal communication to their patients. In cases of other staff relaying information (medical assistants or nurses), as long as the communication is provided by a competent and well versed professional a patient shouldn’t expect relay of information by the provider over the phone directly. Requests that contradict the clinic’s model will often be met with a need for a second appointment and you should understand there are additional scheduling, coverage and financial concerns associated with such.

CONCLUSION

Both a patient and a provider have every reason to have their above rights to be met. Reasonable expectations contained within should always be granted. Ultimately, no clinic is one size fits all. Should a patient feel they are not getting what they value they can feel free to search out another clinic that will better serve their needs. But patients should be forewarned if your expectations are not reasonable or clear you will likely find yourself bouncing from clinic to clinic and never find the continuity you search for in a primary care clinic. Conversely, no clinic should feel they have to alter their operations or reasonable expectations to meet the needs of every individual patient and their differing desires; and in these cases it is not wrong to suggest a patient they should go elsewhere. However, clinics should also be aware and responsive to popular expectations or they will quickly see their patient panel size shrink below a sustainable level.