Scheduling a telehealth and in-person mix that actually works

Decide which visits belong where

Start with a clinical decision, not a scheduling one. With your providers, list which visit types can be done well by video and which need the patient in the room. Common candidates for telehealth include some follow-ups, results reviews, medication check-ins and certain counseling visits. Anything needing a hands-on exam, procedure, vitals the patient can't take at home or testing belongs in the office. The right list depends on your specialty, your payers' coverage rules and your state's requirements, so check those for your own practice.

Put the list on the desk guide. If schedulers must ask a provider every time, telehealth will be offered inconsistently, and patients will be booked into the wrong format.

Give schedulers a short question to ask as well: "Would you prefer to come in, or would a video visit work for you?" Offered as a choice for suitable visit types, it lets patients who struggle with travel or time off work keep appointments they might otherwise cancel.

Three ways to structure the mix

• Telehealth blocks. A set part of a session, such as the last hour of each afternoon, is reserved for video visits. Providers switch modes once, not repeatedly. This is a good starting point for most practices.
• Telehealth days or half-days. A provider works a full session virtually, possibly from home. This frees exam rooms for other providers, which effectively adds in-person capacity to the building.
• Mixed scheduling. Any slot can be either type. It's the most flexible for patients but the hardest on providers, and it tends to cause delays as each switch takes time. If you use it, add a few minutes of buffer before each virtual visit.

Use telehealth to free rooms

The hidden benefit of grouping virtual visits is room capacity. In many practices, the real limit on in-person visits is exam rooms, not providers. If one provider spends Tuesday afternoon on video visits from an office, their two rooms are available for another provider who could otherwise only use two.

Illustrative example: a practice with six exam rooms and three providers, each normally using two rooms. If one provider moves a four-hour session to telehealth, another provider could use three rooms for that session and see, say, four more in-person patients. At $150 a visit, that is $600 per session in added capacity, on top of the virtual visits themselves. Your numbers will vary, but it's worth checking whether rooms are your real bottleneck.

Preventing virtual no-shows

Virtual visits fail in a few predictable ways: the patient forgets, can't find the link, has a technical problem or is somewhere they can't talk. A short process catches most of them:

1. At booking: confirm that the patient has a suitable device and a private place to talk, and explain how they'll receive the link.
2. Reminder: send the visit time and how to join, without the reason for the visit in the message. Tell the patient what to do if the link doesn't work.
3. At visit time: if the patient hasn't connected after a few minutes, the desk or medical assistant calls or texts right away. Many virtual no-shows are really technical problems solved in two minutes.
4. If they can't connect: offer a phone visit if appropriate and allowed, or rebook on the spot with specific times.

Scheduling details that save time

• Make the format obvious. Use a distinct appointment type for virtual visits so the format shows clearly on the schedule and in the export.
• Separate check-in work. Virtual patients still need insurance verification, forms and copay collection. Do them before the visit, since there's no counter to stop at.
• Plan for conversion. Some virtual visits will need an in-person follow-up. Hold a few short in-person slots in the following days for these.
• Track by format. Report no-shows, utilization and visit duration separately for in-person and virtual visits.

What to measure

Add a few rows to your weekly scorecard: virtual visits completed, virtual no-show rate, share of virtual visits that started late because the patient couldn't connect, and in-person utilization on days with telehealth blocks. If virtual no-shows run higher than in-person ones, the connection process is usually the cause, and the fix is in the reminder and the at-visit-time contact. For calculating no-show rate consistently, see how to calculate your no-show rate.