Five Steps to Improving Patient Access

Access, the time between a patient's request for an appointment and the next available appointment on your schedule, is a concern that is getting increasing attention. For medical practices nationwide this can affect patient-satisfaction scores and jeopardize future revenue from third-party payers. The rationale is obvious. If patients have to wait to get an appointment to see their doctor, it can result in delayed treatments and compromised clinical outcomes. In addition, if they must wait longer for appointments, they may try unorthodox home remedies that could further jeopardize their health. Here are five steps to take to make sure patients get appropriate access to care in your office:

Step 1: Measure access. Find out how long a patient must wait to get an appointment at your practice. Over a 30-day period, prepare a log of appointment access for each day. The first available appointment is often the result of a same-day cancellation, so also track the second and third next-available appointments. Do so at the beginning of each day to ensure consistency. Graph your findings and look for variations. For example, fitting a patient in becomes far more difficult in a two- or three-physician practice if one doctor is on vacation or in some specialties the demand is far higher on Mondays.

Step 2: Monitor denied appointment requests. To further assess the effect this may have on the practice, for one week track the number of patients who were unable to get an appointment each day, and the reason for their call.

Step 3: Gather the troops. Schedule a staff meeting to share and discuss your findings. Include the schedulers, nursing staff, and at least one physician. Some denial reasons may appear legitimate, others may seem avoidable. Here some common responses from staff:

"The patient was too picky - she could only come in on certain days or times."

"His physician had no appointments, and the patient wasn't willing to see another provider."

"I'm a scheduler - I can see when the next available appointment is, but I can't be expected to understand the severity of a patient's complaints."

Once you've given staff a chance to have their say, discuss what might be done to improve patient access. For example, if you have an average of four denied patients per provider, each day, you might consider a combination of these strategies:

• Add two appointments for each physician by double booking the first appointment of the day with a new patient and a non-chronic established patient or a post-op. While the new patient is checking in and giving her history, the physician could be seeing the established patient. This could be accomplished again in the afternoon.

• Reserve four appointments on the daily schedule for each provider, opening the blocked appointments in the morning.

• Develop scripts for schedulers to further probe the symptoms and potential urgency of patient complaints.

• Nursing staff can provide the scheduling team with a list of symptoms that require a visit within 24 hours.

• A policy can be set that identifies patients who should be triaged by a nurse, based on symptoms.

• Refer chronic complainers to a nurse for evaluation of appointment need.

• Explore the potential for developing an open-access appointment scheduling system.

• Hire a part-time provider to provide same-day care.

Involving staff and getting everyone's input is critical to this process. It is also an essential component to getting buy-in for whatever actions you plan to take.

Step 4: Develop a plan. Once you have analyzed your findings and discussed future actions, it is important to develop a written plan. Create an action plan that includes:

• A written description of each action item;

• The major steps required to complete each action item;

• The dates when preparation will begin;

• The dates when implementation will take place; and

• The person who will be responsible for guiding each action item through implementation.

Remember, the practice manager or a supervisor will need to serve as the team leader to guide the entire action plan.

Step 5: Make the commitment - walk the talk. Developing an action plan is an important tool to guide your practice's progress on improving patient access to care. In order to stay on top of things, schedule follow-up meetings to review the plan and monitor progress. Regular meetings keep communication open, ensure staff accountability, and identify reasons that may require altering your plan.

Four weeks to six weeks after the targeted completion date for the last item on the action plan, measure appointment availability to ensure access has improved. Continue to do this at least semi-annually so that you become aware when demand increases and access issues reemerge. Healthcare reform will put appointment access front and center, and so must you!

Judy Capko is a healthcare consultant and author of the popular books “Secrets of the Best Run Practices,” 2^nd edition, and “Take Back Time.” Based in Thousand Oaks, Calif., she is a national speaker on healthcare topics. She can be reached at judy@capko.com.