Managing Patient Expectations: Access to Care

May 3, 2012

Access to care is the number one patient expectation …and it's probably controlled by your least-experienced employee.

You may or may not want more patients in your practice, but everyone needs to acquire and keep the patients with good insurance and diagnoses that match the core competencies of the practice. These patients offset losses in other areas and make work more meaningful. Unfortunately, these patients are the minority, and they are the most discriminating. That is what this series on managing patient expectations is really about - preparing for inevitable change that will not only necessitate a shift in the status quo, it will rewrite it.

Adaptation and preparation are critical to the future and the determinant of today’s revenues and tomorrow’s value. A major part of adaptation is meeting patient expectations. Of the ten expectations we have explored over the past several months, access to care is the most important.

The reason is fundamental. Overall healthcare spending is nearly static for the second year running even though healthcare costs continue to rise. How can this be? The continuing trend is for people to be more selective in receiving care - meaning they are sicker when they seek it.
Insurers compound the increase in acuity by discouraging use of emergency rooms and urgent care centers through higher deductibles, out-of-network penalties and copays, driving sicker people to physicians.

So, with patients letting things get progressively worse before seeking treatment, it is only natural that being seen quickly is now a much higher priority for a fast growing majority of people.

The burden then falls on physicians’ offices to accommodate. Most do not, and it typically has little to do with schedule and everything to do with the scheduler.

HCP’s Sarah Lindemuth and her research team recently completed a comprehensive project for a prominent regional neuroscience practice that included an in-depth look at their competitors through some “secret shopping” and secondary fact finding.

They compared competing practices’ process for setting appointment times, the length of wait, and the quality and effectiveness of their approach; these are all factors at the top of patients’ priorities.

“Secret shopping” calls were based upon the premise of episodic back pain, with a sudden increase in pain and new leg and foot numbness; a clinical indication to be seen quickly by a specialist, not an emergency room.

Nineteen neuroscience and neurosurgery practices and practice groups (including our client) were contacted by our secret shoppers, all with the same story.

Wait times for appointments for an acute episode that could lead to permanent damage were disturbing. Three, or 16 percent, said they could see the prospective patient in five days or less; three more needed one to two weeks; nine, or 47 percent, said it would take two to three weeks; and, four, or 21 percent, said that it would be a month or more.

Most offices or centers were friendly and reasonably helpful. Some were rude. Some were impatient, as if the call was interrupting more important priorities, and others were almost hostile.

It is not likely that these responses had anything to do with the doctors’ priorities, but rather those of the staff. The person fielding calls and scheduling appointments is the linchpin - and probably the junior, and least-paid employee.

How practices answer their phones is a reliable indicator of how the patient will be treated when they visit, and people sense this intuitively, particularly those patients you want the most. It is also a reliable indicator of opportunity and a useful tactic in determining where to locate a competing office, which was an underlying purpose for this study.

Patient acquisition, retention, and referrals begin and end at the front desk, including, and in particular, how telephone calls are answered and processed. They either enhance or negate everything else that happens in between.

The harsh reality for many practices is that their future is firmly in the wrong hands.
The most important thing that you can do is to train staff to let the patient’s condition, stress level, and status determine urgency, not the schedule.

Survivors of upcoming changes will meet patient expectations for access to care, and will adapt to new expectations, as they arise. If you do nothing else, do this.

Find out more about James Doulgeris and our other Practice Notes bloggers.