Adopting Advanced Access

1

Adopting Advanced Access
Change Management Topic
Practice Support Program
www.practicesupport.bc.ca
2
Purpose

• To introduce ADVANCED ACCESS as a way of
  organizing a practice so that patients are seen
  when they want to be seen

3
What is advanced access?

• Advanced access is an innovative approach for
  patient appointment scheduling.
• Its a structured and systematic method to help
  ensure that patients can see their doctor when
  they need to and at a time that is convenient for
  them.

Dr. Jeff Harries Pauline Sykes, MOA,
Penticton If you can see a patient when they
want to be seen, thats absolutely the best time
to see them. Its the most efficient and
compassionate time. Dr. Jeff Harries
4
Access problems

• Patients get sicker waiting to see their doctor
• They are more fearful
• They resent delays and get angry
• They seek other advice
• They are siphoned off to walk-in clinics
• They crowd ERs
• They dont get good CDM
• They die

5
Objectives

• After completing this module, you will be able
  to

• Assess your appointment scheduling system
• Create an action plan for implementing changes
• Measure demand for services in your practice
• Determine supply of services in your practice
• Calculate the backlog of patients
• Reduce the backlog of patients

6
Objectives continued

• After completing this module, you will be able
  to

• Streamline your scheduling system
• Balance supply and demand of services
• Evaluate the changes you will make
• Manage variations in demand for and supply of
  services on an ongoing basis

7
Benefits of advanced access for patients

• See their physician when they need to be seen
• See their physician of choice
• Receive better continuity of care
• Feel more confident about their medical care and
  the health system
• No wait/no waste of time

8
Benefits for physicians and their staff

• See patients when they want to be seen
• Enables staff to manage patient appointments more
  efficiently and effectively
• Feel less stress and get more professional
  satisfaction
• Creates capacity to see more patients
• Creates capacity for more coordinated, planned
  care
• Fewer no-shows

• Dr. Davidicus Wong, Burnaby
• Family physicians are under constant time
  pressure, and the waiting times for appointments
  can become unreasonable.
• Systematically evaluating access and capacity has
  helped me run my office more efficiently.

9
Benefits for physicians continued
From a business point of view, our practice has
seen an approximate 25 increase in net
revenue. The reason for it is that you can
recapture patients from the walk in clinics. They
are typically your easiest, low intensity visits,
then youre actually seeing extra revenue. Dr.
David Attwell
Dr. David Attwell and MOA Sheila Harding, Victoria
I now have enough office time to get all the
paperwork done, and Ive freed up more time to
spend with my children and enjoy the rest of my
life. Dr. Davidicus Wong
Dr. Davidicus Wong with his family
10
What we can achieve through advanced access

• Moving to advanced access improves
  profitability, improves patient and physician
  satisfaction, and very importantly, it opens
  capacity for improving other intractable
  problems. Somewhat unexpectedly it also opens up
  access to emergency departments, hospital wards,
  and specialty clinics.
• Scaling Up the Deployment of Advanced Access
  A Way Out of Crisis Marcus Pierson, MD,
  Whatcom County, WA

11
Some key concepts

• ACCESS3rd next available appointment is industry
  standard. For family practice, the gold standard
  is ZERO!
• CAPACITYNumber of appointment slots
• DEMANDNumber of appointments requested
• BACKLOGNumber of patients waiting for an
  appointment

12
Improvement model
13
What to measure

• How much time to 3rd next available appointment?
• How many patients in your practice?
• Capacity How much work can your practice handle?
• Demand What do your patients need/want?
• Wait lists by appointment type
• Continuity How often is patient is seen by own
  MD?
• How many no-shows?
• Revenues

14
How to improve access

• Work down the backlog.Offload work, put in more
  hours, dont add to the backlog. Takes 3 to 6
  weeks.
• Understand and manage demand and capacity.Review
  general patterns of demand and capacity, and plan
  to increase capacity at times when demand is
  high.
• Reduce appointment types.Only two are needed
  short appointments for regular visits, and long
  appointments for physicals and new patients.

15
What happened in my practice

• Eliminated backlog
• Improved patient flow reception room waits are
  seldom longer than 20 minutes
• Patients who call in the morning are seen the
  same day, and those who call in the afternoon are
  seen the following day

• Fewer no-shows and fewer patients lost to walk-in
  clinics
• Able to accept new patients
• Less rushed with each patient
• MOA more engaged with patients
• More time for family and other activities

16
What impact does Advanced Access have on billing?

• The Business Case
• Average of 10 25 increase in net revenue
• More time for planned care
• Short visits recapture the EASY visits
• Free more time for coordinated, planned care
• e.g., take advantage of the Complex Care Fees
• Advanced Access module participation
• Talk to your Practice Support Team about whats
  involved and how you can be compensated to learn
  and test changes in your practice

17
To get from here to there ...

• RECOGNIZE that the current system is unworkable
  and something has to change
• BELIEVE that advanced access needs to be part of
  the change
• COMMIT to change

18
Some tips

• Next Tuesday is a good time to start.
• Cancel/adjust things that dont add value.
• Cancel/adjust all things that increase demand or
  decrease supply.

19
How to get started

• Contact your Practice Support Team
• Work down the backlog. Dont let a backlog
  develop again
• Match supply and demand
• Do todays work today

20
Consider ...

• The significant problems we have cannot be
  solved by the same thinking with which we created
  them.
• Albert Einstein

21
Summary

• Advanced access allows BC physicians to manage
  their practices more efficiently and relieves
  stress on everyone.
• More importantly, patients report a much higher
  level of satisfaction with their medical care.

• Dr. Jeff Harries and staff, Penticton
• It's a wonderful way to treat our patients. And
  it's wonderful for the doctors and MOAs. It's a
  win-win for everyone!
• Pauline Sykes, MOA