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Planning can reduce the back-to-school patient crunch

A column about keeping your practice in good health

By Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted Aug. 2, 2010.

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The back-to-school season can be a hectic time for a doctor's office. Last-minute checkups, vaccination requirements and school forms all can increase workloads considerably. But with good preparation, communication and scheduling, medical practices can meet patients' needs in a timely manner and reduce the number who will turn to retail clinics and other facilities.

"Parents know how important continuity of care and having a pediatrician who knows your child is," said Avril Beckford, MD, a pediatrician at Wellstar's Pediatric and Adolescent Center in Austell, Ga. She also is immediate past president of the Georgia chapter of the American Academy of Pediatrics, but was speaking on her own behalf. "And if there's competition, we work harder and jump higher to provide a service that is superior so that parents make the choice to come to their medical home."

There is no one-size-fits-all strategy for handling the back-to-school season, but experts suggest that those who run medical practices consider several issues.

The first challenge is encouraging parents to bring their children in as early as possible.

Some practices send reminder postcards or make phone calls. Others place information about back-to-school and sports physicals on websites, blogs, electronic newsletters and social media. For example, Jen Brull, MD, a family physician in Plainville, Kan., issues reminders on her practice's Facebook fan page.

"The main thing is to be proactive so we don't have 60 people calling on the day before school starts," said Dr. Bull, who also is president of the Kansas Academy of Family Physicians but was speaking for herself. "And we have some young patients who are [Facebook] fans who tell their parents they need to come in. That's been very successful, and it's free."

Physicians also must consider whether to charge for filling out the numerous forms needed by pediatric patients to attend school or participate in athletic activities. Many practices will include filling out a form as part of a visit, although some add a fee if the paperwork needs to be taken care of at other times. The fee partially covers the staff time, but also can increase patients' motivation to have forms ready at the time of the visit.

Other practices have created systems aimed at reducing the time office staff spends on the paperwork.

Forms were really "backing up the front desk," according to Jill Stoller, MD, incoming chair of the AAP's section on administration and practice management. To alleviate the bottleneck, she set up a secure drop box in the lobby of her practice, Chestnut Ridge Pediatric Associates, in Woodcliff Lake, N.J., along with posted instructions on how to use it.

Patients can deposit forms in the drop box and then pick them up three business days later, after paying a modest fee. If a patient needs the completed form sooner, there is an additional charge. In its first year, the approach has had the desired effect, Dr. Stoller said.

Adjusting schedules

The next issue to consider is whether appointment schedules should be changed to accommodate a possible increase in demand for well-child visits, which often require more time than, and take time away from, sick visits. Many practices find setting up schedules to allow room for the longer checkups makes sense.

"We always have room for a sick child, but, in the summer time, we have a whole lot less sick children, so we change our schedules and double the amount of checkups we give," said Linda Rickey, practice administrator of North Fulton Pediatrics in Roswell, Ga.

Some practices extend hours into the evening and weekends to accommodate patients' schedules.

Practices also need to make sure they have enough vaccine in stock since so many patients need to be immunized around this time.

None of the recommended immunizations is in short supply this year, but sometimes that has been an issue in the past. A bigger challenge is the budget shortfalls in some states that impact government-run vaccination programs.

Previously, some states were able to combine money from the federal Vaccines for Children program and their own money to provide vaccine for children with and without insurance. For example, North Carolina had a universal vaccination program that allowed practices to get vaccines at no charge from one source. But state funding reductions mean that some practices in the state now need to order and pay for vaccines provided to children with insurance.

"We used to get all [vaccines] from the state. Now, we have had to order between $8,000 and $9,000 worth of vaccine [from multiple companies]," said Jonathan Fowler, chief financial officer and practice manager of Village Pediatrics of Chapel Hill in North Carolina. "We were lucky to have that program, and we are sad to see it go."

Whatever strategy a practice needs for the back-to-school season, most experts say the key is having it mapped out well before classes begin.

"Every practice is so unique and so different that they have different needs depending on the community," said Brandon Betancourt, practice administrator of Salud Pediatrics in Algonquin, Ill. "But be prepared and have a good plan."

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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