• Expediting Access to Care With Same-Day Appointments

    Kenyokee Crowell Jan 25, 2018

    0118_Leadership Blog_Kenyokee CrowellFrom courier services to dry cleaning to gift delivery, among others, many industries have transitioned to offering same-day services that accommodate consumers’ increasingly busy lives. But when seeking health care, patients generally continue to experience long wait times for an appointment with a clinician. In fact, physician appointment wait times have increased by 30 percent since 2014, according to a 2017 Merritt Hawkins  survey. Across 15 large metropolitan markets, wait times across five specialties average about 24 days, up from 18.5 days in 2014, 20.5 days in 2009, and 21 days in 2004.

    When required to wait days or weeks for an appointment, patients are often left frustrated and might even decide to forgo seeking care. While this issue certainly was not unique to Allegheny Health Network (AHN), our integrated healthcare delivery system based in Pittsburgh, we sought to change the experience for our patients by offering same-day access to care.

    How It Works

    Consistent with our patient-centered care philosophy and continuous efforts to increase access to care, AHN introduced same-day appointments in January 2017. Patients can schedule a same-day appointment by calling AHN’s centralized call center, known as Care Connect, between 7 a.m. and 11 a.m., Monday through Friday. An appointment is offered with the most appropriate healthcare provider and at the most convenient location based on the availability of services. The provider could be a primary care physician, specialty physician, nurse practitioner, or physician assistant.

    Same-day appointments are scheduled on a first-come, first-served basis. When patients call after 11 a.m., they are offered either a same-day appointment, pending availability, or the next available appointment.  

    Getting Started

    The implementation of same-day appointments at AHN did not happen overnight. In fact, it required careful planning and a team-based approach that involved physicians, IT staff, office staff, communications, marketing, and more. It required viewing access through a different lens and embracing a “do today’s work today” philosophy to execute on the idea.

    The process involved assessing patient volumes and scheduling trends by specialty, market, and season, and making predictions based on historical data. A “same-day appointment” type was created and built into the electronic schedule to reserve an inventory of appointment slots for each day. In essence, same-day appointments on a given date are not available for booking until 12:01 a.m. on that date; patients can call the office when it opens at 7 a.m. to schedule one of the open slots  

    We conducted a soft launch to test the theory and tweak processes as needed. By January 2017, AHN was ready to market its expanded-access offering to the public.

    Critical to the success of the program in its earliest stages was gaining physician support. The same-day team includes gastroenterologist Elie Aoun, MD, AHN’s medical director of clinical access, who worked with physicians to educate them on the initiative and address concerns. It was crucial to gain buy-in from our physicians and to see their concerns as opportunities to refine and improve the process.  

    Another key was the work of Diane Allen, vice president of Care Connect, who closely monitored access levels, particularly at the start of the program, and addressed concerns as needed. 

    Signs of Success

    In 2017, more people in the region turned to AHN for their healthcare needs. More than 150,000 same-day appointments were scheduled, including approximately 89,000 for primary care and 65,000 for specialty care. AHN estimates that 5 percent of patients who obtained a same-day appointment in 2017 were new to the health system.

    Same-day appointments offer patients a convenient way to address smaller health issues, such as when a patient experiences upper respiratory symptoms and wants to make sure it is nothing serious before boarding a plane for vacation.

    As well, many patients have sent notes of gratitude for the opportunity to receive immediate care that, in some cases, saved lives. In one instance, a patient was new to the Pittsburgh area and was experiencing severe urological symptoms. After seeing an advertisement for AHN same-day appointments, he called to schedule an appointment with a urologist. He was evaluated that day and scheduled for the necessary testing in the following days. The testing revealed a mass on one of his kidneys. In other markets, this patient might have had to wait several days just to get started on his care journey.

    We remain committed to continually adapting the same-day appointment program to fit our patients’ evolving needs, and to identifying new ways in which we can increase access to care. Breaking down barriers to access and providing more immediate care is important not only because patients say they want it, but because many of them need it and because they deserve it.

    Kenyokee Crowell is senior vice president, clinical access, Allegheny Health Network, Pittsburgh. 

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