Those of us in the trenches of medical care are always seeking new ways to improve our practices. This means we must be willing to try new things, and not infrequently we are often pleasantly surprised when our experiments succeed!
Over the past few years, government bureaucrats have spent a lot of time and effort informing physicians how best to provide medical care. The consequences of this healthcare overhaul have been high-deductible insurance, burned-out physicians, and frustrated patients. While we optimistically wait for healthcare “reform” to be reformed, there is much we providers can do to improve the care we offer patients.
A major dilemma for patients is simply how to access good care that is both convenient and affordable. Complicated electronic health records (EHRs) and paperwork have reduced the number of patients a physician can see per day. Patients often cannot be seen by their primary care provider (PCP) because of long waits on the phone and triage systems that often misdirect patients to emergency departments. Thus, patients are abandoning their “medical home” and seeking care elsewhere. This means that patients are using retail-based clinics that have extended hours and competitive prices for the uninsured or underinsured, and are being tempted to utilize the $49 telehealth visits promoted by some insurance plans. To thrive in these challenging times, practices should consider all options to facilitate patient access. If you have an open mind, you may even consider changing your “traditional” practice to one that provides “direct primary care.” Read on.
Before we continue, it’s worth mentioning that there are numerous ways to make pediatric practices more efficient, with the goal of increasing capacity beyond 20 patients a day. Simply by increasing capacity by just a few patients each day, you improve patient access (and increase practice revenue)! Methods that can help accomplish this goal include: 1) improving use of EHRs (or using scribes); 2) using technologies to expedite diagnosis and screenings; 3) having age-appropriate scales in exam rooms (to improve traffic flow); and 4) having staff assume new responsibilities (recording chief complaints, giving vaccines if they do not do so already, and so on) so that the provider’s menial chores are minimized when you enter exam rooms.
Adding capacity also means that you have a mechanism is place to optimize scheduling of patients. This means minimizing “no-show” appointments by enforcing a strict office policy that makes these events rare. It also means anticipating the need for sick visits by keeping same-day slots available depending on the day of the week and the season of the year. Most practices see more patients on Mondays and Fridays, with fewer patients seen during the middle of the week.
You can also improve patient flow by adopting a “wave method” of scheduling appointments so that you book 2 patients for the same time slot and see whoever shows first. Many practices that use this system report that it improves workflow significantly. Another option is to provide evening hours if you anticipate that you will see more patients with extended hours and not merely displace patients that are usually seen during the day to your evening hours.
I’ve spoken to some pediatricians who have lost patients to convenient care clinics in their neighborhoods. They have regained patient volume and allegiance by implementing a walk-in clinic type of practice during certain hours, and staffing appropriately. The bottom line is, if you are willing to innovate, you can improve upon your present system and increase capacity without working harder. You can even consider adopting a very successful system for scheduling patients that is nearly 20 years old, called Open Access Scheduling (OAS).