See More Patients Sooner Without Working Longer Hours

Kenneth J. Terry, MA


February 06, 2013

Won't I Be Swamped With Patients?

The advantages of open access include lower no-show rates, increased patient satisfaction, and less work for staff in managing the schedule. Appointments don't go away in open access: About a quarter of patients prefer to come in later than the day they call in, and there are also some follow-up appointments, so only about two thirds of schedules are open at the start of each day. But if open access is done properly, the wait time for appointments should drop to no more than a day.

In addition, because individual clinicians are not fully booked in advance, patients are more likely to see their regular physician when they visit the office, Bagley notes. That not only pleases patients but is also good for the continuity of care.

So why do so few practices use this approach? One reason is that doctors are either afraid that they'll be overwhelmed by patient demand or end up with time on their hands -- or both. But neither of these fears is warranted, experts say. "Basically, you're doing the same amount of work, but without the backlog," says Bagley.

In fact, the amount of patient demand for a doctor with a panel of a given size is fairly predictable. Consequently, a practice need not expand its hours to provide open access. Although demand does go up and down from one day to the next, "you have to deal with that anyway," Bagley points out. "The average workflow is the same, so why are you doing last week's work today instead of doing today's work today?"

However, it's not so easy to switch to open-access scheduling. For one thing, practices can't go straight there from traditional or carve-out scheduling; first, they must work down their backlog of appointments, usually by working harder every day for several weeks.

Bender, a family physician, provides some insight into how difficult it can be to achieve open access. Back in 2007, when his practice started its medical home, he and his colleagues recognized that scheduling was the key to patient access. They started a walk-in clinic during their evening and Saturday hours and booked no appointments for those blocks of time.

That didn't work for everyone because some folks needed to be seen during regular hours. So the practice gave its nurses some triage protocols, allowing them to see people with minor acute problems in a "retail clinic." But that didn't address people who had more serious complaints -- an issue the practice sought to resolve by opening up the schedules of its nurse practitioners.

Finally, the practice switched to carve-out scheduling for its doctors. Up to then, Bender recalls, the physicians had resisted this approach because they were afraid that not all of the open slots would be filled and that their incomes would drop as a result. However, that didn't happen, and about 6 months ago, the majority of doctors progressed to same-day scheduling. Bender, who uses open access himself, views it as a competitive advantage over his peers who are booked out for 3 weeks and tell patients with urgent needs to go to the emergency department.

"This is market-driven economics," says Bender, who is the incoming president of the Colorado Medical Association. "Patients want this, consumers want it, and we're offering it."