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IMPROVING PATIENT ACCESS TO CARE

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IMPROVING PATIENT ACCESS TO CARE Open Access – PowerPoint PPT presentation

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Title: IMPROVING PATIENT ACCESS TO CARE


1
IMPROVING PATIENT ACCESS TO CARE
  • Open Access

2
If we keep doing what we are doing, we will keep
getting what we got
  • Yogi Berra

3
Every system is perfectly designed to get the
results it gets
  • Paul B. Batalden MD
  • Co-founder Institute for Health care Improvement
  • Founding Director Center for Healthcare
    Improvement and Leadership The Dartmouth
    Institute

4
Open Access
  • Why should you care?

5
Is Baldwin Family Health Care Ready for Open
Access Scheduling?
6
Reasons for Change
  • Increased patient satisfaction
  • Increased provider and staff satisfaction
  • Improved continuity of care.
  • Reduced rate of no shows
  • Reduced demand for after hours care and use of
    urgent care (reduced costs)
  • Reduced visits per patient
  • When patients can see their own provider,
    demand drops by 5
  • Reduction in telephone time for Triage staff as
    less time is needed when patients are scheduled
    to be seen today.
  • Nearly eliminates need for patient reminder
    calls.

7
Access Models
  • 1) Traditional
  • 2) First Generation Open Access
  • Carve Out
  • 3) Second Generation Open Access
    Advanced Access

8
Traditional Scheduling
  • Reservoir is full with routine visits at the
    beginning of each day
  • Urgent cases are accommodated by double booking,
    overtime or running behind.
  • Most Common System in offices
  • Average waiting time for medical appointment in
    the US is 3 weeks.
  • Accommodates demand with a restrictive and
    complex categorization system
  • New vs. Established Pt.
  • 10, 15, or 30 minute appointment
  • Wellness vs. acute problem
  • Per Murray and Tantau Do last months work
    today.

9
Carve Out / 1st Gen. Open Access
  • System utilized by BFHC / GLFC
  • Hold a quantity of urgent care appointments for
    same day scheduling.
  • Quantity is based on predicted demand
  • Accommodates for some (much) of the urgent need.
  • Increases complexity of scheduling
  • Designating Urgent Care or Same Day provider
    decreases continuity of care.
  • Drives dates for scheduled / routine appointments
    further into the future.
  • Staff may be forced to steal from spots held
    for same day visits in order to get in patients
    who need to be seen.
  • Per Murray and Tantau Do some of todays work
    today.

10
Open Access
  • Removes all distinction between urgent and
    routine visits.
  • Patients are placed on the schedule as they call
    for appointments.
  • Need More Here
  • Per Murray and Tantau Do todays work today.

11
Panel Size
  • About 2,500 patients
  • 0.7 to 0.8 percent of a providers patients will
    call for an appointment each day.
  • Share data on BFHC panel sizes

12
Causes for Failure
  • Not assigning Primary Care Providers
  • Continue to run under Carve Out system
    believing it is open access.
  • Routinely running overtime for visits and
    overbooking providers
  • Not maintaining continuity of care.
  • Diverting care to urgent care or same day clinic

13
Standard Pattern of Demand
  • Increases very quickly in morning
  • Flattens at about 10 AM
  • Drops over lunch
  • Drops more from 2pm til end of day
  • Demand for appointments after 4PM is about 4 of
    volume.
  • Late night demand often created when provider
    cannot fit patients into day appointments and
    only open time is evenings.

14
Transition
  • How to get from here to there

15
Principles
  • 1) Understand, measure and achieve a balance
    between supply and demand
  • 2) Recalibrate the system (or reduce the
    backlog)
  • 3) Reduce the number of queues by reducing the
    variety of appointment types or lengths (queuing
    theory)
  • 4) Create contingency plans for times of
    heightened demand or lessened capacity
  • 5) Influence the demand (e.g., by matching
    patients with their own physicians, making the
    most of current visits and rethinking
    return-visit intervals)
  • 6) Manage the constraints or bottlenecks (e.g.,
    remove from the physicians any work that can be
    done by someone else).

16
Open Access Tips
  • Offer all patients an appointment on the day they
    call regardless of the reason for the visit.
  • If they do not want to be seen the day of the
    call, schedule an appointment of their choosing.
    Do not have them call back on the day they want
    to be seen.
  • Allow providers to pre-schedule patients when
    clinically necessary (good backlog). Normally 20
    to 30 patients per 1000.
  • All appointments will be on standard length of
    time.
  • Reduce types of appointments (the fewer, the
    better)
  • Appointment length should match provider practice
    style.
  • Panel size must be manageable
  • Protect provider schedules from colleague
    overflow
  • Develop plan for extreme demand or provider
    absence
  • Reduce demand for unnecessary visits.
  • Reduce future demand by maximizing todays visit

17
High Demand Times
  • Double book with patients PCP
  • After several double bookings, offer an
    appointment with a different provider
  • Agree to stay late
  • Offer appointment with designated same day
    provider and advise patient that there will be a
    wait.

18
How to Reduce Backlog
  • Reduce Workload
  • Increase intervals for return appointments
  • Utilize alternatives to face to face office
    visits
  • Phone calls
  • E-mail
  • Group Visits
  • Maximize activities at each visit
  • Transfer duties to support staff to allow
    provider to see more patients in same amount of
    time
  • Reduce provider interruptions
  • Support staff (RN?) manage sub-populations

19
How to Reduce Backlog
  • Increase Availability
  • Add Appointments
  • Use Administrative Time
  • Defer Time Off
  • Match Capacity to Demand
  • Modify schedules to have more providers working
    when demand is the highest

20
Key Points
  • Reinforce the relationship between the patient
    and their PCP. This needs to be a key priority.
  • Ensure accuracy of records as to who the patient
    identifies as the PCP
  • Start every appointment on time.
  • Agree what on time means.
  • Make sure systems are in place to allow provider
    to see patient at the time scheduled.

21
Phone Scripts
  • Receptionist Which provider do you see?
  • Patient I have seen Dr. Doe but it doesnt
    really matter.
  • Receptionist It is really better for you to
    see the same one as frequently as possible so
    that they get to know you better and can take
    better care of you. Dr. Doe is not in today, but
    I can schedule you tomorrow with her when she
    returns.
  • Patient I would rather come in today.
  • Receptionist Thats fine, you can see one of
    the other providers today and next time we will
    try and get you in with Dr. Doe.

22
Phone Scripts
  • Patient I would like to make an appointment
    with Dr. Doe.
  • Receptionist When would you like to come it?
  • Patient Tomorrow sometime
  • Receptionist Dr. Doe is not in tomorrow. She
    could see you today at 300 today or she will be
    back on Thrusday and I could schedule you then.
  • (Patient gets to choose)

23
Phone Scripts
  • Patient I would like to make an appointment
    for next month with Dr. Doe for my physical
  • Receptionist We really try not to schedule out
    so far, since plans change and it can be hard to
    keep an appointments that is scheduled so far in
    advance. Would you kike to come in sooner, or
    would you like to call back within a few days of
    when you would like to be seen? We will have
    appointments available then
  • (If patient is insistent and the schedule is
    open, go ahead and schedule, but make a not for
    someone to confirm appointment the day before.)

24
Phone Contacts
  • It is the patients choice, accommodate them
    whenever possible.
  • Always confirm PCP and schedule with that
    provider whenever possible.
  • If a patient wants a future appointment, do not
    ask them to call back on the day they want to be
    seen, this just increases phone traffic.
  • Try not to schedule out any further than 2 weeks
    since the no show rate rises dramatically after
    that time.
  • When pre-scheduling appointments, guide patients
    toward known low demand days or times.
  • When scheduling for another day, try to encourage
    the early morning appointments.

25
Measures
  • Percent of Same Day Work
  • No Show Rate
  • Patient Satisfaction
  • Panel Size

26
Next Steps
  • Provider Buy In
  • Key Staff Buy In
  • The people who do the work need to transform the
    work
  • Site Specific Plan and milestones
  • Staff Education and Training
  • Patient Education
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