Open Access



There is a great article in Slate.com about "open access," which is a scheduling method that allows practices to see patients on the same day. We have been using this system where I work for a few years now, and I can tell you it works.



When I first started here, our patients had a standard wait time of roughly three weeks before they could see their primary care physician. Then I came across research that showed it was possible to minimize waiting times and do the work as it comes, and not plan for it in the future, which only frustrates the patient and causes extra work maintaining a backlog of appointments. It also reduces no-shows significantly, since a patient is far more likely to come in on the same day they call.

Mind you, it took a lot of overtime at first, and it was a solid two months before we were able to whittle the appointment book down to a managable size. We now schedule about 30% of our patients in advance, and leave the rest of the slots open for people who call that day. For us, Thursday has proven to be a particularly busy time, so we stay open later.

Here's a handy reference for anyone wishing to implement open access:

1. Move toward advanced access by working down your backlog of appointments.



2. Roll out the new system by showing, not telling, patients how it works. When we try to explain our systems, we often make them overly complicated.



3. Begin offering every patient an appointment on the day they call your office, regardless of the reason for the visit.



4. If patients do not want to be seen on the day they call, schedule an appointment of their choosing. Do not tell them to call back on the day they want to be seen.



5. Allow physicians to pre-schedule patients when it is clinically necessary ("good backlog").



6. Reduce the complexity of your scheduling system to just three kinds of appointments (personal, team and unestablished) and one standard length of time.



7. Make sure each physician has a panel size that is manageable, based on his or her scope of practice, patient mix and time spent in the office.



8. Develop plans for how your practice will handle times of extreme demand or physician absence.



9. Encourage efficiency and continuity by protecting physicians' schedules from their colleagues' overflow.



10. Reduce future demand by maximizing today's visit.

At first, some of our doctors were very skeptical about this approach. The backlogged schedule is a classic sign of success in a medical practice--proof that you are thriving. Unfortunately, it is not beneficial to the patients, and it creates a static sense of bureacracy.

This new approach actually bonded the doctors and staff, giving them a renewed sense of purpose. It also streamlined our practice, since it forced our doctors to really analyze how and when certain patients should be scheduled for return visits.

As an added bonus, word of mouth was fantastic, and we wound up with an increase in patients (every customer survey we have done nets us high marks). Personally, I enjoy the freedom of spending each day doing work that is current and in the moment. To quote the motto of one of the doctors who developed the system, we "do all of today's work today."

Does your practice use the "open access" system? If so, how is it working? If not, what do you think of it? I'd love to hear your input!