- Research shows high-performing enterprises focus on patient access.
- Same-day access builds patient trust and loyalty.
- Practice-based walk-in clinics can aid continuity of care.
When it came to patient access, leaders of Annapolis Internal Medicine thought they were satisfying demand. After all, they held 30 appointments open every day for same-day visits.
But when they audited their data for federal quality measures in 2006 — tracking requests for appointments against available slots — they discovered a disturbing fact. Those 30 appointments were all filled by 9 a.m. Patients who called any later were out of luck.
Where were they going instead?
“We realized that patients who could not be scheduled must be going to retail clinics,” recalls practice manager Yvette Perry. “But they’re our patients. Why are we not able to accommodate all these people?”
So the primary care group took swift action and opened a walk-in clinic of its own, downstairs from the main clinic.
Ensuring rapid access
It was a characteristic move from a high performer. In an ongoing project, athenahealth researchers are examining key financial and operational metrics from across a national network of 99,000 providers and have identified the top 10 percent of performers. Annapolis Internal Medicine is one of them: A busy primary care group, serving more than 20,000 patients, that deliberately studies its data and focuses intensely on the total patient experience.
Opening a clinic was a bold response to an access problem faced by healthcare organizations large and small. Access tops patients’ wish lists across the care continuum. A recent study from the Commonwealth Foundation found that 73 percent of Americans say it is difficult to make doctors’ appointments when they want them, or to receive care after hours without going to an emergency room. Retail clinics, numbering 2000 by 2016 and accounting for six million visits a year, are increasingly filling the void.
“Given a rise in high-deductible health plans, people are looking for lower cost options than the ER or their doctor’s office,” says Ateev Mehrotra, M.D., associate professor of healthcare policy and medicine at Harvard Medical School. “And many other options are emerging — telemedicine, retail clinics, e-visits — saying ‘we can be both more convenient and lower cost.’”
In Annapolis, Perry understood the potential toll on patient loyalty — and revenues.
“Saying ‘We can’t help you today. We can help you tomorrow’ means you probably will never see them,” Perry says. “You’ve probably lost that business. Maybe you lose the relationship.”
Once they realized they had an access problem, Perry her colleagues did their homework, documenting every call from every patient for two weeks to see how many appointments they couldn’t schedule beyond 30 slots per day. They found that each day, 30 to 40 patients were going without care or seeking it elsewhere.
And they determined that adding another nurse practitioner wouldn’t cover the gap, Perry says. “There was just too high of a demand and, no matter what, we wanted to be accessible for our patients.”
The Annapolis Internal Medicine Walk-In Clinic opened within months, staffed by four nurse practitioners, including a diabetes educator. Open Monday through Friday from 7 a.m. to 6 p.m. and on Saturdays from 8 a.m. to 2 p.m., it serves only established patients.
“Their full medical record is already there,” notes Perry. “They don’t have to fill out new paperwork or go to a doctor that they’ve never seen before.”
Now, 60 to 80 patients showed up for care each day, about a quarter of the medical group’s overall daily patient volume.
“The walk-in clinic is an extension of our main office,” says Perry, “an area where our patients can come in, not have to make an appointment — just have us accessible when they are not feeling well. And they love it.”
The physicians love it, too. Kevin Groszkowski, M.D., a physician partner, says the clinic allows him to be present for all his patients. Even when his schedule is full and he’s seeing patients in the main office, nurse practitioners downstairs in the walk-in clinic can consult with him in real time, as needed.
“The patient actually sees the collaboration between the nurse practitioner and the physician working together to make sure they are receiving the best care possible,” Groszkowski says, “even though we’re working in different locations.”
A resource to improve staff performance
Separate same-day care also means the staff in the main office doesn’t need to manage concurrent workflows for scheduled and walk-in patients. Phone traffic is reduced as the front desk no longer takes calls for same-day appointments.
“Our receptionists can register patients without doing eligibility checks or last-minute paperwork,” Perry says.
Now, Annapolis Internal Medicine is looking at expanding the clinic’s offerings to include pre-op visits, wellness visits, women’s health, and travel consults. They’ve also created an onsite lab and radiology suite.
“The overall setup of our office makes it much easier for the patient, much easier for us,” Perry says, “and we stay really productive.”