The top concerns for most physician practices include increasing patient-care quality, improving the patient experience and maximizing reimbursement under value-based payment models. One factor that positively affects all three of these trends, while delivering numerous other benefits is the reducing of patient wait times.
The key is to decrease wait times at every step of the healthcare process. That means time spent waiting for an appointment, waiting in the practice's reception area, and waiting in the exam room.
The good news is practice managers have more control over wait times than they might think. By analyzing readily available scheduling data, working with physicians to make small and gradual changes, and shifting duties away from the front desk, physician capacity can expand over the long run and dramatically shrink wait times.
Clinical and financial impacts
Wait times have always been an important issue for practices, but mostly for patient care reasons. A patient with an acute or unmanaged chronic condition forced to wait for an appointment might become sicker, leading to an emergency department or urgent-care visit.
With the recent expansion of value-based care models, wait times have become a financial issue as well. For example, a health plan's value-based payment program may tie patient satisfaction scores to reimbursement — and few frustrations impact satisfaction more than waiting. From a fee-for-service perspective, speeding wait times by increasing physician capacity results in increased volume, which drives up practice revenue.
In light of these clinical and financial impacts, practices should consider the following five tips to help improve patient wait times by operating more efficiently and increasing physician capacity:
1. Find a physician champion
The first step is to find a physician leader who wants to drive change and understands how patient access influences care quality and financial performance. Any scheduling or workflow change designed to improve efficiency or capacity is likely to receive a warmer reception from a clinical colleague aligned with the practice manager.
2. Analyze wait times and schedules
With a physician champion on board, practices should analyze the average wait time for the third — not first — available appointment. Studying the wait time for the first available appointment is not a reliable metric due to the frequent cancellations and no-shows that occur at practices, which makes the "first available appointment" wait appear artificially brief.
3. Study provider schedules
Next, analyze provider schedules to determine if they are truly working to full capacity. Does the amount of time providers spend each week on direct patient care match contract requirements? Is too much "overbooking" time blocked? Over time, it's easy for inefficiencies to creep into schedules.
Look for large chunks of time where providers do not see patients — including unused "overbooking" time — to find places where additional appointments slots could be added. If there is more availability, add hours gradually. Make an effort every quarter, for example, to add one hour of direct patient care to the daily schedule. Don't try to zoom to top capacity all at once; rather, chip away at access issues steadily.
Anticipate pushback on scheduling changes, too. For instance, one common complaint is that the EHR creates documentation inefficiencies. If this is an issue, practices should look for technology solutions that can help physicians complete charting faster.
4. Work ahead
Complete the benefits-eligibility verification process and any authorizations before each appointment. The goal is for patients to arrive at the practice, check in and quickly confirm their insurance information. Long lines at the front desk greatly annoy patients, especially if they also waited months for the appointment.
Cutting down on "overbookings" also has a positive effect on the front office. These same-day slots should be reserved for emergency cases. Otherwise, staff must hurriedly verify eligibility for these new patients, instead of serving the patients already in the practice.
5. Ditch the front-desk phone
Front-desk staff should be responsible for creating a positive, personal patient experience. Their duties should center on greeting patients and checking them in, answering their questions and relying messages to clinical staff. Yet too often, these staff members must interrupt conversations with the patients in front of them to answer the telephone and schedule appointments. This inevitability leads to long lines at check-in, and a less-than-satisfying patient experience.
Alleviating the problem is easy: simply move the phones to a separate office area. Dedicating one or two employees focused exclusively on phone service typically pays for itself by eliminating waits and thereby enabling more patient throughput.
Improving access is a win-win
Wait times are only going to become more of a concern as care demand increases, along with patients being forced to pay out of pocket. Patients who must wait months for an appointment will likely take their care needs and their dollars elsewhere. By decreasing wait times and improving physician capacity, practices can gain a competitive advantage in their markets, increase patient satisfaction and ensure prompt high-quality care.
About the author:
Johanna Epstein is vice president of management consulting services for Culbert Healthcare Solutions