We live in a world that belongs to the customer. Most organizations from multiple sectors recognize that sustainability and profitability are achieved by listening to the voice of the customer, by understanding what customers want and need. Healthcare systems are starting to recognize the importance of a patient-centered, highly efficient operating model capable of creating an extraordinary patient experience.

A medical office visit should be about delivering a positive patient experience. A patient experience where optimized patient flow, increased process efficiency and improved staff and physician’s alignment are paramount. However, there is a shared perception that medical office visits have become inefficient, more clerical and less focused on the delivery of care, causing patient, staff, and physician frustration.

Medical practices realize the revenue cycle begins at the front-end (scheduling, pre-registration, eligibility and authorization, and upfront patient collections), and most of the issues causing bottlenecks and delays during the patient’s visit are usually the result of inefficiencies identified in the same processes.

Pre-Visit Planning is an excellent approach to improving and integrating the front-end. It can be described as a standardized process that transforms patient access from the time an appointment is scheduled to when the patient arrives on site. A pre-visit planning process will streamline the front-end, remove waste and improve patient satisfaction, and create a memorable patient experience.

The Patient Access Paradigm Shift

A positive outpatient experience begins with patient access. Access includes every step of the journey that a patient must complete to engage with a chosen physician. From scheduling the visit and having all the care options available to a well-informed pre-encounter process, the journey will help create that positive experience. Moving from old school patient access (compliance, a fee-for-service reimbursement) to trending market drivers (value-based care, patient satisfaction) is the paradigm shift that medical practices should embrace to create an extraordinary patient experience.

Pre-visit planning is a business transformation initiative aimed to improve patient access, increase operational efficiency and achieve staff and physician engagement and alignment. These are all important elements to keep a healthy and efficient revenue management system, crucial to the financial health of the medical practice.patient_access

Scheduling: Centralized vs. Decentralized

Integrating your front-end is a strategic decision entailing a strong understanding of all activities taking place prior to the visit, the cross-functional and cultural aspects of those involved in these activities, and a clear vision of what the patient experience should be.

The goal of pre-visit planning is to achieve patient, staff and physician’s readiness to ensure a meaningful visit. The journey encompasses 5 main processes:

  • Scheduling and pre-registration
  • Financial readiness (insurance verification, eligibility, authorizations)
  • Clinical readiness (pre-visit testing, patient instructions)
  • Logistical readiness (appointment confirmations, reminders, pre-check-in options)
  • Patient arrival and check-in

Although all the processes in the pre-visit planning journey are important, the scheduling process is crucial to the success of the initiative and the trigger to the next steps in the readiness journey: financial, clinical and logistical readiness.

A medical practice will face an important decision when implementing pre-visit planning: centralized or decentralized scheduling:

  • Centralized scheduling enables the use of new scheduling technology (electronic registration, patient portals, mobile apps, instant notifications, etc.) that, if properly implemented, can be a huge enabler for patients, staff and physician’s satisfaction.
  • Decentralized scheduling provides flexibility to specialty-specific activities. The key aspect in a decentralized environment is to make sure that flexibility doesn’t become independence. In other words, just because the process is decentralized it doesn’t mean that it can’t be standardized.

Centralized Scheduling: Decision Trees and Standardization

Centralized scheduling has become the go-to solution for integrated pre-visit planning activities. From designing algorithms deployed through the EMR system to developing state-of-the-art standard work to implement specialty-specific decision trees, the opportunities are endless if you stick to the principle of patient centricity.

However, centralized scheduling will require a redesign of the scheduling infrastructure to improve patient flow and process efficiency. The solution must standardize all specialty-specific characteristics essential to the medical practice and identify those characteristics that can’t be standardized. A true understanding of the similarities and differences between specialties will lead to standardization, and standardization is key to successful algorithm development.


Algorithms and decision trees are both very important attributes to an effective centralized scheduling process. An algorithm is the set of rules that a computer system will follow to achieve a specific goal. In a medical office, a centralized scheduling algorithm is written to walk the patient through a set of rules to schedule the right patient at the right time with the right physician. A decision tree is a decision support tool used to display an algorithm. Decision trees consider all critical specialty-specific decisions and their likely consequences. A crucial aspect when creating decision trees is to do so without adding unnecessary complexity and variability to the process.

The key to standardizing scheduling is to leave aside the specialty-specific-exception game and focus on the task at hand which is to identify the 80% of the activities in the process that can become a standard work for all specialties. Then, consider the 20% of the activities that can’t be standardized and build rules for those exceptions. The result will be an efficient operating model, standardized and without waste.

 Final Thoughts

Pre-visit planning is about understanding value and focusing on the activities the patient would be willing to pay for. The goal is to design a process that brings the patient to the center of everything, encourages staff and physician engagement and alignment and enables the use of technology where and when it’s needed. This approach brings together processes, people, and technology to design what is best for the patient and to improve patient access.

At the end of the day, the objective is always the same: creating an extraordinary patient experience.

Daniela_MolnauToday’s blog was written by Daniela Molnau, Consulting Director at Vizient.

Daniela brings more than 15 years of business transformation and process improvement experience primarily in the healthcare industry. Prior to Vizient, Daniela served as Senior Director Operational Excellence with Matrix Medical Network providing PMO design, project and portfolio management, leadership development, and lean operations support. Daniela also served as a Global Director Business Improvement with Rio Tinto implementing large scale transformation initiatives and delivering over 40 million net EBITDA bottom line results. She obtained a Master of Business Administration from the Universidad Externado, South America and holds a Lean Master Black Belt certification.

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