36C25019R0093-016.pdf

VA NORTHERN INDIANA HEALTH CARE SYSTEM (VANIHCS)

December 2017 POLICY NO. 11-71-17

CLINIC CANCELLATION POLICY

1. PURPOSE: To provide Policy and procedure for the cancellation of all clinics and the rescheduling of patients’ appointments to ensure continuity of patient care in accordance with Veterans Health Administration (VHA) Directive 1231, Outpatient Clinic Practice Management, dated November 15, 2016.

2. POLICY: The Policy of the Department of Veterans Affairs Northern Indiana Health Care System (VANIHCS) is to minimize the impact of clinic cancellations. Clinic cancellations, especially those with short notice, negatively impact the clinical care of patients and the efficient operations of the health care system. Clinic cancellations contribute to poor customer service, patients being “lost to follow-up,” and to clinic waits and delays.

3. DEFINITIONS:

a. Clinic Cancellation: Clinic cancellation means an appointment is cancelled by the clinic, not the patient. This is also called cancelled by clinic in the Veterans Health Information Systems and Architecture (VistA) scheduling package. Reasons for cancelled by clinic listed in the VistA scheduling package include appointment is no longer required, clinic is cancelled, clinic staffing, inpatient status, patient death, patient ineligible, scheduling conflict/error, transfer outpatient (OPT) care to other VA, weather, or other:

(1) Routine Cancellation: A provider clinic session or a portion of a provider clinic session that may require changing patient appointments due to the unavailability of the provider when the request is made in advance of 60 days or longer before the scheduled session;

(2) Urgent Cancellation: A provider clinic session or a portion of a provider clinic session that may require changing patient appointments due to the unavailability of the provider when the request is made less than 60 days before the scheduled session; and

(3) Emergency Clinic Cancellation: A situation where the need for a clinic cancellation could not be anticipated (typically less than 48 hours’ notice).

b. Clinical Lead (CL) and Administrative Lead (AL): The CL and AL roles will work in tandem daily and be responsible for the core processes as listed in the responsibilities section of this Policy. CLs are responsible for addressing the staff and processes that occur in the clinical care setting. Administrative leads are responsible for addressing staff and processes that are administrative in support of clinical care.

POLICY NO. 11-71-17

c. Clinic Practice Management Team: The combination of facility leadership, the Group Practice Manager (GPM), and the collective CLs and ALs.

d. Contingency Planning: Contingency planning provides for the ability to maintain normal clinic operations in the absence of providers and/or support staff. The intention of the contingency plan is to minimize appointment cancellations and thus prevent backlog and delayed patient care.

e. GPM: A GPM is a facility-level position meant to oversee access and quality care in the outpatient clinic services. This position aligns to facility Executive Leadership and helps coordinate the efforts of the CLs and ALs.

4. PROCEDURES:

a. Delay in Starting Clinic on Time:

(1) Providers who are going to be late for the start of their scheduled clinic sessions on any given day must notify their supervisor (or designee) prior to the starting time of the session. If the supervisor is not available, the Service Chief must be notified;

and

(2) Providers must also communicate with the clinic nurse manager when they are going to be delayed. The nursing staff must be notified when a provider is delayed more than 30 minutes after the scheduled appointment time.

b. Routine Cancellation:

(1) It is the responsibility of the Service Chief to determine how many providers may be absent at one time, while ensuring sufficient providers remain to meet unscheduled care needs; and

(2) No Affected Patients:

(a) If there are no affected patients (patients scheduled during the proposed cancellation period), then the clinic may be cancelled without approval by the Chief of Staff (COS);

(b) The provider initiates a request for clinic cancellation by submitting the request in writing through their immediate supervisor to the Service Chief. In the case of no affected patients, no justification for the provider’s request is required. The provider’s request is subject only to Medical Center and Service Leave Policies;

(c) The Service Chief will determine if the clinic can be rescheduled, taking into consideration VANIHCS Leave Policies and the recommendation of the supervisor;

(d) If approved by the Service Chief, the Service will request the clinic be cancelled by using the Clinic Cancellation group in Outlook; and

(e) The Clinic Administrative Staff will cancel the clinic.

(3) Affected Patients:

(a) If there are scheduled appointments, the provider and Service will ensure patients are seen within 30 days of the PID (Patient Indicated Date);

(b) If scheduled patients are cancelled and not seen within 30 days of the

PID, COS approval is required;

(c) The provider will follow the process for Urgent Cancellations as outlined in 4.c. below.

c. Urgent Clinic Cancellation: Requests for clinic cancellation with less than 60 days’ notification entail significant patient hardship. Not infrequently, patients cannot be reached and then show up for their original appointments. Also, they often need medication support if they are at risk of running out of prescriptions.

Thus, providers are encouraged to plan and not submit requests for clinic cancellations with less than 60-day lead-time. Before canceling a clinic session, the requesting provider must attempt to find coverage for the clinic:

(1) All clinic cancellations initiated between 45 and 60 days prior to a clinic session require approval by the Service Chief unless it is Sick Leave. Any clinic cancellations initiated less than 45 days prior to a clinic session require approval by the

COS;

(2) All Clinic Cancellation Requests within 45 days will be initiated by the provider utilizing the Urgent Clinic Cancellation Request (see link to Attachment). The request will go through the immediate supervisor and the Service Chief to the COS. The Request must be filled out completely; and

(3) If approved by the COS:

(a) The Service will request the clinic be cancelled by using the Clinic Cancellation group in Outlook;

(b) The Clinic Administrative Staff will reschedule the affected patients as outlined in the rescheduling plan, ensuring that the rescheduled appointment is within 14 days of the original desired date. The Clinic Administrative Staff will notify all affected patients by phone and will generate cancellation and rescheduling letters;

(c) The Service arranges for alternate coverage for patients who could not be contacted by telephone and who might show up for their original appointments; and

(d) As needed, the provider is responsible for renewing any prescriptions that may run out prior to the patient’s next scheduled visit.

d. Clinic Cancellation Due to an Emergency:

(1) On occasion, it may be necessary to cancel a clinic due to the illness of a provider or some other unanticipated event, with very little notice. The following are the procedures for Emergency Clinic Cancellation:

(a) The provider contacts their immediate supervisor (or designee). If the supervisor is not available, the Service Chief must be contacted to request leave and to request the clinic be cancelled on an emergency basis;

(b) The provider, supervisor, or another responsible individual, contacts the

Clinical Service Chief responsible for the provider’s clinic by page and/or by telephone indicating that the clinic needs to be cancelled on an “emergency” basis;

(c) The Clinic Administrative Staff (during administrative hours) or the

Administrative Officer of the Day (AOD) (during non-administrative hours), attempt to contact patients before their appointments and offer them the opportunity to be seen by another provider on the day of the original appointment. If the Veteran chooses not to be seen by another provider, then the Veteran will be rescheduled within 14 days of their PID;

(d) The Service Chief ensures adequate cross-coverage to care for patients who need to be seen (as originally scheduled) or who may present because they could not be contacted;

(e) As soon as possible after the emergency cancellation, the provider who cancelled or another provider designated by the appropriate clinical Service Chief if the canceling provider is going to be absent for an extended period, reviews the charts of the patients who agreed to be rescheduled and develops a written plan to ensure that all patients are seen within 14 days of their original desired date. This may entail overbooking, seeing patients during administrative time, or arranging for another provider to cross-cover;

(f) The Clinic Administrative Staff will reschedule the affected patients as outlined in the written plan, ensuring that the rescheduled appointment is within 14 days of the PID. The Clinic Administrative Staff will notify all affected patients by phone and will generate cancellation and rescheduling letters; and

(g) The provider is responsible for renewing any prescriptions that may run out prior to the patient’s next scheduled visit.

e. Clinical Expectations: Regular clinic attendance is viewed as a major professional responsibility. Furthermore, clinic attendance and notification practices will be tracked for each provider and clinic. Clinic attendance and “cancellation” practices will be used for evaluation purposes such as performance evaluations, renewal of clinical privileges, special recognition awards, incentive salary components, and allocation of new and distribution of existing service/section resources.

f. Abuses will be addressed using progressive discipline as outlined in the Master

Agreement and may also include notification of the relevant supervisor, Service Chief, and COS; an unfavorable performance rating; disapproval of leave requests; Leave Without Pay (LWOP) status; and non-renewal of clinical privileges and VA appointment.

5. RESPONSIBILITIES:

a. The COS is responsible for the general implementation of this Policy and may reverse cancellations if it is in the best interests of patients or the organization. The COS is also responsible for determining the need for “for the benefit of the organization” cancellations.

b. Clinical Service Chiefs are responsible for:

(1) Acting on requests made by providers that result in clinic cancellations;

(2) Ensuring that sufficient coverage is available to treat the patients who are scheduled; and

(3) Developing adequate contingency plans.

c. Providers are responsible for avoiding clinic cancellations by requesting leave more than 60 days in advance of the time needed. In addition, providers will ensure that:

(1) Patient charts are reviewed to determine individual patient needs;

(2) Patients are rescheduled within 14 days of their original desired date; and

(3) Arrangements are made in conjunction with clinic staff and leaders for alternative coverage for patients who need an appointment on the day originally scheduled.

6. REFERENCES: National Clinic Cancellation Policy

7. RESCISSIONS: Medical Center Policy 11-71, Clinic Cancellation Policy, dated November 9, 2015.

8. REVIEW DATE: June 13, 2020

9. FOLLOW-UP RESPONSIBILITY: Chief of Staff

X

AUDREY L. FRISON, DM, MHA, BSN, RN

Associate Director Patient Care Services

WAYNE Z. MCBRIDE, DO, MPH

Chief of Staff

JAY H. MILLER

Associate Director for Operations

JOHN PHILLIP SHEALEY, MBA

Assistant Director

MICHAEL E. HERSHMAN, MHA, FACHE

Director

Link to Attachment

Attachment

Urgent Clinic Cancellation Request

Date of Request: Click or tap to enter a date.

Clinic Information Requesting Provider: Click or tap here to enter text.

Affected Clinic(s): Click or tap here to enter text.

Cancellation Begin Date: Click or tap to enter a date. End Date: Click or tap to enter a date.

If cancellation is less than a full day, enter time frame: _____________________________.

Rationale (Reason for cancellation, reason not requested sooner): Click or tap here to enter text.

Scheduling Information Will this Cancellation result in ANY Veteran(s):

(1) to be rescheduled? Choose an item.

(2) to be seen > 30 days from PID/CID? Choose an item.

(3) to be seen by another provider? Choose an item.

(4) having to be cancelled again by this clinic within the last twelve months? Choose an item.

IF “yes” to (1) above, indicate how the Veteran(s) will be rescheduled. (Check all that apply.)

☐ Rescheduled before current appointment.

☐ Available standard slots ☐ Outside of grid ☐ Overbooking ☐ Other If other, explain: Click or tap here to enter text.

☐ Rescheduled after current appointment.

☐ Available standard slots ☐ Outside of grid ☐ Overbooking ☐ Other If other, explain: Click or tap here to enter text.

IF “yes” to (3) above, provide details on rescheduled appointment and communication plan.

Click or tap here to enter text.

Coordination The Clinic Nurse Manger (identify below) was contacted and is prepared to support the plan.

Individual concurring: Click or tap here to enter text. Date: Click or tap to enter a date.

The Medical Administration Service was contacted and is prepared to support the plan.

Individual concurring: Click or tap here to enter text. Date: Click or tap to enter a date.

Approval Service Chief is responsible for verifying all above information. For urgent clinic cancellation requests <60 days, Service Chief approval is required; for cancellation requests <45 days, Chief of Staff, or designee approval is required.

Service Chief

Chief of Staff