See More Patients Sooner Without Working Longer Hours

Kenneth J. Terry, MA


February 06, 2013

Mrs. Smith, You Could Come in This Afternoon

Imagine a scheduling system in which people can get an appointment on the day they call or walk in, regardless of what their complaint is. Known as open-access, advanced-access, or same-day scheduling, this is a radical approach in 2 ways: First, it is totally patient-centered in that it gives up control over the clinician's schedule to the patient; second, it doesn't distinguish between urgent and nonurgent appointments. Its guiding principle, as open-access originators Mark Murray and Catherine Tantau pointed out a decade ago,[1] is to "do today's work today."

A major thrust of the patient-centered medical home, for example, is open-access scheduling, which allows patients to be seen on the same day they request an appointment. Patient-centeredness, including patient engagement and improved access to care, is a focal point of the new value-based healthcare delivery models.

Yet, most practices that call themselves a patient-centered medical home don't have full open-access scheduling, Bagley observes. "I think they're working toward it or are doing enhanced carve-out scheduling," he says, referring to an approach that reserves some time slots for same-day appointments and walk-ins.

For example, Mullins's 3-doctor practice has achieved recognition as a level-3 patient-centered medical home from the National Committee on Quality Assurance (NCQA). But she says the practice uses a hybrid of open access and other kinds of scheduling "to help our patients have the best access they can have."

John Bender, MD, the leader of a 15-provider primary care practice in Fort Collins, Colorado, says that 5 of the group's 8 physicians are using open-access scheduling. (The other doctors are part time or semiretired.) It took 5 years for the NCQA-recognized level-3 medical home to reach this point after going through a series of changes in its scheduling approach, Bender notes.