Arrived and then Completed Appointments

[sandi]

Is there any way to link a trigger for completed appointments to marking the appointment complete. And in the same vein, is there anyway of having a trigger to seating the patient in the chair triggered by something. Possibly clicking on the waiting room over the patient and then seating the patient and the notes for that patient open? If this is a new request is it possible to create one. Thanks

[jordansparks]

Are you asking to add triggers to the automation feature? A trigger for completing an appointment would be easy. A trigger for seating a patient would also be easy. That would happen when you change the confirmed status over on the right of the Appointments module as long as you had it linked to the Time Seated field as discussed in the manual. But just curious what you would do with those triggers. You suggest popping open the notes for that patient, but I don't know what that means. You mean procedure notes? Which ones? Wouldn't you first want to see what procedures you are about to do before you are presented with a place to enter procedure notes? Or do you mean some other kind of notes?

[sandi]

Jordon, I do realise about the trigger setup in setup modules and Ive already done that.
You misunderstand me. Im trying to find a way of having the patient seated and dismissed and the status changing automatically in the waiting room on the right without pressing anything on the right as I forget to do it most of the time. A previous software I used did this for me in a simple yet clever way. When a patient was clicked on the right it asked did I want to seat the patient in a pop up, if I entered yes the status changed to seated, if I entered no then the patients name appeared on the top of the bar and I could view their records, this would be in OD at the very top of the blue bar and the name changes on top.
They were dismissed when the appointment was marked complete, that acted as the trigger.
It would be awesome if you could incorporate this in or plan to, a requested feature would be great. Thank you

[jordansparks]

We currently mark the appointment "complete" right after seating the patient in order to start getting the notes in order and to finalize all the finances. That gives the assistant the entire appointment time to get it right. I think we should probably be "seating the patient" rather than "setting the appointment complete", but we just haven't quite figured out what that will look like. Then, right before the patient gets up, we should be "setting the appointment complete". Doing it that way would help with a lot of this. The front desk wouldn't be allowed to take action on an incomplete appointment, so it would also help enforce the office flow that we've been recommending for years.

[sandi]

Jordon would you not agree that the way I used sounds much more efficient. If I currently click on a patient on the waiting room in the right, you cannot select a patient using it either, as clicking on a patient in the waiting room does nothing which isn't logical.
Lets say I did click on a patient in the waiting room, I would hope for the records to then be in that patient, and It asking me if I wanted to seat them(removing them from the waiting room and putting the seated trigger), even if it did this it would be fantastic ignoring the completion if needs be for those who can remember to do so. Thanks!

[Pruce Dental]

Jordan...

As far as finalizing all the finances...I think OD should run a realtime insurance estimate and patient co-pay amount right on the scheduler or even better out of view on the edit appointment screen. The only way currently that I see for giving a patient an estimate of their co-pay is to submit their claim and then it shows in the account (unless I am missing something). Many times when confirming appointments a patient will ask what they owe for the appointment and the answer is not always apparent.

Is there a feature request for this already?

PS sorry to hijack this thread...

[Hersheydmd]

We currently mark the appointment "complete" right after seating the patient in order to start getting the notes in order and to finalize all the finances. That gives the assistant the entire appointment time to get it right. I think we should probably be "seating the patient" rather than "setting the appointment complete", but we just haven't quite figured out what that will look like. Then, right before the patient gets up, we should be "setting the appointment complete". Doing it that way would help with a lot of this. The front desk wouldn't be allowed to take action on an incomplete appointment, so it would also help enforce the office flow that we've been recommending for years.

Jordan, I would never mark the appt complete right after seating the patient. The treatment planned for a particular visit changes too much and too often, and if marked complete in advance it is too easy to forget to change it later. Minor procedures are added or subtracted from planned appts all the time. Therefore, at the end of a visit we first we check the appt and un-attach or delete any procedures that weren't performed, and add any that weren't tx planned, then we type up and sign and set each procedure complete and only then mark the appt complete.
Someone will ask, what do you do if the patient goes to the front desk before the notes are typed, signed and marked complete. The clinical staff has been trained to, at the very least make sure the correct tx is attached or unattached to the appt before the pt goes up front (in the appt edit window) so the tx plan fee for the appt will be correct. It is easy to see what is attached to an appt because all of today's attached procedures show up yellow. The front desk staff is trained to check the "fee for this appt" (which they can view in the appt edit window or in the appt module screen) if the appt is not yet marked complete. Since switching to this protocol we have had many fewer billing/payment errors, where the patient under or overpaid for the appt.

[jordansparks]

Maybe I should have said to mark it complete right after you decide what you're doing. It's perfectly ok, though, if it changes. The assistant is supposed to be constantly updating the changes throughout the appointment, AND doing a final check at the end.

No, the patient should not be allowed to get up out of the chair until the procedures are finalized, all notes are done, etc. The front desk should DEFINITELY not be interacting with the patient until that entire appointment is marked complete.

[Hersheydmd]

Maybe I should have said to mark it complete right after you decide what you're doing. It's perfectly ok, though, if it changes. The assistant is supposed to be constantly updating the changes throughout the appointment, AND doing a final check at the end.

No, the patient should not be allowed to get up out of the chair until the procedures are finalized, all notes are done, etc. The front desk should DEFINITELY not be interacting with the patient until that entire appointment is marked complete.

Jordan,
You are talking about an ideal situation. As much as I try to have the notes finalized immediately, that is not always feasible. You're assuming that every doctor and hygienist works with a chairside assistant - not always the case. Staff also get sick or have emergencies
Sometimes you just have to run into the next room to see an emergency that was squeezed in and the roving assistant or temp has to clean the room and get it ready for the next patient. There isn't always time to type up notes between patients. Do a survey. You will find a great many doctors enter their notes at lunch or the end of the day. A system has to be flexible so that it works in all situations, ideal and not ideal, even as we strive for perfection.

[jordansparks]

I'm going to leave out the issue here of finalizing the notes. We can agree to disagree on that. Instead, what I want to focus on is the system for everything else besides the notes.

It only takes a moment for the chairside staff, whoever that may be, to make sure all the procedures are correct including surfaces and fees. Taking the time to do that before releasing the patient is FAR more important than jumping over to the next patient. If you break the system, then it slows everyone down because they have to keep redoing things. The front desk MUST have accurate records in order to finish checking out the patient.

I'm not talking about an ideal situation at all. I'm talking about a system that I personally used and enforced with 100% compliance for over 10 years. The only time a patient made it to the front desk too soon was when they quickly got up at the end of the appointment because they had to use the bathroom. We had physical charts at the time to hold our xrays, and so we were able to handle that situation by not passing off the chart to the front desk yet. What's currently missing in OD is a way to handle paperless offices with some sort of digital passoff from the chair to the front desk.

[jordansparks]

If I currently click on a patient on the waiting room in the right, you cannot select a patient using it either, as clicking on a patient in the waiting room does nothing which isn't logical.
Lets say I did click on a patient in the waiting room, I would hope for the records to then be in that patient, and It asking me if I wanted to seat them(removing them from the waiting room and putting the seated trigger), even if it did this it would be fantastic ignoring the completion if needs be for those who can remember to do so. Thanks!

I agree. You could look through the feature requests for that and vote for it or add it.

[Hersheydmd]

Jordan,
I agree. We do exactly what you said. If we don't have time to type up and sign the notes, we at least check over all the procedures and make sure the correct procedures are attached to the appointment before the pt gets to the front (we are also paperless, so we don't have charts to pass down). We don't necessarily mark the appt complete (because then we might forget to go back and do our notes). But it doesn't matter, because, if the appt wasn't marked complete, the front desk can look at the "Fee for this appt" and knows what to charge for the visit.

Don't think by any means that this is our usual modus operandi. This is the exception, not the rule, for those situations where we are unable to finish our notes in time. But it works. It's eliminated the need for the front desk to intercom the operatories every time a patient comes up to see if the account module is updated and correct. And the patient doesn't have to hang around the front desk waiting for the doctor or hygienist to finish their notes. And by not marking an appt complete until the notes are done and signed, it's now easy to look through the schedule and see which appts/notes need attention.

[jordansparks]

I disagree that you can check out a patient who only has TP procs. It would be better to build some other system to track your incomplete notes.

[Pruce Dental]

Hershey...

How do you give an itemized walkout statement or receipt to show cash paid without the procedures posted?...Why not just list all the patients on a piece of paper and then cross them off after you check/double check that their notes were added?

I

[jordansparks]

That is an excellent suggestion. No chance of anyone slipping through the cracks if you cross them off instead of the other way around.

[Hersheydmd]

Sorry if I am beating a dead horse here. I guess I have a very unique situation that wouldn't work for most.
We rarely give patients walk out statements. We are PAPERLESS and 100% committed to being paperless (only a problem in the lavatory). We don't print a statement unless the patient asks for it, which is rare. You would be surprised at how many people are just as happy not to have the paper. Most will just throw it away anyway. If someone asks for a statement we first offer to e-mail it to them rather than print it. The only exception that we still print is the credit card receipt.
Since going paperless we stopped mailing statements. Payment is expected at the time of service. We will accept assignment of benefits only if the patient leaves a credit card on file to handle any balance not paid within 90 days (I was skeptical about trying this, but I've been amazed at how well it is working and how few objections there have been). After the insurance payment arrives we charge the balance on the card and e-mail, text, or call the patient to inform them.
Anyone who can't pay their entire bill at the time of the visit is given the option of setting up recurring automatic credit card payments or leaving a series of post-dated checks (which is legal in NY). We are very flexible about the terms - basically whatever monthly amount is comfortable for the patient. This has taken one huge headache off of my front desk staff. No more billing and chasing people to get paid.

We will have to agree to disagree. Maybe it wouldn't work for someone else but this works very well for me.
Besides Jordan, patients make payments all the time on multi-visit prosthetic procedures that are in progress and not yet marked complete. I don't see the difference.