Open Access Scheduling “Doing today‟s work today”

MedInf404- DL Winter2011 Biljana Spasic Claire McCardle

Clinics

Edinburgh Hospital and Clinics •350 bed hospital •Emergency Department •20 Ambulatory Multi –Specialty Clinics •20K Discharges •200K clinic visits •Clinic practices 4-10 physicians per practice

•Clinic Services ( high volume) •Family Practice •Urgent Care •Ob/GYN •Pediatrics

Problem Definition

Traditional Clinic Scheduling ◦ Wait time for next routine appointment (3rd next

available appt > 45 days) ◦ Patient cycle time is currently 75minutes ◦ Care diversion to ED & Urgent Care ◦ Managing „no shows‟ & triaging calls ; No show rate of

50% ◦ Capacity planning „overbook‟ ◦ Managing appointment back logs

Impact

◦ Challenges with care coordination (28% of patients see PCP)

◦ Inadequate and timely access to a PCP is a major source of patient dissatisfaction

◦ Staff dissatisfaction

Objectives

1. Endorsement

◦ “Open Access‟ as a strategic initiative

2. Review

◦ Proposal for “Open Access” plan

3. Approval

◦ Budget approval for feasibility study

“Do Today’s Work Today”

Open Access

◦ Same day appointment scheduling

◦ Match patient to Primary Care Physician

◦ Appointments are scheduled by availability not by appointment type e.g., no differentiation between urgent and routine appointments

Paradigm Shift ◦ Underlying theory: demand is predictable

◦ Balance demand and provider capacity

◦ Simplify appointment types

◦ Optimize and consolidate services for each visit move from episodic care to continuity of care

Historical Challenges

◦ Adoption Physicians “volume is money” Giving up control of schedule Skepticism existing resources can manage demand Benefits not clearly defined for staff

◦ Cultural Routine care can “wait”

◦ Logistics Poor demand and capacity planning Lack of monitoring and reevaluation of demand Lack of contingency plans

Current Trends

Patient

Consumer Driven Market

New Business Models

Quality

Tech Advance

s

Success Stories

Allina Medical Clinic (AMC) in 2 years

◦ Increased patient- physician match rate from 65% to 75%

◦ Increase in net gain in charges per patient visit from $8.45 to $11.80

Kaiser-Permanente Roseville, CA in 1 year

◦ Reduced wait time for appointments from 55 days to 1 day

◦ Improved appointment rate with PCP from 47% to 80%

The Mayo Clinic Primary Care

◦ Reduced wait time from 45 days to within 2 days

◦ Lowered total number of daily visits

The Alaska Native Medical Center

◦ Reduced wait time from 30 days to 1 day

◦ Improved appointments rate with PCP from 28% to 75%

Fairview Red Wing Clinic, Minnesota

◦ Reduced cycle time from 75min to 40min

◦ Increased time with physicians

Proposal

Strategy &

Assessment

Phase 2

Rollout Operations,

Support

Vision Clinic 3 Clinic 4 Clinic n

Monitoring,

Improvement,

Support

Feasibility Clinic 2 Clinic 1

Phase 1

Pilot

Q2 2011 Q4 2011 Q4 2012

Vision

•Open Access strategic initiative

Feasibility

•Proposal for governance and adoption •Analysis of capacity and demand • Work effort for process redesign • Technical solution proposal and estimates • Plan and cost for the pilot • High Level Plan and cost for the project • Site visits or calls • Total cost of ownership • Benchmarking

Pilot • Scheduling process • Measures • Technical solution

Review and

approval,

start Pilot

Review and

approval,

start Rollout

Review and

approval,

close Project

BOD review

and approval,

start

Feasibility

Benefits

Practices reduce or

eliminate delays in

patient care without

adding resources

Demand for

appointments

decreases

Patients see their

own physicians

more often •enhanced continuity of care

•better health care

•higher patient satisfaction

Medical practices

often realize cost and

efficiency savings •clinical time used efficiently

•reduced hours managing “no

shows” and backlogs

Measures

Appointment Availability

measure un-booked capacity

third next available appointment

Demand include patients who tried to access the system but were unsuccessful

Continuity number of appointments with PCP

Panel size balance provider panels for size and acuity

Productivity office efficiency

No-shows number of missed appointments

Cycle time elapsed time from patient‟s arrival to patient‟s departure

Satisfaction patient

staff

Best Practice Implementation Steps

Measure supply and demand

Identify a test team of early adopters Simplify

appointment types,

standardize

appointment lengths

Reduce backlog

Develop staff contingency plan (demand vs. physician availability)

Reduce demand for one-on-one visits

Measure appointment availability

Duration: ◦ three months

Resources: ◦ Internal

◦ Consultants

◦ Site visits

Cost: ◦ $100,000.00

Feasibility Study Requirements

Summary, Approvals

Endorsement

Review

Approval

•Open Access as a strategic initiative

•Proposal for “Open Access” plan

•Budget for the Feasibility Study

Questions

References

Murray M, Tantau,C. Exploding the Access Paradigm (FPM,September 2000: 45-50)

UD Department of Health & Human Services, AHRQ Agency for Healthcare Research and Quality, Open Access Scheduling for Routine and Urgent Appointments http://www.cahps.ahrq.gov/qiguide/content/interventions/OpenAccessScheduling.aspx

Murray M, Bodenheimer T, Rittenhouse D, et al. Improving timely access to primary care: case studies of the advanced access model. JAMA 2003;289(8): 1042-6.

Murray M and Tantau C. Must patients wait? Jt Comm J Qual Improv 1998;24(8): 423-5.

Murray M and Berwick DM Advanced access: reducing waiting and delays in primary care. JAMA 2003;289(8): 1035-40.

Commander‟s Guide to Access Success Appendix J 082807