Same-day appointments have become critical for hospitals trying to keep patients within their health system.
“In general, our patients want instant everything. It’s just the society we live in now,” says Tracy Bird, FACMPE, CPC, CPMA, CEMC, CPC-I, a Medical Group Management Association consultant.
For hospitals, the ability to offer same-day scheduling carries huge implications for patient satisfaction — and revenue. “Ability to access care is critically important,” Bird notes.
If a patient cannot schedule an appointment for when he or she wants, that person probably is going to look elsewhere. They might turn to an urgent care center or ED that is outside the hospital system. From a revenue standpoint, this is terrible. “Many hospitals are still experiencing declining patient visits,” Bird says.
Proactively working to put patients back in the pipeline using same-day or next-day appointments fills the revenue lost from all the surgeries that were canceled during the COVID-19 pandemic. “Patients want to be seen when it is convenient for them,” Bird explains. Marketing same-day availability can draw patients who would not otherwise have chosen the facility or providers.
Certain facilities directed schedulers to work remotely when the pandemic started, an arrangement that continues in some places. However, this should not hinder same-day scheduling. “That’s the beauty of remote scheduling. You can access the schedule from anywhere,” Bird observes. It calls attention to the importance of creating systems that can handle real-time checking of eligibility and benefits. “That step is critically important. It just has to be done,” Bird stresses.
Scheduling same-day appointments is only part of the solution. The hospital also has to be paid. “We need to know that patients have current coverage, whether they’ve met their deductible, or if the visit will be out of pocket,” Bird says.
Sometimes, patients want a same-day appointment for a service that requires authorization. That is when things become tricky. “Those are a little bit harder to do,” Bird acknowledges.
This is a particular problem for some high-volume services, such as pulmonary function tests. Some health plans require prior authorization for every test. If the hospital sees a lot of insured payers, it becomes a tremendous amount of work to obtain all the authorizations. “That’s simply too onerous. At that point, you are having a conversation with the payer,” Bird explains.
Revenue cycle leaders can clarify the tests are needed for every patient to set a baseline level. Some hospitals have negotiated to bypass the authorization requirement for those particular tests. “The argument, ideally, is backed up by clinical guidelines that show it’s appropriate to perform the procedure on every patient,” Bird says.
Also extremely helpful are data showing how often the procedure was approved. If it is approved 99% of the time, that is convincing proof the authorizations are a huge waste of everyone’s time.
“That’s the kind of data you should be able to get from your practice management system,” Bird says. If the visit involves something that needs authorization, that is no reason to abandon same-day scheduling altogether. “There is always the option to at least get a patient in the door to be evaluated,” Bird offers.
The provider can assess whether a particular test or procedure is appropriate. “For those tests that require authorization, it means a second trip back, and patients are not happy about that,” Bird cautions.
That is one reason same-day scheduling, when handled by patients, “is a double-edged sword,” Bird says.
Staff need to monitor those appointments closely, to verify insurance before the patient comes in. Some systems allow patients to upload their insurance card, making this easier. “The system should be able to automatically check eligibility and alert staff if something doesn’t look right,” Bird says.
Some payors do not give an answer for a week or 10 days, causing all kinds of problems. “That’s when it’s time to engage the payor in a conversation and say: ‘You are putting an undue burden on our staff, and it’s an access-to-care problem for your insured member,’” Bird says.
For hospitals that want to offer more same-day appointments, this is by far the biggest obstacle. “Most payors do not offer real-time authorization approvals,” says Dan Medve, director of revenue cycle management at Cleveland Clinic.
Most health plans follow at least a 72-hour turnaround time for those requests. “This creates significant challenges to obtain an authorization prior to service for same-day appointments,” Medve laments. This is especially problematic if diagnostic testing is needed “stat.” The hospital often struggles to recoup reimbursement for these procedures because of a “no auth” in place. “Some payers do not allow retro authorization,” Medve adds.
Cleveland Clinic has sidestepped some of these issues with a strong focus on preservice processes. In 2020, the department started offering patients video chats with financial advocates. “If there are financial clearance issues with the same-day appointment, this process allows the patient to get concerns addressed quickly,” Medve explains.
Same-day appointments also were facilitated after the department negotiated some prior authorization exemptions. Health plans have agreed to this for certain procedures that often are approved preservice approvals or carry a high percentage of appealed approvals post-service, says Robert McDaniel, another director of revenue cycle management at Cleveland Clinic.
The department also uses technology to ensure payment for same-day appointments. “This includes real-time submission and decisions by automating the inbound/outbound transactions,” McDaniel says.