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A structured, data-driven approach will ensure success.
Most medical groups are in the midst of confronting a multitude of issues and changes related to the COVID-19 pandemic. This multifaceted crisis has created significant operational challenges, including substantial decreases in volume, managing labor expense through furlough or compensation adjustments, increasing supply expense for personal protective equipment (PPE), and rapid deployment of telehealth, all while revenue has been significantly impacted. This leaves us with the question: What will operations look like post COVID-19, and, in some cases, will the medical group survive? One important way to stabilize operations is to resume patient flow as soon as possible, when allowed, and the planning for patient access should take place now.
For years, many medical groups have struggled with primary care patient access, but not all have been successful in providing adequate access to the patient populations they serve. Mastering patient access (equalizing supply and demand) isn’t easy, but addressing it with a structured, data-driven approach will help ensure a higher level of success.
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Understand Patient Volume
Analyzing your pre-COVID-19 volumes for clinic visits is crucial to preparing for and predicting volumes post-COVID-19. Review the past 12 months (pre-COVID-19) of office visits and track and trend the visit volumes by provider, by day of the week to understand the variation that occurs by weekday and to establish new provider schedules moving forward. This helps you to understand higher demand days so you can more appropriately staff in the future. Going a step further and analyzing visit types (new patients, physicals, follow-up visits, etc.) will help inform patient mix going forward.
To assist you in planning your long-term telehealth strategy, measure the telehealth volume if you recently implemented telehealth and further analyze those visits to determine which visit types worked best in that format. This will establish a baseline for what visits are appropriate for telehealth in the future as telehealth is expanded and more commonplace. Telehealth will likely play a much larger role in the future and can serve as an additional option for patients, which may not only improve patient engagement, but also help to address patient access.
Examine Future Capacity
As mentioned, patient access has been an issue for many medical groups even prior to the COVID-19 pandemic. Optimizing provider schedules and offering patient-friendly tactics become more important when challenged with the potential for pent-up demand. Once patients return to the workforce, they may be more likely to request appointments outside of the normal workday. Schedules may need to be expanded to early morning, evening, and weekend hours to align with patient demand. Ensure that all hours are covered by rotating providers’ schedules to allow for greater access over longer periods of time. Staff with more providers on higher demand days, which are typically Mondays and Fridays. Make sure providers are scheduled evenly throughout the rest of the week so that there isn’t a day with a small number of providers. Set a minimal provider-level standard for clinics.
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Revisiting your model of care is even more important at this time. Utilize advanced practice clinicians (APCs) and ensure there are guidelines established in advance for which conditions will be seen by the physicians and which will be seen by the APCs. Many groups instituted more defined triage processes during the pandemic, and this should be a strategy that continues moving forward to ensure patients are seen in the appropriate setting (office, virtual, or urgent care). Utilizing urgent care clinics where appropriate helps to shift urgent care needs to the appropriate setting and ensures the chronically ill, preventive health, and follow-up visits are being seen in the office.
It is unlikely that all of your clinics will be opened in one day. Phasing in the opening of the clinics enables you to gain insight into real-time demand while allowing the ramping up of patient volume, as well as provider and clinic staffing. Begin with a smaller number of primary care clinics and move to medical and surgical specialties. Consider if there will be a need to have respiratory clinics for potential COVID-19 patients and/or follow-up visits once the clinics reopen.
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Prepare for and Prioritize the Patient Backlog
It may be difficult to measure the true backlog of patients, but history should be a good indicator of future appointment demand. Backlog consists of all patients scheduled into the future prior to the pandemic, as well as those patients who had to be canceled because of clinic closures. Take into consideration the telehealth visits that have taken place in the interim that may need follow-up. Once you know your pre-COVID-19 daily, weekly, or monthly visit volume, use that as a minimum number of slots and expand schedules from there. Adding just two appointments per day per provider can result in 460 more patients per year (2 slots x 5 days per week x 46 weeks = 460). If you have a high no-show rate, consider increasing the number of slots or altering scheduling guidelines to accommodate for that.
Prioritize which patients will be contacted first to be seen once the clinics re-open. You may stratify patients by any number of approaches, including by diagnosis, risk, or in order of first canceled visits. Utilize telehealth visits where appropriate and create guidelines for scheduling staff regarding appropriate visits for telehealth. Many organizations are taking advantage of the current downtime to do Medicare Well Visit exams via telehealth. Since a majority of telehealth programs were rapidly set up to accommodate need, now is the time to go back and put guidelines and structure in place around how these visit types can be maintained and incorporated as an option for patients and providers.
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Establish a New Normal
Develop an action plan up front to ensure success. Action plans provide a roadmap for the entire care team, promote engagement in the process, and establish accountability. Action plans also help to keep tasks on track, as well as provide a historical documentation of process changes. Measuring and monitoring the progress allows for corrections to be made midstream, if needed. Create the plan now so that there is no lost time once clinics reopen. This will help establish your staffing needs and guide when and where to deploy staffing.
Take advantage of the good habits that were established during the pandemic, such as daily huddles and enhanced communication. These techniques not only should be utilized during a time of crisis but should become a part of your normal daily operations.
This is an important time to reset and not just return to operations as usual. It is an opportunity to rethink your operations and patient flow and redesign it to me more efficient. Take advantage of the new visit modalities and re-examine your care model. Ensure staff are always optimizing their skills and working at their top of their license. Be intentional at examining every aspect of patient flow and take this opportunity to create the most efficient operation that best serves the patient population, promotes high patient satisfaction, and engages providers and staff.