How to Implement Open Access Scheduling at Your Medical Practice

March 5, 2014

Implementing open access at your medical practice may not be as difficult as you think. Here's how it can work.

It may be time for your medical practice to implement open access, also referred to as advanced access or same day scheduling. It certainly deserves serious consideration.

Here's how open access scheduling works, and why your practice may want to consider it.

Defining open access
Open access covers a variety of scheduling approaches, including completely unscheduled (a la an ED or urgent care center), open blocks of time on certain days, and a specific number of appointments kept open in each clinic session.  A practice could utilize more than one of these options, as well as traditionally scheduled appointments.  The imperative is to do what makes sense for the patients and the providers.

For instance, it might make sense for an OB to block out Tuesday mornings for first and second trimester appointments and let patients come in at their convenience for these typically quick appointments. The methodology could also support scheduled group meetings at the beginning or end of the open access period to disseminate general information and answer typical questions.

Another alternative is to reserve the last appointment time in each clinic session for same-day appointments, and be willing to work through lunch or after the regular workday until all patients have been seen.

Making open access work
Open access requires an explicit service promise from the practice to the patient. The purpose of a service promise is to manage patients' expectations and provide something against which to hold the practice accountable. 

Here's an example of a service promise related to open access:
• If you call our office before 9 a.m. and want to be seen the same day, someone in the practice will see you before the end of the day.
• If you call our office after 9 a.m. and want to be seen the same day, you may have to wait until the next business day to be seen.
• The provider you see (if it is not your primary physician) may ask you to make a follow-up appointment with your regular physician.

Open access can mean different things to different people.  It is vital that each practice develops its own definition.  It is also important for patients to be on notice that they may not be seen until Monday if they call on Friday after noon.

Solutions to common open access concerns• How does a practice avoid empty appointment slots on some days and being overwhelmed on other days?
The solution is not necessarily easy, but it is simple:  Ease into open access based upon a good understanding of your current operations.  Monday mornings are probably a busy time for the phones, as patients call in about problems encountered during the weekend.  Does that mean that the practice needs more open time on Monday morning, or does Monday afternoon make more sense?

Based upon the specialty and the patient population, some types of appointments will create natural opportunities for open access and they don't have to be every week or every month.  A pediatrics practice, for example, might run an immunization or sports exam clinic for parts of several days just before school starts.

• What about insurance verification?
The best answer is to have an effective way to quickly verify insurance coverage.  Supplement that process by asking patients to provide a credit card to be billed in the event the office cannot verify insurance coverage.  If the patient subsequently provides adequate, current insurance information, the practice can file the claim and have the payment sent to the patient.

Authorizing a charge in lieu of insurance is more palatable to patients when the practice is accommodating them with promptly provided care.

Benefits of at least partial open access
The two primary benefits are increased patient satisfaction and improved practice productivity.  Patients are happier because they can be seen more quickly.  They are also happier because they can be seen in their regular setting with all of their records available, instead of in an urgent care center they know nothing about. 

Waiting room time, within reasonable bounds, is not as aggravating when there is not a set appointment time.

Practice productivity should increase for several reasons.  No shows and cancellations drop because less time elapses between the appointment and its scheduling.  Average visit lengths tend to be shorter because the visit is more focused on the precipitating issue.  Open access visits require no appointment reminders.

Open access is not a silver bullet, but it does have promise.  What do you see as the pitfalls and benefits?