Tuesday, November 5, 2013
A person gets sick, calls the doctor and schedules an appointment for later that day. A simple enough concept, but one that hasn't often been utilized in health care. Until recently.
Several local medical practices have implemented or are moving toward implementing open-access appointment systems that allow patients to be seen the same or next day. It's part of their effort to be certified as "patient-centered medical homes," which is becoming a standard in primary care as a way to improve outcomes and lower costs.
Patients at Health Care Access used to line up outside the Lawrence safety-net clinic early in the morning to try be seen. While they still do from time to time, it happens less frequently after the clinic instituted open-access scheduling earlier this year. The clinic previously allowed walk-in appointments, but those patients often would have to sit in the waiting room for hours, if they even got in with a doctor at all. Now they can call ahead and schedule a set time for later in the day.
Advocates say this system simplifies the job of front-desk staffs, who are no longer burdened with determining how sick each patient is and who needs to see a doctor the quickest.
"Before, all our appointments were scheduled full and patients had to wait until we had a cancellation," said Kathryn Franklin, a receptionist at Health Care Access. "This is much more efficient."
It's essentially a change from doing what's most convenient for the practice to what's best for the patient, noted Shelly Wakeman, executive director for Health Care Access.
"We're shifting the way patients think. We can get them in on the same day but we like them to call ahead of time," said Kim Scarbrough, communication and policy manager for Health Care Access.
The clinic now leaves every other appointment open, or a total of eight a day. Health Care Access had an open access no-show rate of 18 percent in September and 8.6 percent in October. Both are lower than the typical no-show rate for such a facility.
Lawrence Memorial Hospital's family practice clinics have been offering same-day scheduling for the past couple of years. Physicians leave open a set amount of appointments each day for patients with acute illnesses. It's been beneficial to patients and doctors alike, said Barb Karr, director of family practices for Lawrence Memorial Hospital.
"It's a patient satisfier. And if someone gets sick the night before and calls that morning, physicians want to be able to get those patients in quickly," said Karr, who oversees Total Family Care and Mt. Oread Family Practice in Lawrence, Eudora Family Care, Family Medicine of Baldwin City, Family Medicine of Tonganoxie and McLouth Medical Clinic. "We have routinely seen in our past that when someone's sick and makes an appointment for the next day or more than 24 hours in the future, they tend to get sicker and will probably go to the emergency room or somewhere else, and then we'll have a no-show."
Heartland Community Health Center is in the process of instituting a same-or-next-day appointment system, which the Lawrence clinic hopes to have online by Dec. 1.
At Heartland, patients who call in the morning will be seen later that day. If they ring in the afternoon, they will be scheduled for the following day. The system will also have a feature to notify chronic disease patients when they are due for a checkup.
Doctors have traditionally booked their schedules to account for no-show rates of anywhere from 20 percent to 50 percent, said Heartland Medical Director Dan Purdom.
"There's always the fear that if everyone shows up, then we'll drown. But physicians have generally taken great comfort in having a full schedule for the next two weeks," he said. "Now If it's Monday and we're talking about Wednesday, probably Wednesday's schedule doesn't have anything on it yet. That's the part that physicians find frightening."