Same-day appointment needed? Answer is ‘Yes’

When a patient asks for an urgent appointment at Tufts Medical Center in Boston, “the answer is never ‘no,’” says Pamela Nettles-Gomez, business operations manager of internal medicine and adult primary care.

“We will find a way to make it work,” says Nettles-Gomez. “We also ask our patients to understand that their primary care physician works in a collaborative team model.” This model means that if the patient’s primary care physician is not available on the day he or she wishes to be seen, another team member, which might be a different primary care physician, a nurse practitioner, a registered nurse, or a medical assistant, will take care of the patient.

“It’s all about personalizing the experience for the patients and providers alike,” says Nettles-Gomez. “Patients need to know that someone is there for them, no matter what day of the week it is. Providers don’t want someone who has never met them or their patients answering their phones.”

‘The volume will come’

If patients know that the office is flexible and the healthcare team is available whenever needed, “the volume will come,” says Nettles-Gomez. “We have made same-day access a reality by using a multipronged approach.” The patient access department has made these changes:

• Schedules are a mix between open-access and defined appointment lengths and types.

“For example, if a provider’s schedule is not fully booked on any given day, those slots are available to any of our patients who want to be seen,” says Nettles-Gomez.

• Managers closely track the number of same-day appointments and look for trends.

Based on historical data, managers know that same-day availability is very low the day before and after New Year’s Day, on Martin Luther King Day, and during school vacation weeks.

“We are proactive. We work with our providers to save same-day appointments in advance,” says Nettles-Gomez. “On these days, we also make sure that our urgent care physician is working.”

• Calls are answered by a call center.

“However, our call center is somewhat atypical,” says Nettles-Gomez. “The words ‘call center’ sometimes come with a bad connotation these days. Providers feel like someone they don’t know will be answering their phones.”

To avoid this, call center employees are considered as much a part of the team as any other hospital employee. “They sit with the other employees, attend meetings, and interact with our physicians and nurses constantly,” says Nettles-Gomez. “They understand provider preferences and know who ‘squeezes patients in’ or will extend clinic hours when necessary.” (See related story on obtaining authorizations for same-day add-ons, below.)


For more information on same-day scheduling, contact:

Jill Eichele, CHAA, Manager, Patient Access Services, Littleton (CO) Adventist Hospital. Phone: (303) 734-2130. Email:

Pamela Nettles-Gomez, Business Operations Manager, Internal Medicine/Adult Primary Care, Tufts Medical Center, Boston. Phone: (617) 636-5972. Email:

Same-day add-ons? Get auths in place

Delays avoided for patients

Some patients who were same-day add-ons had to wait lengthy periods of time in registration areas at Littleton (CO) Adventist Hospital simply because an order or authorization wasn’t in place.

“Depending on the situation, patients waited anywhere from 30 minutes for two hours to have their test because we were waiting on an authorization,” says Jill Eichele, CHAA, manager of patient access services.

Same-day add-ons are now reserved for urgent/stat exams only at Littleton Adventist Hospital, due to challenges in obtaining pre-authorizations prior to the patient’s arrival. Another challenge was making sure a valid order was in place. “If we run into either one of these issues, it causes delays for the patient, which we would like to avoid,” says Eichele.

The goal is to ensure everything is in place before the patient arrives, so the patient’s visit can go as smoothly as possible. When the authorization is in place before the patient arrives, it cuts registration wait times down to under 10 minutes. “If it is something that we know does not require a pre-auth, and the clinical department can accommodate, we do try to get the patients in as quickly as possible,” she says. Screening mammograms, X-rays, EKGs, and most ultrasounds fall into this category.

“By scheduling them for the next day, it gives us enough time to have everything ready for them,” says Eichele. “If we keep the patients and physicians happy, this will lead to increased repeat business and referrals.”

Fewer problems for patient

If a patient’s same-day request can’t be accommodated, registrars explain that to ensure insurance will cover the test, they need to schedule the patient a couple of days out so they can make sure proper authorization is in place. “We also explain that we don’t want them to have to wait when they arrive, and this helps streamline the check-in process,” says Eichele.

Between 5% and 10% of tests are same-day add-ons. “We let any stat requests go through even if we don’t have an auth, as we don’t want to delay urgent patient care,” says Eichele.

A tool notifies health benefits advisors when an appointment is added on, and they also get a printout for all same-day add-ons. “That allows us to prioritize and work on getting the authorization ASAP,” says Eichele. “If we need further clinical information, we work very closely with the physician office to obtain these authorizations.”

Insurance companies often request lab results, a list of medications, and results from previous testing to ensure the test meets medical necessity. Registrars call the physicians’ offices and ask them for the information the insurance company has requested to expedite the authorization process.

“We really want to ensure that the tests and procedures are authorized, so the patient is not responsible for the entire bill if their insurance were to deny it,” says Eichele. “Having the work done on the front end creates a smoother process for the patient from beginning to end.”