Offering same-day doc visits
When leaders at Pittsburgh-based Allegheny Health Network last spring started looking for ways to get more patients access to care, wait times immediately stuck out as an area in need of fixing.
Like at many other systems across the country, Allegheny patients must wait weeks before they can see a specialist. This lag time can result in noshow appointments, which ultimately hurts Allegheny’s bottom line and alienates patients.
“One of the biggest frustrations for patients is the amount of time they have to wait to see a physician,” said Dr. Elie Aoun, medical director of clinical access at Allegheny. “We live in a world where almost every service is on demand ... healthcare has been lagging behind.”
Motivated to give patients this on-the-spot care, Allegheny Health Network began offering same-day appointments in January. The initiative began as an option for patients who want to see a primary-care physician but has since been extended to 25 specialty service lines across the system’s network. The option is available for patients at most of Allegheny’s 250 outpatient clinics spread across Western Pennsylvania.
Local advertisements promoted the option to patients. Call-center employees also tell patients when they book an appointment that same-day access is available if they call between 7 and 11 a.m. Clinics also offer it to walk-in patients.
The effort required a complete overhaul of how Allegheny schedules appointments. The eight-hospital system evaluated patient data around volumes at outpatient clinics and how long patients wait to see doctors. Based on that analysis, Allegheny determined how many slots should be kept open at certain clinics for sameday appointments. The system then altered the technology of its appointment center by closing off certain blocks of time for advanced booking. Those blocks of time become available on certain days as an option for same-day appointments.
“This was a way that we could predictively model what demand would be,” said Kenyokee Crowell, senior vice president of clinical access at Allegheny.
The initiative didn’t require hiring any new workers. Allegheny employs about 2,800 physicians. Nurse practitioners and physician assistants can also see patients the same day.
Physician support was key in successfully rolling out same-day appointments, Aoun said. The system brought in physician leaders across a variety of service lines to hear their concerns and get their advice. The doctors were quick to jump on board, Aoun said. “Physicians want to find ways to improve access to their patients.”
Physician buy-in can be the hardest part of implementing same-day appointments, said Ken Hertz, a consultant at the Medical Group Management Association who has studied the practice. It’s a breakdown of the status quo, and it requires physicians to take on risk, he said. An open slot on a doctor’s calendar dedicated to a same-day appointment could go unfilled, causing them to lose out on reimbursement dollars.
Allegheny isn’t the first system to take on same-day appointments, but most are limited to primary care. Same-day access to specialists is much rarer. Aoun said it requires a lot of planning and development, but “any hospital system can potentially do this.”
The MGMA’s Hertz said there might be an uptick in the number of health systems that offer same-day access to specialists because it aligns with a push to give more patients control of their care. But the industry isn’t always open to changes, he added.
At the end of the first quarter, Allegheny expects to see that the initiative has led to cost savings and a decrease in no-show rates, Crowell said.
Offering same-day appointments also gives Allegheny a leg up against its local Pittsburgh competitor UPMC. Both systems are integrated delivery networks.
UPMC didn’t respond to a request for comment but Crowell said competition wasn’t top of mind when Allegheny decided to offer same-day scheduling. “At the end of the day, we have patients as our customers and we have to offer services in demand by our population,” she said.
Allegheny has found there is substantial demand for the same-day option. Since the initiative launched at the start of the year, 36,000 patients have scheduled a same-day appointment. Of those, 22,000 were with a primary-care doctor, and 14,000 were with a specialist.
Crowell said Allegheny expects those numbers to grow. An initial survey of patients found 96% enjoyed their same-day appointment experience. “This has been a way to put our patients first,” she said.