Open-access model improves care, pleases patients, and increases revenues

[Guest guest]

Oct 29, 2002

Open-access model improves care, pleases patients, and increases revenues

New Orleans, LA - Rheumatology practices are notorious for long waiting

periods before patients can obtain appointments. Restructuring the practice

around an open-access model can be done in a real-world setting and can

improve access to care, patient satisfaction, and the financial performance

of the practice, according to Dr D Newman (Geisinger Medical Center,

Danville, PA). Doing so has cut the time to a third available appointment in

the daily clinic schedule from 60 days to below 2 days and reduced the

appointment cancellation rate from 40% to less than 15%. Patient mix has

also shifted as outside physicians become more willing to refer patients,

and the proportion of patients whose insurance pays for 70% or more of

charges has increased from 57% to 64%.

Newman's department includes 4 rheumatologists and numerous other fellows,

residents, and clinical and administrative staff. " We see about 11 000

patients per year, " he said in a plenary presentation to the 2002 American

College of Rheumatology meeting. We retooled the process of patient care

based on the ideology of the idealized clinical office practice (IdCOP). "

The transformation included 4 steps: reserving " open-access " hours for

patients to be seen within 72 hours; eliminating the " bad backlog " of

patients who should have been seen already and increasing the " good backlog "

of patients to be seen in the future; developing a return appointment system

centered on the patient's needs; and developing a protocol for use by

primary care physicians treating knee osteoarthritis (OA), with the goal of

shifting more of the initial care to the primary care setting.

" Open access means that we keep open a predetermined number of access slots

for 'same-day' patients. Keep these slots open until 72 hours in advance,

and do not allow them to be scheduled before that 72-hour point, " Newman

said.

Patients who need return appointments within 3 months or less are given an

appointment time before they leave the clinic. Patients who need return

appointments more than 3 months away are given a card that instructs them to

call at the time their appointment is due to schedule an appointment. If

they do not call, a reminder in the clinic system triggers a follow-up call

from clinic staff.

Development of the knee protocol for primary care physicians came about

because the rheumatologists were faced with an increasing number of patients

with knee OA. " We were seeing lots of knee patients for whom little had been

tried, " Newman said. " At first this was due to patient interest in

hyaluronic acid, but it continued beyond that. "

The protocol includes an overview of current OA treatment, with web links

for additional information, and a " smart set " of check-off boxes that

include such things as medications, education, nutrition, and assistive

devices. " If a rheumatology consult is placed for knee OA, the primary care

physician is guided through steps to take before referral. This has reduced

our number of new, untreated knee OA referrals by 6.7% despite a 49.8%

increase in our total new referrals, " Newman said. That helped free up

schedule time for more appropriate patients, and this soon became known in

the physician community. " Outside physicians who had not been referring

patients to us due to our long waiting time for appointments began referring

us, so our patient mix has shifted, and this has improved our payer mix, "

Newman said.

Patient satisfaction also improved significantly, as did financial

performance of the practice.

Janis

Cited source

Newman ED et al. " The rheumatologist can see you today " : successful

implementation of an open access model in rheumatology practice. American

College of Rheumatology [abstract 961]. 2002. Available at:

http://www.rheumatology.org.