Of­fer­ing same-day doc vis­its

Modern Healthcare - - INNOVATIONS - By Maria Castel­lucci

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.

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