Patient access needs to develop approaches for “immediate engagement of a patient’s concern” at the point of initial contact, recommends a June 2015 Institute of Medicine report, Transforming Health Care Scheduling and Access: Getting to Now.1 This immediate engagement includes same-day service.
“‘Open access’ can be utilized in many areas, such as ancillary departments and physician offices for primary and pediatric care,” says Eston Allison, MBA, MHSA, CHAM, an access management analyst at Ferrell Duncan Clinic, a Springfield, MO-based multispecialty physician clinic. Allison says patient access leaders need to do the following:
- Identify the daily average demand.
- Come up with a number of patient slots, based upon historical and seasonal data, that are needed for same-day or next-day appointments.
“Be willing to be challenged in trying something new. Pilot it, and deploy it if it works,” says Allison. If appointment slots go unfilled by a specified deadline, he adds, staff should attempt to move up patients if possible so providers stay busy.
“Open access may work best, if there are multiple providers, where only one provider is the open access provider of the day,” says Allison.
Same-day access requires careful coordination between the scheduling/pre-services team and ancillary departments, emphasizes Paige Popp, product director at Experian Health, a provider of technology for hospitals and healthcare providers.
“This is especially key to ensuring that patients with insurances requiring 24 to 48 hours to turn around authorizations are not placed into same-day appointments,” says Popp.
To avoid claims denials, the same-day process should be automated through the hospital’s scheduling application.
“Payer requirements must be linked with appointment parameters,” adds Popp.
No-shows at 50%
At Downtown Health Plaza/Wake Forest Baptist Health in Winston-Salem, NC, patient access areas were seeing an uptick in “no shows,” as well as extended waits for available appointments.
“Everyone’s, including our patients’ ‘to do list’ is getting longer. The priorities of daily life can conflict with medical visits,” notes health center manager Monica Brown, MPH.
“No shows” cause problems with access because other patients are needlessly turned down for appointments. “Another patient could have been scheduled if the patient cancelled in a timely manner,” says Brown.
The closer the appointment time is, the more likely the patient is to show up, she notes. “This is evident in our internal medicine practice, where new patient slots can be several months out from the time of the call,” says Brown. “The show rate is approximately 50%.”
Same-day/priority access is now offered at primary care areas and specialty clinics. “There are designated slots built into the schedule for each area to accommodate same-day appointment requests and appointments within a specified timeframe,” explains Brown.
When a patient calls to request an appointment, patient access staff ask, “When would you like to be seen?” “If the patient responds ‘Today,’ the rules of same-day access apply,” says Brown. “If the scheduler cannot locate a slot, they contact the clinic for options, such as another provider, overbook, or urgent care.”
Most open slots are filled on a daily basis. On a given day, in a pediatric practice, about 20 slots are available for same-day and next-day appointments.
When same-day or next-day appointments are made, “patients are more likely to show,” Brown explains. “It minimizes the impact of increased throughput that can be created by overbooking patients.”
Additionally, clinic hours were extended on weeknights and Saturdays.
“In addition to reducing our ‘no show’ rate, it also reduces unnecessary ED visits,” reports Brown. “We are now looking into text reminders to increase the ease of cancelling appointments.”
- Monica Brown, MPH, Health Center Manager, Wake Forest Baptist Health, Winston-Salem, NC. Phone: (336) 713-9621. Fax: (336) 713-9619. Email: firstname.lastname@example.org.
1. Institute of Medicine. Transforming Health Care Scheduling and Access: Getting to Now. Washington, DC: National Academies Press; 2015.