A Pennsylvania health system has scheduled 145,000 same-day appointments in this year’s debut of the offering, and they now make up 15% of its primary care visits.
Patients want same-day appointments. Providers resist because they replace filled appointments with open blocks. But to drive patient volume, same-day appointments work. Allegheny Health Network drove primary care volume at least 5% in a single year behind a strategy of same day appointments.
Following months of preparation, Allegheny Health Network started offering same-day appointments in January for more than 150 primary care physicians and 20 specialties including surgical practices. Since the initiative was launched, AHN has scheduled 145,000 of them.
Patients can request a same-day appointment if they call before 11 a.m.
The program gives AHN a competitive advantage and supports quality clinical care, says Kenyokee Crowell, AHN's senior vice president of clinical access.
"If you call for a same-day appointment and are a primary care patient of AHN, even if you do not see your [usual] provider, you will see a colleague of the provider who will have access to your medical records, your medical history, and your medication."
She says patient satisfaction has been high among patients booking same-day appointments, with primary care patients posting 96% satisfaction and specialty patients posting 92% satisfaction.
AHN, with eight hospitals in western Pennsylvania, is a subsidiary of Pittsburgh-based Highmark Health, with $18.2 billion in 2016 operating revenue.
Currently, Crowell says about 15% of AHN's primary care appointments are same-day and 2% to 3% of specialty appointments are same-day. She says same-day appointments are largely responsible for an increase in AHN's patient volume this year, with new patient volume up 7% and existing patient volume up 5%.
"The increase started exactly when the same-day appointments rolled out for the organization, so we feel the same-day appointments have contributed to that increase., she says.
Planning, Executing and Tweaking
Pre-launch planning was a primary key to success for the initiative, Crowell says. "We started a process of analyzing historical data in July of last year in advance of our go-live in January."
During the planning phase, she says health system officials focused data analysis on primary care because those practices had historically received the highest volume of requests for same-day appointments.
"We looked at that primary care data, we looked at Epic, and we met with each of our physicians and administrators for the different service lines to try to put together an algorithm. … It was not a cookie-cutter approach. The algorithm tended to be a little bit different depending on the specialty and, in some cases, by market."
AHN assured physicians that their appointment inventories would be handled with care, with the needs of individual physicians taken into consideration, Crowell says.
"For newer physicians in our organization, they may have plenty of availability; but for our busy providers, we had to think carefully about what the need for same-day appointments was, because we wanted to make sure we had adequate access to provide the service."
Including practices in the planning process was critically important, she says.
"That's where the magic came into play. This was not a spreadsheet exercise—the analytics are great and the numbers are great, but they only tell a portion of the story. You need to talk with the people who know their business best, which are our physicians."
She cites the example of a physician with a special clinic one day a week. If six same-day slots were needed per day at the practice, most days it made sense to deploy those slots equally among the practice's providers. However, on the clinic day when the doctor was seeing certain types of patients, fitting in his share of same-day slots did not make sense.
Tailored to Patient Behavior
Implementing same-day appointments involved technical elements and setting appointment inventory to fit patient behavior, she says.
"Once we had an idea of what we thought the need would be, we needed to take an inventory of appointment slots off-line, so they would be available for same-day appointments in the future. We worked with our IT department to create an appointment type in our Epic medical record system."
AHN's centralized scheduling center was tasked with setting most same-day appointments. For patients who call requesting a same-day appointment but have a potentially pressing clinical need, the appointment is often scheduled at a local practice.
Understanding patient behavior at the practice level was essential, Crowell says. "The inventory did vary by specialty, by geographic locations, and, sometimes, by day of the week. Anywhere from 25% to 40% of our same-day appointments for an entire week are booked on Mondays, which are by far the highest volume days for same-day appointment requests."
Spreading the Word
When AHN launched same-day appointments, the health system promoted the initiative with a "multi-channel marketing campaign," Crowell says. The effort included television, radio, print and online advertising, public transportation ads such as bus-wraps and notepads and stickers in physician offices.
After the initiative was launched, the appointment inventory at many practices required adjustment throughout the year, she says.
"The biggest lesson that we learned is that this is not a program that you can research, develop, launch and put it on the shelf. It is a very active process to continue to tweak it."
With same-day appointments usually driven by convenience rather than clinical need, the initiative reflects a patient-centered approach to care, Crowell says.
Same-day appointments also exemplify a business imperative for a consumer-oriented approach to medical care, she says.
"Healthcare needs to get its act together. If there was any other industry where you had to wait days or weeks for a service, you would probably go someplace else."
Christopher Cheney is the senior clinical care editor at HealthLeaders.