Patient Access

Patient Access Throughput: The Strategy to Success

In today’s healthcare world, health systems experience constant change and at times, a state of the unknown. Patient care is the business of the hospital and when processes are inefficient, business is inefficient.  Medical groups and hospital systems are focused on reducing costs and consequences to patients, staff and the organization as a whole.  However, the overall goal is to improve the ability to optimize how efficiently the processes and operations are managed.

Opportunities for Improvement

  1. Lengthy admissions/outpatient wait times continue to be a major area for improvement
    1. Cross-training scheduling staff to create accounts, schedule, and begin the pre-certification process will reduce the number of calls to the patient prior to the date of service (DOS)
    2. Assign verifiers to “physician teams”
    3. Manage block schedules
    4. Provide the benefit of obtaining co-pay, deductibles, and (out-of-pocket) OOP during the pre-registration process to minimize intake process at the time of arrival
  2. Engagement
    1. Minimize patient complaints through service recovery methods
    2. Open communication with physicians/departmental leaders (i.e., office visits/monthly meetings)
    3. Educate and engage employees to increase customer service
  3. QA, QA, QA! – Accountability is KEY!
    1. “On Your Mark” accountability will minimize errors, denials, rebills, wait times, and patient complaints


As organizations strive to exceed the patient’s expectations, they must continue to explore new ways of streamlining the patient access processes to improve the patient experience. Today’s consumer is a savvy, educated consumer and they anticipate exceptional service.  The following patient access initiatives can benefit organizations in serving their patients:

  • Pre-registration – Online access, patient portals, etc.
  • Patient access advisors
  • Customer service training
  • Discovering strengths by utilizing the Lean Process, Six Sigma, Eagle Wings, etc.
  • Leadership development (placing the patient’s needs first)

Ongoing Initiatives

Health systems have an interesting road ahead of them, but one thing is certain – the patients come first. Staying abreast of updates on the national and local level is essential to implementation of any strategic initiatives moving forward.  Organizations must continue to make their experience the best, and exceed the goals of stakeholders while doing so.  Communication, education, exploring options and listening to the “customers” will help healthcare providers reach those successful practices.







Access to Care ….or Lack Thereof

Long Appointment Wait Time, Your Horrible Parking Lot and Your Mediocre Front Desk: Your New Patients’ Experience

I am back on my “Patient Access” soapbox as a result of a recent visit to your private practice in the suburbs of Philadelphia. I had a fairly significant medical concern and wanted to get to a specialist as quickly as possible in the event I needed treatment.  Knowing that I was seeking an appointment as a new patient in a high demand medical specialty area, I figured it would be weeks or even a month or more before I would secure an appointment, so I got to work right away.  Like most patients, I got on the Internet and started to review specialists in my area; trying to find a physician that was well qualified, accepted my health insurance and would minimize my drive time so that I didn’t have be away from the office for hours.  I chose you, a qualified physician that had a new patient appointment available in twenty-seven days.  Twenty-seven days.  I was actually delighted that I was going to be examined by a high demand specialist in under a month. Delighted! What does this say about physician access for some specialists?  Have we lowered our expectations so much that getting an appointment four weeks from the date of request is considered acceptable? It’s a question that won’t be solved as I write this blog, but it is food for thought.

Twenty-seven days later, I arrived for my 10am appointment. It was 9:30am when I arrived and your parking lot was completely full.  Cars were double parked, and your underground lot was impossible to navigate with a Mini-Cooper, let alone the Chevy Tahoe I was driving.  I had to park across the street and up two blocks risking a ticket as I was not doing business at this location.  I was frustrated and five minutes late for my visit when I opened the door to your office.  When I approached the front desk to provide my name and an apology for being late; I was greeted with silence.  Not a “Good Morning”, not a “What is Your Name”, not a word.  I wondered if I chose not to say anything upon arrival if the sour woman at the window would have acknowledged me at all.  She proceeded to have conversations with her equally sour colleagues behind the window while she grabbed my insurance card and personal identification.  The only words spoken to me were to ask for my $40 dollar copay.  Not even a “Thank You” upon payment, was uttered.  I was completely unsatisfied, to say the least and was silently hoping to receive a patient satisfaction survey in the mail.

To be completely objective, I was pleasantly surprised that I waited only five minutes before being escorted to an exam room and even more pleased when you arrived to see me less than five minutes later. Your exam was thorough and you were on your game. What a shame that so many barriers were put up before I even had the chance to meet you.

Now here’s the question. Was the wait, aggravation and less than courteous support staff worth it?  Would speaking to the specialist about her access problems help?  Would anything actually change?  Should I start again with a new provider that has better access to care and a friendlier staff?  Should I drive further away and wait longer to have a better experience?  The answers to these questions are very personal and real for patients.  Access to care is a serious issue that can and will determine the success of your practice.  Look at the little things.  They are larger than life for the patients on the other side of the window.

Transforming Access Through Scheduling Redesign

Long wait times can be a symptom of scheduling and access problems. When new providers join a practice, significant time and effort is put forth to “create” the schedule and the scheduling guidelines.  Rarely is any effort spent reviewing the schedule once the on-boarding phase is completed.

Providers may be satisfied from the perspective of their practice when their schedule is full. However, this is not always a win-win if patients are complaining about the schedule. Delays in care can result in unnecessary costs and less revenue.

There are a variety of strategies which can be utilized to improve patient access. Some practices use team medicine such as the pairing of providers with Nurse Practitioners or Physician Assistants. When care is presented as a unit or a team (and in a positive light by the provider), patients are more likely to see an advance practice clinician when a provider is full.  Practices with significant capitated or bundled income may find it helpful to build the access infrastructure by adding non-provider touches to patient care such as dieticians, nurses or health coaches.  Another option is cutting edge methods such as mobile apps, social media, shared medical appointments, outreach through a patient portal, texting or telephone calls, or virtual care visits.

It can be helpful to review triage protocols to be sure they encourage patients to be seen when new acute conditions arise or established chronic conditions are worsen. Often times patients can be managed by a staff member and providers may miss important signs of a problem.  Determine if refill protocols include standards for visit frequency and ongoing surveillance with diagnostic testing such as lab or radiology.

Ensure the practice has optimized the clinical workflow to be efficient. This includes standardizing rooms and staff duties, co-locating providers near staff to enhance communication, adding huddles to the day to discuss potential issues/concerns and decreasing patient wait time for ancillaries which are ordered at the time of service or in advance by primary care physicians prior to referral to the specialists.

Governance can play an important role when it comes to managing access. Jointly develop standards and guidelines between providers, administrators and staff. Requests to change templates should run through the operations team in order to ensure the schedule is not compromised.  Review schedules in a meaningful way once or twice yearly; confirm a provider does in fact have the required number of patient care hours available and the designated number of new patient appointment slots each day.  Ask questions to understand the reason for blocked or appointment slots on hold. Scheduling protocols can erode over time with meetings and non-work responsibilities which can reduce productivity.   Employ use of automation features and ensure they are hard wired to allow for search optimization and same day visit access.

The “third next available appointment “ represents a nationally reported measure against which practices can monitor their performance with a goal of seeing patients when clinically indicated and when they desire to be seen. Offering this type of data to providers, managers and staff can help to engage them in solving the access puzzle together.  Given the complexity of scheduling, it may be necessary to utilize one or more interventions on a regular basis.

Jill Berger-Fiffy , MHA, FACMPE Senior Consultant

Jill Berger-Fiffy , MHA, FACMPE
Senior Consultant

Improving Patient Access: What’s Your 3rd Next Available Appointment?

In continuing the quest to ensure that my colleagues are seeking ways to improve patients access to care; I thought a discussion regarding the 3rd Next Available Appointment would be beneficial.  The 3rd Next Available Appointment metric is often misunderstood, and as a result, not utilized. I would venture to say, if this metric is not one of your top three Patient Access Key Performance Indicators (KPI’s), you need to make it so.  Some might say, “why not measure the calendar days between the day a patient makes a new patient appointment with a physician and the next available appointment? What makes the 3rd available appointment a better indicator of access to care?”

The 3rd Next Available Appointment is preferable to the next available appointment because it is a better reflection of slot availability within your scheduling system.  Given that patients cancel appointments at the last minute, reporting the first available appointment may give a physician practice manager a false sense of timely access.  For example, you are the manager of a busy orthopedic practice.  You are measuring the next available appointment time by physician in an effort to provide patients with a new patient appointment in under three days.  Despite the fact that you confirmed your appointments for the day, a new patient calls to cancel her visit for this afternoon.  Moments later, another patient calls to cancel his new patient appointment for tomorrow with the same orthopedic surgeon.

If you were to report on this surgeon’s Next Available Appointment, and you ran this report from your scheduling system right now, your next available appointment for Dr. Smith would be this afternoon. As a manager, I would assume this means Dr. Smith’s new patient availability is under the three day threshold and my patients are receiving timely access to care.

Now let’s run the third next available appointment for Dr. Smith. In doing so, you find that the 3rd next available appointment for a new patient is 19 days.  The two cancellations received today, while providing an open slot for another new patient to fill, is not a true reflection of Dr. Smiths’ patient availability and as such, intervention should be initiated.

Most scheduling systems include this report as part of their standard package. If you have access to it, run it for every physician in your practice.  Run it often and act on any adverse results.  You’ll find a significant increase in patient satisfaction as well as a positive boost in revenue will be your reward.

MIR_3944-Johanna Epstein

Patient Wait Times Should Be Your Priority

The firestorm over the comments made by VA Secretary Bob McDonald regarding the length of time veterans wait for healthcare has gotten me on my soapbox. By stating that Disney doesn’t measure wait times for guests’ queueing up for Space Mountain, McDonald was trying to point out that the VA should focus on the veteran’s overall healthcare experience when trying to quantify satisfaction.  I have spent years working on ways to improve patient satisfaction in the large, academic physician practices where I have been fortunate enough to have been employed.  I have conducted focus groups, spoken to patients one on one, sent surveys and read countless studies about how to positively impact the patient experience.  I have found that asking patients to wait what a patient perceives is too long for care is the single biggest driver in patient dissatisfaction. I have also found that wait times for care (otherwise known as access to care) is the single biggest reason patients leave health systems to seek care from your competitor.

Evaluating the patients’ overall experience is indeed important. Effective clinical care, responsiveness to patients’ questions, a pleasant staff and appropriate follow up are obviously critical to the continuum of care.  However, if a patient has had to wait weeks or months to receive an appointment, coupled with waiting far too long in a waiting room and examination room, the memory of the care quality is overshadowed by the often times tortuous wait.

Too many patients decide the wait is too long and choose another healthcare provider that is accessible. Unfortunately for our Veterans they have no choice.  They are forced to utilize a healthcare system that is steeped in bureaucratic and antiquated processes.  Waiting too long in the case of a chronically ill veteran could have serious health implications.

I urge my colleagues at the VA and elsewhere who are responsible for patient access to look at your patient wait times. If you think they are too long, your patients think they are an eternity.  Dig deep to find the root causes of your access problems and solve them.  Your patients and most certainly our Veterans will thank you for it. MIR_3944-Johanna Epstein

Mixed Use Patient Access Centers Improve the Patient Experience

Lisa Monteleone

Lisa Monteleone

By Lisa E Monteleone, RN-BC, BSN, MHA

Mixed use centralized patient access centers are an important investment for medical groups and health systems as they provide an access point for current and prospective patients. A decentralized or splintered patient access design or a poorly performing centralized center can result in patient frustration and lost revenue.

Patient Access

Effective implementation and management of a mixed use centralized patient access center is key to attracting and retaining patients. What is “patient access?” It’s everything that affects a patient’s ability to get to the right care, at the right time, for the right reasons, at the right location. Patient access most often includes the operational functions of referrals, scheduling, insurance, registration and payment collections.  It also includes IT systems, facility and workflow design, staff training and management, the right mix and number of providers, as well as the coordination of care and services between multiple sites across the full continuum of care.

When it goes wrong

In the recent past you have likely been subject to a poorly performing patient access workflow that resulted in multiple calls, repetitive requests for information, long hold times and inadvertent disconnects. It’s likely this experience left you frustrated and questioning your choice in care provider.  In today’s healthcare environment this experience can be detrimental to the success of the healthcare provider.  To be successful, providers must focus their patient access efforts on the complete patient experience. Overlooking steps adds to the risk of losing the patient to another group or system or generating a less than desirable patient outcome.

When it goes right

I had a recent experience during peak hours with a patient-centered provider of health care services. During the call the representative was alerted via their IT system that there was a financial hold on my account.  The hold did not allow the appointment to be scheduled. I thought to myself, here we go, this is going to take FOREVER!  Boy was I surprised!  In one call that lasted less than 15 minutes, touched three departments, and had minimal repetition of patient information:

  • An outstanding payment – rectified
  • An appointment – scheduled
  • A non-urgent medical request – triaged by a nurse

Positive Outcomes

Mixed use centralized patient access centers accomplish many things for a medical group or health system, not the least of which is call demand management and appropriate routing. In addition to improved efficiencies and operational savings the centers create multi-practice, provider, and service line visibility.  The centers reduce voicemail and email related frustration and eliminate the need for multiple calls.  Mixed use centralized patient access centers are a one-stop-shop for the patient and a command center for the provider:

  • Appointment scheduling & reminders
  • Physician & service referrals
  • Pre-registration functions
  • Follow-up calls / patient outreach
  • Prescription refills
  • Test result communication
  • Symptom based nurse triage
  • Revenue cycle management

Which shape and size fits your need?

Mixed use patient access centers come in all shapes and sizes. The centers can be centralized in a single location or virtually though IT applications and systems.  They can be operational during business hours or 24-hours a day 7 days a week.  The centers can be staffed in-house by the medical group or health system or they can be outsourced to regional or national call centers.  And lastly, the centers can be brick and mortar based or deployed remotely.  Larger medical groups and health systems are likely to use more than one of these models to effectively manage the needs of the patient population and their providers.

Meeting the challenge head on

Health care providers are faced with several challenges at once: an aging and more consumer-oriented patient population alongside reduced payments and a more competitive marketplace. Investing in top notch people, policies, and processes are key to health care provider survival.  Mixed use centralized patient access centers allow medical group and hospital based staff to focus on face-to-face patient management needs at their facilities and offices and as a result improve operational efficiencies, patient satisfaction, and patient outcomes. How does your patient access measure up?