6.A.1. The Problem
6.A.1. The ProblemMost patients report that they always or usually received care as soon as they needed it, but some respondents to the Clinician & Group Survey report that they never or only sometimes got appointments for the care they needed as soon as they needed to be seen—even in urgent cases. Table 6.A-1 shows aggregated results from surveys fielded in 2016. Table 6.A-1. How often respondents got needed care: Percent answering never or sometimes
Source: CAHPS Database Online Reporting System. Comparative data from the 2016 Clinician & Group Survey Database. Accessed July 27, 2017. Studies have shown that inadequate access to a primary care provider remains a major source of patient dissatisfaction.1 One study cited in JAMA confirms that patients are not getting the care they need when they need it:2
Return to Contents 6.A.2. The InterventionOpen access—also known as advanced access and same-day scheduling—is a method of scheduling in which all patients can receive an appointment slot on the day they call, almost always with their personal physician. (Note: "Open access" sometimes refers to the elimination of gatekeepers in HMOs so that patients have direct access to specialists. In this context, it refers only to same-day appointments.) Rather than booking each physician's time weeks or even months in advance, this model leaves about half of the day open; the other third is booked only with clinically necessary follow-up visits and appointments for patients who chose not to come on the day they called (typically no more than 25% percent of patients). This model breaks away from the traditional approach of differentiating between urgent and routine appointments, which results in the routine visits being put off until a later date. Instead of triaging callers by clinical urgency, front-desk staff simply sort the demand for appointments by clinician. According to experts in the design and implementation of the model, it is effective in both managed care and fee-for-service environments.3 "It has one very simple yet challenging rule: Do today's work today." —Murray M, Tantau C. Same-day appointments: Exploding the access paradigm. Fam Pract Manag 2000;7(8):45-50. In essence, the open access model applies the principles of queuing theory and industrial engineering in an effort to match the demand for appointment visits with the supply (i.e., the time of clinicians). It is based on the supposition that the problem is not lack of capacity but an imbalance between supply and demand. Return to Contents 6.A.3. Benefits of This ModelWhile the open access model has not yet been formally evaluated with systematic controlled studies,4 anecdotal evidence points to several benefits of this approach:
Return to Contents 6.A.4. Implementation of This ModelThe literature on open access suggests that medical practices can implement this model in a few months by working through the following steps:
Return to Contents 6.A.5. Challenges of This ModelWhile the implementation of open access scheduling may seem daunting, the primary barriers are psychological rather than logistical. For both clinicians and their staff, this approach seems unintuitive; it defies both their beliefs and their experiences with scheduling systems. Because routine and urgent requests are treated similarly, the model also forces them to abandon the solidly ingrained notion that routine care can wait. Finally, clinical and administrative staff are typically skeptical that existing resources can meet demand.2 That said, the logistical challenges should not be discounted. First, the model requires accurate data on the size of the patient population (for each doctor), the level of demand for visits, and the number of appointment slots available each day. In particular, it relies on the ability to accurately predict demand for same-day appointments.6 But demand is hard to measure retrospectively because the number of past appointments is more a factor of the supply of clinical time than of the demand for services. Medical groups need to obtain this data prospectively, usually by tracking patients calls for appointments as well as requests by clinicians for follow-up appointments. Some practices rely on mathematical models for predicting demand, with mixed success. Computer-based information systems that integrate billing and scheduling can be useful for providing the initial data input for such models.6 The second major challenge is reducing the backlog of appointments. To do this, the group may need to see more patients each day for 6 to 8 weeks.7 A study of practices that had implemented open access scheduling found that all of them had trouble working down the backlog. Moreover, the task was especially difficult for larger organizations, especially when the model was introduced by management rather than by the physicians themselves. One contributing factor was that management recognized benefits in the form of reduced delays in appointment before the physicians saw benefits in the form of a less stressful workday.2 Finally, there are some practices where the demand for appointments vastly exceeds the supply of clinical services. While the open access model can handle excess demand on a given day, no scheduling system works effectively if demand is greater than capacity on a permanent basis. To overcome both the psychological and logistical barriers, medical groups may want to join a collaborative, where they can learn from others dealing with the same issues, or hire a consultant who can guide them through the more challenging terrain. Return to Contents 6.A.6. ExamplesIn the late 1990s, HealthPartners of Bloomington, Minnesota, identified members dissatisfaction with access to care as a major concern. CAHPS data indicated that access to appointments remained a source of frustration for patients; this finding was corroborated by complaints data (specifically, complaints related to access had been increasing over the past year and represented 51 percent of quality of care complaints) as well as a survey of satisfaction with behavioral health. In addition, an analysis of internal data found that appointment wait times had steadily increased over the course of the last several years. In 1999, several HealthPartners medical groups participated in "Action Groups" supported by the Institute for Clinical Systems Improvement (ICSI) in collaboration with IHI. Through the action groups, the teams learned about the Advanced Access model and received support in implementing it at some of the clinics within their medical groups. Initial assessments revealed little progress in improving patients’ experiences with appointment access, primarily because the clinics were struggling to overcome some of the challenges of this model—including the backlog reduction and the skepticism of clinical and other staff. However, over time, the clinics have made measurable progress, including a statistically significant increase in the percentage of respondents that were very satisfied with their ability to get an appointment at their clinic at a convenient time.8 Other examples of successful implementation of open access scheduling include the following:5
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Return to Contents References
Return to Contents What is another name for timeAlso called stream scheduling or fixed appointment scheduling. An appointment scheduling method in which each patient is given a different, specific appointment time. Also called fixed appointment scheduling, time-specified scheduling, or single booking.
What are 2 methods used to schedule patient appointments?Examples of common methods used for scheduling doctor appointments include time-specified scheduling, top of hour scheduling, wave scheduling, modified wave scheduling, integrated scheduling, double-booking scheduling, and clustering scheduling.
What are the different types of appointment scheduling?Here are 8 of the most common appointment booking types are:. Time-slot scheduling.. Wave scheduling.. Wave and walk-in appointment scheduling.. Open appointment scheduling.. Double scheduling.. Cluster scheduling.. Matrix scheduling.. 40/20 scheduling.. What is the most common type of scheduling in a medical office?The most common type of appointment scheduling in a medical office are: Open office hours – This type of scheduling involves no fixed or previous bookings and the office keeps itself open during the working hours. Patients are seen by the physician in the order of their arrival.
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