According to provisions of the Accountable Care Act, an expected 40–50 million previously uninsured patients will be gaining healthcare access during the next 10 years. As a result, savvy physician practices are preparing for the increased demand with a team approach to care delivery that is designed to cut down wait times and optimize physician face time.
The high demand for primary care doctors comes as no surprise to healthcare leaders. Ted Epperly, MD, president of the Leawood, KS-based American Academy of Family Physicians (AAFP), says the country will need to combat a "soaring backlog" of patient appointments by adding some 40,000 physicians over the next decade.
Wait times for an appointment to see a physician or specialist are already hitting record numbers, according to a survey by Merritt Hawkins & Associates. The survey, which includes responses from 1,162 medical offices in metropolitan areas, found the following average wait times by specialty in 2009:
Family Practice
- Longest time: 99.6 days
- Shortest time: 2.47 days
- Average time: 20.3 days
Cardiology
- Longest time: 104.4 days
- Shortest time: 3.4 days
- Average time: 22.1 days
Dermatology
- Longest time: 98.7 days
- Shortest time: 2.5 days
- Average time: 27.5 days
Orthopedic surgery
- Longest time: 59.9 days
- Shortest time: 2.9 days
- Average time: 16.8 days
"Specialty practices in the future will be asked to be much more coordinated and streamlined with whoever else is the primary care physician of the patient," says Roland Goertz, MD, AAFP's president. "The whole system, to be efficient, is going to have to change."
Goertz predicts the following four changes will take place to accommodate the patient influx:
- The adoption of modern tools such as electronic health records (EHR)
- Use of creative and innovative scheduling models
- Designing the hours of the practice to better accommodate patient need
- Focusing more attention on quality measurements such as patient demographics
For example, the Waco (TX) Family Practice Center has expanded its reach by implementing EHRs at 13 sites, says Goertz, who for the past 12 years has acted as CEO of the three foundations that oversee the clinic. EHRs are more efficient than paperwork in terms of communication and data processing, he says. If clinics can speed up communications, they can speed up care delivery.
Healthcare is an industry accustomed to steady growth. But under healthcare reform, the traditional model for care delivery will need to transform—and fast.
Although every patient wants to see his or her doctor face-to-face, many practices are now adopting a team approach to care using group clinics, patient education, and the support system of pharmacists, nurses, nutritionists, and specialists.
David Winters, MD, board chair of the HealthTexas Provider Network, which is composed of more than 470 physicians, admits that he is concerned about the expected onslaught of patients due to healthcare reform and meeting those demands. As a solution, nurses and physician assistants are being asked to step up and perform more procedures when doctors don't have time, he says.
"Those [practices] that do not use midlevels are going to have more of a problem expanding," says Winters. "As reimbursements go down, some physicians will adapt and some will retire early. We worry about wait times in Texas."
The average wait times to see a physician through the Dallas-based HealthTexas Provider Network is anywhere from six weeks to three months, says Winters.
Rod Christensen, MD, district medical director at Allina Medical Clinic, which has more than 45 locations in Minnesota and Wisconsin, is also advocating change in the healthcare delivery model. A pilot program at Allina suggests that increasing the number of clinical assistants will improve "quality access and productivity of physicians," says Christensen.
Shaking the status quo
Physician education plays a huge role in how healthcare will change in the next 10 years because changing the status quo is never easy for doctors who are set in their ways, Christensen says. Support and training classes for physicians and adopting new technology such as EHRs at clinics will help practices meet increased patient demand.
In addition, physicians will need to be increasingly flexible, perhaps adding more office hours or being open to pilot programs, Winters says.
Having physicians change their processes takes leadership. "We start with pilots and we have physician champions who go around and teach how to use new protocols," says Winters.
One of the new protocols Winters is advocating is the patient-centered medical home, which makes the physician responsible for the patient wherever he or she travels. In addition, the use of care coordinators is an ongoing initiative at HealthTexas Provider Network to help prepare facilities to become accountable care organizations.
Christensen stresses the importance of patient education to help reduce the number of unnecessary phone calls or visits as well. Support staff such as pharmacists, nurses, and nutritionists should provide patients with information on their condition and should be encouraged to answer patient questions.
Other solutions healthcare leaders recommend to prepare for the influx of patients include e-messaging, e-visits, and group clinics. "We don't think healthcare will be one size fits all—we think more patients need to be reached in more ways," says Christensen.
For example, group clinics can address multiple patient needs at a single time by a single provider. Diabetes patients often endure many of the same issues and can share experiences and questions through these group clinics, says Goertz. Using this method of care delivery, patients can still get physician face time, and the physician can cut down on repetitive appointments.
Cultural shift
Many established practices are already at capacity when it comes to accepting new patients. Thus, newly insured patients may have limited access to physicians or will need to turn to younger physicians.
As the primary care demand increases, Goertz expects younger, newly established doctors to answer the call—even though many are choosing areas other than primary care to practice. "I am an underlying believer in medical students and trainees responding to this cultural shift," he says.
HealthTexas Provider Network's goal is to expand with 30–40 new primary care physicians per year, says Winters, adding that it is finding there are fewer primary care doctors. The lure of a specialty practice with a narrowed variety of problems is appealing to new physicians, he says.
In addition, the new healthcare delivery model will focus more on communications technology.
High-speed Internet access and mobile devices enable doctors to look up facts without having to run down the hall to hit the books. EHRs also allow more patient-physician face time because less time is spent coordinating treatments, Goertz says.
Open-access scheduling is another tool physicians are considering to cut down on their wait times. If implemented correctly, this can be a powerful tool. Practices shouldn't be daunted by blank appointment spaces if they can be filled at the right rate during the day. The process involves monitoring the number of last-minute appointments within a clinic. If there appears to be a trend, setting aside extra time during the day can reduce patient wait times.
No patient wants to wait until their doctor is ready—they want their doctors ready and waiting for them.
See Also:
The Physician's Place in the ACO
Using the Web to curb waiting-room times
NP Back Pain Assessment Shortens Wait Time
3 Reasons to Market Your ED Wait Times
Anna Webster, Online Content Coordinator for HealthLeaders Media, can be reached at awebster@hcpro.com.