Army Office of the Surgeon General

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Provider TemplatesDeciding What Looks
RightinYour Clinic

• Army Office of the Surgeon General
• Decision Support Business Operations
• POC Martin Doperak D.O.

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Purpose

• Understand the role templates has in patient flow
• Understand the template options in a Family
  Practice template
• Understand what factors should be considered in
  creating or adjusting a providers template
• Understand some tools to evaluate templates

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Definitions

• Templatethe delineation of the number and type
  of patients a provider can see in a day/clinic
• Schedulingthe availability of a template to be
  booked with patients

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What is the Purpose of Templates?

• Guidance to those booking appointments
• What type of patient to book at a given time
• Allows the clinic leadership the ability to
  change the mix of appointments available
• Time of year
• Number of providers available changes
• Population served changes
• Needs of population served changes
• Provides an expected schedule to the provider

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Different Types of Possible Appointments

• Appointment Type
  Access Standard
• PCM-Initial primary care
  28 days
• SPEC-Initial specialty care
  28 days
• ACUT-Acute
  24 hours
• ROUT-Routine Appointment
  7 days
• WELL-Wellness, health promotion
  28 days
• PROC-Procedure with designated duration
  Provider designated duration
• EST-established patient (est patient follow-up)
  Provider designated duration
• TCON-Telephone consult
  Provider designated duration
• GRP-Group care Provider designated
  duration

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Factors Determining the Correct Template

• Patient demographics
• Demand
• Variations within the week
• Seasonal
• Deployments
• Appointment System
• Centralize/decentralize/remote
• Telephone systems
• Clinic Flow

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Appointment Models

• Traditional Model
• Carve-out Model
• Wave/Modified-Wave
• Group/Shared Medical Appointments
• Open Access Model

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Traditional Model

• Acute care are added onto full schedules
• Backlog/Wait list
• Contributed to increase in Acute Care Centers

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Carve-Out Model

• Holding of a specified number of appointments for
  acute care
• Specified numberguess work
• Difficulty in handling the non-urgent patient who
  needs to be seen in the next few dayssteal from
  tomorrow
• Backlog/Wait list

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Wave Model

• Have all patients for the morning or afternoon
  show at up at the same time
• First come, first serve
• Not patient friendly

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Modified/Wave Model

• Load up the front end of each hour and leave open
  slots to catch up
• Advantages minimizes physician downtime, allows
  physician more control of their use of time,
  patient wait is not as long as seen with the wave
• Pitfalls filling catch-up time slots with acute,
  patient selection (new patients, difficult
  patients or patients with complications)

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Group/Shared Appointments Model

• Multiple patients are seen as a group for care
• Three Models
• Cooperative Health Care Clinic (CHCC)
• Older patients with high utilization
• Broad spectrum of care
• Disease-Specific CHCC
• Diagnostically exclusive group
• Targets chronic-disease management
• Drop-In Group Medical Appointments (DIGMA)
• Established patients
• Follow-up care

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Open Access Model

• Patients are offered appointments on the day they
  call regardless of the reason for the visit
• Providers start each day with 70-80 of their
  schedule open
• Do todays work today

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Performance Measures

• Knowing if
• Are you wasting appointments, unbooked?
• Are you meeting the demands of the community?
• Tricare Operations Center (TOC)
• Template Analysis Tool
• Look forward or backward
• Supply of Appointments
• Appointment Activities Tool
• What actually occurred by appointment status or
  type
• MHS Insight
• 3rd Appointment Availability
• Local CHCS run reports

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Template Analysis Tool
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Template Analysis Tool
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Template Analysis Tool
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Template Analysis Tool
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Appointment Activities Tool
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Appointment Activities Tool
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Appointment Activities Tool
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Appointment Activities Tool
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Appointment Activities Tool
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Appointment Activities Tool
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Conclusion

• Aggressive management of templates and scheduling
  is critical to managing access
• Creating templates/schedules that maximizes
  clinic efficiency is one of the most important
  aspects of clinic operations
• Several appointment models are available to the
  clinic manager

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Discussion