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CITY AVERAGE NUMBER OF DAYS WAIT FOR APPOINTMENTS (2009) CARDIOLOGY DERMATOLOGY OB/GYN

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Reduce Patient Wait Times Before it’s TOO LATE!

ABSTRACT

Patient wait times are a strong predictor of overall satisfaction, and central to the Care

Experience component of the Triple Aim initiative associated with the Affordable Care Act. Yet millions of Americans say the waits are too long – both for appointments and once they’re in the practice – and they’re complaining about it. With 30 million more patients about to flood the healthcare marketplace, it’s time for large and small practices to refine their systems for patient access and patient flow. This paper summarizes what you can do to “give the lady what she wants.”

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The quote noted above was by Marshall Field, Chicago mercantile entrepreneur, as he built the country’s first retailing empire. He was speaking to his employees, at the same time that Henry Ford was declaiming that “you can have any color you want, as long as it’s black.”

The rise of consumerism has proven Field correct and Ford wrong. With medical quality an assumed “given,” people today gravitate toward service providers who know what patients want and align their practice patterns and work processes to deliver caring service along with the very best medical care.

Patient access

A quick look at a 2009 study of 1,162 medical offices by Merritt Hawkins shows that, in some cities, average lead times for Family Practice physicians appointments vary from a high of 63 days (Boston) to a low of seven days (Miami). For specialists, the waits are much longer. Here’s a recent comparison of five selected specialties, from longest to shortest lead times (1)

:

CITY AVERAGE NUMBER OF DAYS WAIT FOR APPOINTMENTS (2009)

CARDIOLOGY DERMATOLOGY OB/GYN ORTHOPEDIC SURGERY FAMILY PRACTICE Atlanta 5 15 17 10 9 Boston 21 54 70 40 63 Dallas 8 18 17 45 8 Denver 12 40 15 15 14 Detroit 7.5 12 15 11 14 Houston 11 31 41 17 17 Los Angeles 11 13 26 12 59 Miami 29 12 22 7 7

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2 Minneapolis 47 17 5 20 10 New York 14 11 13 15 24 Philadelphia 11 47 46 22 9 Portland 11 25 19 9 8 San Diego 22 10 35 10 24 Seattle 8 11 39 5 8 Washington DC 18 16 33 16 30

Merritt Hawkins, Average Wait Times by Metropolitan Area(2)

Patient access and scheduling

Patient complaints about scheduling aren’t new, but physicians willing to apply new thinking to this old problem have made significant improvement in the patient experience. In 2012,

Children’s Hospital at Montefiore (NY) reduced wait time for appointments by more than 80%!

Researchers analyzed three years of appointment and operations data, and practice consultants reviewed every step of the scheduling process. “We learned that, although each of our doctors had an allotment of new-patient appointments, those slots were being used for follow-on visits,” according to Rubina Heptulla, MD, lead study author. To break the bottleneck, doctors were persuaded to use the new-patient slots for first time patients only.

“By making practical changes to scheduling and managing patient workflow, we were able to reduce the average wait for a new-patient appointment from eleven to two weeks, even with a complex patient population,” Dr. Heptulla added. By conducting monthly meetings with the Medical Director, there was a significant improvement and an overall increase in new-patient visits. There was also a reduction in the lead time for follow-up appointments, from eight to two weeks.(3)

In your practice

First, examine the performance of your schedulers, and make sure that callers are greeted in a lively and welcoming manner: “Thank you for calling ABC Medical Group, this is Tina, how may I help you?”

When patients ask for appointments with a very busy doctor say, “Thank you, Ms. Blanchard…I’ll do my best.”

If the patient’s preference for an appointment within three days can’t be met, your scheduler needs to sound as disappointed as the patient: “I’m sorry, Ms. Blanchard, Doctor Sutureself’s first opening is Tuesday next week…would that work for you?” If the patient says no, another apology is in order followed by, “I can put your name on our cancellation list and let you know if

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a sooner appointment time comes available.” Further, before ending the call, the scheduler can offer an appointment with another more open provider. “Or, Ms. Blanchard, I see that Dr. Patel has an open slot tomorrow at 2 PM. She’s a great doctor. I know you’ll like her. Would you like me to book that appointment for you?”

Wait times in the practice

According to a recent nationwide poll by Angie’s List, 65% of respondents said they’ve waited more than an hour to see their care provider…37% said that, when they’ve waited a long time to see a doctor, they’re less inclined to ask questions during the physician encounter…nearly 70 percent were not informed that their doctor was running late…and 55% reported that they did not receive an apology.(4)

More formal studies have confirmed the reports of Angie’s correspondents. In a 2012 study of 870,000 medical offices, Vitals.com found that – despite physicians’ efforts to keep to the schedule – average wait times nationwide actually increased by one minute compared with its 2011 data.

“As the supply of qualified doctors remains unchanged, and the new health care law requires that 30 million more Americans have health insurance, this flood of new demand will cause major disruptions to the system,” says Vitals CEO Mitch Rothschild.(5)

Vitals’ 2012 study showed that, if you’re lucky enough to live in Alaska, you can expect the shortest wait to see the doctor – 16 minutes, 28 seconds. Here’s a list of the top and bottom states as measured by length of waiting time once patients have checked in for their visit.

TOP FIVE STATES (SHORTEST WAIT TIMES)

Alaska 16 minutes, 28 seconds

Wisconsin 16 minutes, 29 seconds Minnesota 17 minutes, 8 seconds New Hampshire 17 minutes, 10 seconds North Dakota 17 minutes, 43 seconds

BOTTOM FIVE STATES (LONGEST WAIT TIMES)

Mississippi 24 minutes, 25 seconds Alabama 24 minutes, 3 seconds Arkansas 23 minutes, 40 seconds Louisiana 23 minutes, 3 seconds

Nevada 23 minutes, 2 seconds

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“Twenty minutes is the magic number for patient waiting time,” says Derek Preece of BSM Consulting. “After 20 minutes, patients begin to think their time is being wasted.”(7)

Here’s why it’s important. A 2007 study by BioMed Central showed that, of all variables considered, time spent by doctors with their patients was the strongest predictor of patient satisfaction – and what’s more, patients who felt that their doctor had spent “enough” time with them were less likely to be critical of long wait times. As the study concludes, “time spent with physician is a stronger predictor of patient satisfaction than is the time spent in the waiting room.”(8)

The message for doctors who are rushing through the daily schedule (i.e., seeing more patients and spending less time with each) is that patient dissatisfaction will accelerate as more

consumers enroll in health exchanges and other plans, thus flooding the marketplace.

What you can do

First, ensure that your providers are worth the wait! Talk with them about what’s behind responses to the survey question “Did your provider spend enough time with you?” Let them know that those survey scores have less to do with the number of minutes than with the quality of minutes spent. Skills for appearing to be listening carefully to what patients are

saying…answering questions in understandable ways…good eye contact and other techniques for demonstrating positive body language…motivational interviewing to increase compliance by making patients feel like partners in the care plan – those are the skills high-scoring physicians use to create satisfied and loyal patients who say good things about your practice to their friends and family members.

Most important, help your providers show that they respect the patient’s time. Tell them, before entering the exam room, to compare the scheduled appointment time with their wristwatch and, if the difference exceeds 20 minutes, begin the encounter with an apology, and a thank you for waiting.

And what about staff members? Receptionists, medical assistants and nurses are equally capable of knowing how long patients have been waiting. They can raise satisfaction levels by letting patients know how long the wait is going to be and keeping patients apprised of their status. It’s particularly important to keep patients who may fear that they’ve been forgotten posted

regarding the providers progress.

“One of the best experiences I’ve had waiting for a doctor is when the receptionist told me that they were running behind, and suggested that I spend the 30-45 minutes grabbing a quick lunch.

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Having an idea of how long the wait might be gave ME control of how I wanted to spend my time.”(9)

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(1) Merritt Hawkins, “Average Wait Times by Metropolitan Area,” 2009 (2) ibid.

(3) Children’s Hospital at Montefiore, press release, January 22, 2013

(4) “Do you play the waiting game at the doctor’s office,” WFMY News interview, August 10, 2013

(5) Vitals.com blog, March 8, 2013 (6) Vitals.com & MDx Medical Inc., 2013

(7) “20 minutes is the magic number…,” Medical Economics, April 2013 (8) Anderson, et al., BioMed Central Ltd., 2007

References

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