BUSINESS CONSULT
MIRANDA MOONEYHAM
Senior Manager with ECG Management Consultants
Offering Advanced Access to
Cardiology Care
T
raditional ways of delivering care simply aren’t meeting the health needs and
expectations of the population. How
appointments are scheduled plays a big part, but
that’s changing. In the traditional paradigm, the
physician booked 6 months out is assumed to be
a top clinician. In the new paradigm, the inaccessible physician is increasingly losing patients to
available partners and/or external competitors.
Ultimately, patients want more readily
available care options, and provider groups are
responding. Initiatives for expanding access
range from extended hours of clinic operation to
the development of telehealth programs to the
increased use of advanced care practitioners.
That said, receiving care starts with getting an
appointment. Changing how clinic visits are
scheduled goes a long way toward providing
greater access to care. In this column, I highlight
one particularly effective scheduling solution—
the advanced access model.
TABLE 1
Traditional Scheduling
Multiple appointment types that unnecessarily vary
across providers, which compromise efficient scheduling
Limited number of visit and procedure types standardized within a
specialty.
Schedules filled weeks or months in advance
(backlog).
Templated slots available for new patients, with planned capacity for
urgent visit volumes.
Numerous scheduling rules to protect provider
preferences.
Limited scheduling rules to maximize utilization while supporting
patient preferences.
Laborious manual approval processes in place to approve urgent add-ons.
Defined contingency plan for accommodating new patient demand
that exceeds the number of available slots on a given day.
TABLE 2
Process Step
1
2
Advanced Access vs. Traditional
Scheduling
Finding slots or double-booking providers for
urgent appointments, dealing with no-shows, and
rescheduling requires heavy lifting on the part of
front office staff. Advanced access (or open access)
scheduling offers greater freedom and efficiency
by creating schedules based on providers’ historic
appointment patterns while making room for new
patients and same-day appointments. Though commonly used in primary care, this approach works
for specialty care practices as well. So, how specifically does advanced access compare to traditional
scheduling? (TABLE 1)
Advanced Access — Specialty Care
3
4
5
Key Actions
Analyze baseline
supply and demand,
based on groupings
of providers/practices
» Determine providers groupings based on subspecialty and location (given patient willingness
to travel to surrounding sites). New patients will be offered a visit with the first available
provider within that grouping
Develop a crossreferral strategy for
provider groupings
» Gather key stakeholders to develop provider groupings (by specialty, practice, and region)
Determine strategies
to ensure 2-day new
patient access
» Define new patient appointment volume required to meet new patient demand within each
grouping based on historical volumes
» Communicate to providers which practices are included in each region to promote cross-refer rals
» Ensure practice management systems facilitate cross-referral strategy and allow front-office
staff to schedule for all providers within each grouping
» Standardize provider-centric schedule restrictions and pre-visit testing requirements
» Freeze sufficient number of slots to accommodate new patient demand
» Ensure balanced provider availability by day of week
Train staff and communicate to referring
providers on the new
process
» Train staff early in the process to understand the changes that will be put into place
Update templates for
future go-live
» Hold appointment supply to meet anticipated demand (e.g. four slots per day per provider),
and release for return patients if not filled by a certain time
» Prior to go-live and throughout implementation, train staff on patient scripting to ensure
patients are supported throughout the change in scheduling model
» Update new patient visit types
» Implement control process for blocking of clinic schedules
An Advanced Access Example
I recently worked with a cardiology practice
transitioning from traditional to advanced access
scheduling. This practice included invasive and
noninvasive specialists, as well as electrophysiologists and vascular surgeons. There were two
primary goals of this effort:
1. Ensure 48 hour access for new patients
40 CardioSource WorldNews
2. Decrease provider-specific restrictions to
enable appointing across multiple providers/
practices (to provide the first available visit)
We accomplished the migration from traditional
scheduling to an advanced access through five major steps, each with its own set of actions. (TABLE 2)
Results
The results attained 6 months after the implementation of the advanced access model show demonstrable improvements. Specifically, the following have
been realized:
1. Decreased average patient wait time by 50%
August 2016