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
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