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INTRODUCTION
A bump or bumped appointment is when, contrary to a patient cancellation, a provider cancels on the patient because the provider is not available. Most commonly providers bump appointments because they need to perform emergency care, weather forces the office to close, or a provider is going on vacation. Some practices don’t use the term bump, but utilize a cancellation reason such as “Provider Cancelled” or “Provider Unavailable”.

Alright, we got the housekeeping out of the way, you still with us? QueueDr has focused on scheduling automation of missed appointments for six years so we get quite nerdy about bumps, hence why we are devoting a whole guide to them.
WHY BUMPS DESERVE THEIR OWN GUIDE
While bumps (<1% of the time) are not as common as no-shows (about 5-10%) or patient cancellations (about 20%), they have a significant impact on office operations. This occurs for three reasons.

First, because it is the office having to reschedule the patient which is the inverse of what usually happens (it also reminds one of the famous Seinfeld bit on reservations: https://www.youtube.com/watch?v=4T2GmGSNvaM).

Second, bumps tend to happen at inconvenient times for the staff. If the office is closed for a snow day, that same snow impacts the staff and their families. It’s made even more insane since many PMs don’t allow remote access, so staff have to drive in to access the schedule!

Third, is the sheer volume of calls that need to be made, within a tight timeline. When a bump occurs, an entire day’s worth of patients need to be called and rescheduled. Offices often have to pull from other teams (ex. Billing) to get all the calls made as fast as possible.
WHY PRACTICES BUMP 
Apart from some technology, which we will get into later, here are some ideas you can implement today to help you improve patients access without burdening your staff (or patients).

Acts of A Higher Being
The most common reason practices bump patients is due to weather related closures, from high waters and floods to slippery roads. The reason offices close is for the safety of their providers, staff and patients.

Medical
Not all specialities have to navigate the waters around medical bumps daily however, the most common specialties to bump are OBGYN and surgical specialties. OBGYNs frequently have to leave the office at a moment’s notice because a patient goes into labor. Completely surprising no one, newborns don’t stick to a schedule, so an OBGYN has to be nimble. We’ll get into some solutions for this problem later. Surgeons are also called into the OR when they are scheduled to be in the office.

Vacation
The third major reason offices cancel is that a provider is going on vacation. I don’t mean to make it seem like a provider is leaving to take the afternoon off. Most commonly, a patient is booked for their appointment 6 months or more in the future. So, when an office is notified of a provider’s vacation schedule, they have to bump patients affected. This is yet another argument for not scheduling patients more than 3 months in advance (the other argument is that it increases the no-show and reschedule rate dramatically).

BEST PRACTICES FOR MANAGING BUMPS
Based on our analyses, practices reschedule 30-50% of bumped appointments within a week of the original appointment. Part of the reason is process and part is purposeful (not everyone needs to be rescheduled). How should a practice deal with bumps? First and foremost, apologize for the inconvenience.
 
Contact the patient
This shouldn’t be said, but your humble author once showed up to an 8 am appointment with 1 inch of snow on the ground to find the office closed for two hours. No notice, apology, or anything.

Set standard cancellations reasons
Some EMRs have a specific cancellation type called “Bump” which staff should use when bumping an appointment. Make sure to educate them. For those without this cancellation type, make sure there are specific cancellation reasons for bumping. One for weather, another for provider unavailable. Make sure staff use them. We find that staff do not use the correct cancellation reasons because they weren’t trained to AND because they do not see a reason to.

Two reasons that staff should use the correct cancellation reasons. First, using the correct cancellation reasons allows a healthcare group to analyze the prevalence of cancellations. Including bumps as regular cancellations will throw off the numbers and make it look like an office has more cancellations than they do. Second, it makes it quite hard for staff members to pull a report or utilize a bump list to reschedule those patients.

Use a bump list
Most EMRs have a list showing what patients have been bumped, if not, pull a report based on cancellation reason and call those patients or use OnDemand Schedule Management, see below). Reschedule patients off the list as you reach them.

OnDemand Schedule Management (ODSM)
AI-enabled schedule management tools that help you manage daily and long-term fluctuations within your schedule to improve patient access, eliminate “patients falling through the cracks” and reduce at risk revenue. The most sophisticated ODSM solutions are fully automated and completely customizable so your staff doesn’t have to do any extra work.

Open the provider’s schedule
Does the provider have time on their schedule that was blocked off that you can open up? If so, use it!

Offer alternative provider

The patient won’t be excited to know they are being rescheduled, find out what is most valuable to them, seeing the same provider or being seen earlier. If they want to be seen faster, try offering the patient other providers who have more availability on their schedule.

Don't reschedule everyone
Remember, if a patient doesn’t need to be rescheduled…then don’t reschedule them. When you are making your bump rescheduling calls, make sure the patient still needs to be seen. For example if their rash disappeared or if they have a follow-up a week later, don’t reschedule them!
WAYS TO MAKE BUMPS SUCK LESS FOR YOUR PATIENTS
Based on our analyses, practices reschedule 30-50% of bumped appointments within a week of the original appointment. Part of the reason is process and part is purposeful (not everyone needs to be rescheduled). How should a practice deal with bumps? First and foremost, apologize for the inconvenience.
 
Set expectations
Make sure the patient knows bumps are a possibility. Tell patients when they book their appointment that there is a possibility that they can be bumped and the day will come when the doctor has to bump their schedule for them! We’ll share data below on what appointment times are most frequently bumped however you can also look at your bump reports to find trends for your organization.

Don’t schedule patients more than 3 months out
The probability of cancellation, whether it be no-show, patient cancellations, or bumps increases the further out you book an appointment. The probability of bumping for vacation reasons is highest for appointments booked over three months out. HELPFUL TIP: align your booking windows with your vacation request requirements so you have less overlap. Ex. If physicians are required to request PTO 3 months out, encourage your scheduling to book no further than 3 months out. Find more on this topic in “ The Definitive Guide to No-Shows”.

After reviewing thousands of bumps, we compiled the most frequently bumped dates, times and months. 
 
Top five most bumped appointments
1 (and 2). Monday and Thursday at 9am
3. Friday at 9 am
4. Monday at 10 am
5. Wednesday at 9 am
The lesson: be weary of morning appointments. The data shows that all of the days of the week are bumped with relatively equal frequency. 

Seasonality 
We’ve talked about the main reason for bumps above. This seasonality is reflected in the data. December, November, October, and July are the most bumped months. Those are the months dominated by vacations and inclement weather.
CREATIVE IDEAS TO TRY
We talk to thousands of practices, but we don’t run one. But here is what we know, the current workflow for bumps has two major flaws. The workflow is labor intensive for the staff, this can be alleviated using OnDemand Schedule Management. Second, providers who bump are quite busy,thus it may not always be possible to rebook patients into a slot that’s coming up. You may have to book a patient out months! So here are two ideas that may help. We’d love feedback on them. These are for practices that frequently bump patients
    1 . Leave one day open every week or every two weeks just for bumped appointments. Choose your “least busy” day and have part of it completely open for bumped appointments. If the spots are open the morning of, then use those slots for any call-ins. Think of it as open access for bumps.
    2. Have a Part-Time provider whose sole job is to see bumped patients. This can be a costly solution and requires selling patients on the team care approach. However, having a floating provider who goes between offices just to see patients bumped can help and can improve patient access. It’s something we’ve proposed in our “Definitive Guide to Cancellations”.

CONCLUSION
Bumps flip the paradigm of cancellations on its head. Instead of a patient cancelling, it is the office cancelling on the patient, often with short notice. Because of this, the bump workflow requires equal attention to both efficiency in rescheduling and customer service. Every patient must be notified and dealt with regarding the unfortunate scenario. Bumps are very common for many practices and offices must communicate that reality to patients. From autonomous technology to unconventional schedule utilization, there are many ways healthcare organizations can improve both the patient and staff experience when it comes to bumps.
Enjoy That Reading?
Check out The Definitive Guide to No-Shows.
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Schedule time with QueueDr.