Try Advanced Access Scheduling

Creating timely access to care for patients is an increasingly important agenda item for many medical practices. Why? Because improved access means happier patients -- and happier referring physicians. Besides, many payers are measuring and rewarding physicians based on accessibility. Practices that embrace improved access have also discovered efficiencies in their operations.

Many medical practices now see the benefits and are embracing a new method of scheduling -- and working -- called "advanced access." This new method is based on a combination of four principles.

Four steps to success

First, patients want care from their own physicians, not a covering physician, for acute visits. When patients are able to see their own physicians, their demand for appointments actually decreases by at least 5 percent, according to a study presented at the 2000 Institute for Health Care Improvement Conference in Chicago.

Second, processing work on a real-time basis is critical to cost-effectiveness and efficiency. How can practices avoid unnecessary delays? Say, for instance, patients' telephone messages are taken by an operator, evaluated by a medical assistant, reviewed by a physician, and return calls are made by a nurse. This messaging process involves multiple staff resources, and may take an hour or an entire day to get back to the patient.

The solution? Schedule appointments when patients call, rather than routing their requests through so many channels. Every hand-off reduces the time that staff can productively spend on patient care (and billable activities). Spend time on patient visits instead of finding ways to keep patients out of the practice.

Third, creating timely access demands a balance between provider supply and patient demand. In order to meet patients' demands, there must be a reasonable supply of providers. If the wait time is growing, supply and demand are out of balance. Consider improving efficiency in the office, managing time better, or recruiting an additional provider.

Finally, accommodating appointment requests on time is key - many practices have consistent access gaps. For example, if it took 45 days to see a new patient last July and the wait time is 45 days this July, demand is not growing faster than the supply of appointments. There is no reason why the time to the next available appointment can't be zero days (or one day for specialty practices to allow for the ability to capture referrals and authorizations).

Implementing advanced access is not effortless, but remaining focused on your patients' needs will make the transition easier.

How to do it

Here's what you will need to do to implement advanced access principles in your practice:

o Everyone -- from the patient to the provider -- needs to believe in the method. Staff will almost instinctively want to deflect demand, thinking that they are "saving" work. Patients may be confused about why they can suddenly be seen right away. Providers will be anxious about open schedules when they walk in every morning.

o Work through the backlog. To implement advanced access, your practice must first eliminate its backlog of patients waiting for appointments. If your time to next available appointment is five weeks away, it will likely take your practice five to six weeks to accomplish this objective. Long days may be the easiest solution for you, but consider early mornings and weekend hours during this phase.

o Develop an effective process for registration and record retrieval. Since many patients will be scheduled on a same-day basis, your administrative staff must be prepared for the visit (referrals, insurance verification and benefits eligibility, for example), and records staff must be able to fulfill requests rapidly.

o Plan contingencies. If patient demand exceeds capacity, what will happen in your practice? Is there an agreement that the demand will be deflected to a certain provider?

o Start on time. For real-time work processing to create efficiency, the clinics must start on time.

o Prepare for variability in your day. Most likely, variability exists under your current system. It won't go away under advanced access. There may be days that you need to stay late to meet your patients' needs. On average, however, your day will be shorter.

o Empower staff to meet the patients' needs. For example, instead of needing five hand-offs for every telephone message, develop a process to manage them on a real-time basis. Real-time processing allows you to reduce staff time in rework and the inevitable errors that result from multiple hand-offs.

o Eliminate "the front versus the back" mindset. Working as a team is essential to creating an environment in which you can serve the patient in a timely manner. Consider ways to speed communications between the "front" and the "back," including close physical proximity for the clerical and clinical staff.

o Simplify your appointment types. Appointment distinctions become largely irrelevant under advanced access. Reduce your appointment types to three or four -- new patients, established patients, urgent patients, and procedures, for example.

o Plan for the visit. At the time an appointment is scheduled, ask patients if there is anything that they need taken care of during their visit. Look in the chart for upcoming immunizations, well-woman checks, and so forth. Meet with your staff at the beginning of each clinic session to anticipate patients' needs. "Pull" the work into today.

o Complete the visit. Don't put off work until later in the day. Dictate the notes, finalize the paperwork, send the referral, or transmit the prescription to the pharmacy at the time the request or need arises. Consider the length of your appointments. Many practices find that they need to increase the spacing of appointments (for example, from every 15 minutes to every 20 minutes) if paperwork is included. In doing this, remember that real-time work is more efficient than batching work. It can reduce the length of your workday.

o Schedule follow-up visits with patients as you normally would, but be sure they aren't clustered. That is, don't schedule all follow-up visits on Mondays. If you find that patient demand for visits is higher on Mondays, your practice should attempt to schedule follow-up visits on another weekday to leave room for same-day appointment requests.

o Manage the demand of your patients with an appropriate supply of providers. If your practice receives word that 1,000 new patients have signed up with your practice, seek out temporary help until you can recruit a permanent provider to meet the patients' needs. Manage vacations in a similar fashion; the majority of your providers cannot go on vacation at the same time that patient demand peaks (e.g., flu season). There is no magical formula to determine the perfect patient panel, but if you find your time to next available appointment growing, you'll know there is an imbalance.

o Greet walk-ins with information regarding your new policy of advanced access. Knowing that they can be seen on a same-day basis may encourage them to call ahead next time to schedule an appointment - even for the same day. The few hours you will have to prepare for their visit clinically and administratively make it a win-win for the patient and the practice. If walk-ins persist, measure their frequency and anticipate them.

Elizabeth Woodcock can be reached at ewoodcock@physicianspractice.com.

This article originally appeared in the July/August 2002 issue of Physicians Practice.