Advanced-access patient scheduling has been around for about a decade, but the concept is still catching on with physician groups skeptical of their ability to accommodate same-day appointments. Gregg Broffman, M.D., medical director of the 110-physician Lifetime Health Medical Group in Rochester and Buffalo, N.Y., says moving his group to same-day scheduling in the late 1990s took "some carrot and some stick." In fact, his personal physician was one of the most resistant until she saw colleagues becoming champions. "It was wonderful from my perspective as a patient not having to negotiate when and how to get in to see her," he says.Pointing out the realities of same-day scheduling, Broffman says, can help reduce physicians' various fears about change and may lure hold-outs off the fence:Fear 1: Insatiable demand.
Physicians worry that opening their schedule will leave them swamped with work, but this is a false expectation, Broffman says. By carefully measuring and predicting supply and demand, advanced access ensures adequate coverage and can help determine the need to hire new clinicians to handle the workload. Fear 2: Fewer encounters.
Use of same-day scheduling has shown to decrease the number of annual encounters with individual patients. At the same time, it boosts the likelihood that patients will see their personal physician, rather than be worked in with the first available clinician. As a result, patients are more satisfied with their visits. Clinical outcomes rise while costs decrease, because a person's regular practitioner is less likely to order unnecessary tests or prescribe medication than a clinician who is unfamiliar with the patient's history, Broffman says. Fear 3: Lower revenue.
Decreased volume would suggest a dip in practice revenue, but the opposite has proven true. Early adopters that saw a 10 percent to 15 percent drop in encounters had about an 8 percent increase in "relative value unit," which is used to measure the robustness (read: "dollar value") of an office visit, says Catherine Tantau, B.S.N., co-creator of the advanced-access model and president of Tantau & Associates, a consultancy in Chicago Park, Calif. Broffman recommends teaching doctors the value of "max packing." When a diabetic patient makes an unplanned visit, for example, physicians can look ahead to his next scheduled appointment and "max pack" the initial visit by performing the future check-up that day. "The visit can code at a higher level, and I have an appointment open in two weeks to see a new patient possibly," he says. -Kara Olsen