How Can You Think Creatively to Meet Patient Demand and Improve Access?

A Good Problem to Have

By Cliff Megerian, MD, FACS
President, UH Physician Network and System Institutes

UH Clinical Update | November 2019

One of the keys to University Hospitals’ future success is that we’re perceived as the most frictionless organization at which to access healthcare. So continuing this year and next, we will be spending a lot of time and effort having our physicians and administrators work together to meet the needs of people in our local community who want to receive care from UH physicians.

Here are some eye-opening numbers. In the beginning of 2018, our call center – also known as central scheduling – received between 75,000 and 80,000 phone calls each month. The calls are predominately from new patients seeking appointments. 

In less than two years, that number has grown to an average of 115,000 people calling each month.

With the addition of new methods by which patients can request access, such as online scheduling and other digital options, that number is still growing week to week. This is a reflection of the esteem in which our patients hold our physicians and our hospital system. We can be very proud of that.

But with every privilege - and this is a privilege - comes significant responsibility. We as a group of physicians and care providers need to work together to manage this, by quickly seeing patients so that they will continue to turn to us.

Managing this challenge is imperative. In the future, and already today, the success of a healthcare organization will no longer be measured just by the numbers of heads in hospital beds, or surgeries performed each day. Instead, we’ll be measured by the total number of lives attached to our organization.  So we want to encourage people in our community to continually choose UH for their healthcare.

How will we do this? We’ve already started. For example, we have improved our ability to schedule patients through new tools such as Schedule Me Now (SMN), which are being deployed in physician offices. Patients can also now schedule their own appointments online.

We and our fantastic group of primary care providers have also made a commitment, by doubling down on the practice of scheduling patients before they leave their office. It might be for a referral, a future visit or imaging, for example. By immediately closing the loop between the completed appointment and the next one – which might be with a specialist – we will decrease the number of calls coming through central scheduling. That means our agents will be able to spend more time with new patients seeking appointments at UH.

We also are working very hard to increase the availability of appointment slots, using a number of strategies. Some departments, such as psychiatry and orthopedics, have created walk-in clinics at specific sites throughout the region. This allows same-day access for patients who need to be seen. It lowers their wait time and opens up spots for others. Some departments also are using fellows and nurse practitioners to allow for same-day or next-day access.

Other departments are considering something that is often overlooked: no-show rates.

Nationally, these vary from 6 to 20 percent, depending on the city, the specialty and the local population’s access to transportation. We are not immune - our no-show rates vary from 7 to 13 percent, depending on the specialty and the practice site. Think about it this way: a no-show is, in essence, like an unfilled airplane seat on a plane that is flying, regardless, to its destination.

I have addressed this in my own practice. Two weeks ago, I was in my Minoff clinic in the afternoon and I had 20 patients scheduled. I routinely have a 10 percent no-show rate and indeed, that day, two of my 20 patients were absent. So now, working with administrators in my department as well as through the system, we are adding slots, using the demonstrated no-show rate.

When I go to my clinic and expect to see 20 patients, I am prepared to see 20 - whether they are the 20 that were scheduled or 18 of them, plus two more that were added in the morning because two cancelled. My practice and team are ready to see the 20, and I planned all along to see the 20. So I’m simply making the most efficient use of my time and the best use of our patient’s time.  This might work well in many other practices.

The bottom line is, there are ways like this where we can address issues with access. We know that patients face delays in access because we hear from them. We can and must improve this. Statistics show that patients who have an appointment within a week are most likely to keep it; those who get an appointment that is two weeks away, or longer, often do not.

I hope that our work in this area, and other methods that we may not have yet considered, allows us to expand our bandwidth, expanding the reach and the impact that our physicians have.

Just a few short years ago, UH as a whole took care of 700,000 individual lives per year; now we take care of nearly 1.3 million per year. This is because of the increase in the size of our footprint, as well as the fact that the cost of care at UH is lower than our competitors, while our quality is very high.

That’s why large payers and employers turn to us to manage their patients and their employees.

We must make access one of our principal goals of excellence. Accommodating the demand by current and future patients will allow us to promote the continued growth of UH, and our own practices.