University Hospitals Transformed Patient Access and Improved Revenue by Nearly $10M

The Cleveland health system expanded its use of centralized scheduling to reduce no-shows and increase new patient visits.

Two years ago, more than 30 percent of new patients coming to University Hospitals (UH) had to wait at least a month before they could see a physician. More than one-third of appointments resulted in a cancellation or a no-show.

“We recognized that we weren’t going to grow as an organization if we continued down that path,” says Maria Kamenos, vice president of patient access services. Concerned about the negative effect on revenue and patient loyalty, leaders at UH developed a strategy to improve access across the health system.

Since implementing their strategy in 2013, UH has realized nearly $10 million in revenue improvements because of physician referrals that have been converted to arrived (completed) appointments, fewer no-shows and cancellations, and revenue from incremental new visits.

The following are some of the key lessons learned from UH’s two-year journey.

Ask the C-suite to provide a high-level vision as well as oversight. At the beginning of the project, Kamenos met weekly with a steering committee that included the community hospitals’ presidents, the president of the physician practices, and the health system’s CFO, CIO, and chief marketing officer. “With so many C-suite executives, the steering committee was the muscle that helped us get things done,” Kamenos says.

Use physician liaisons to uncover root causes of access issues. UH’s physician liaisons started by soliciting feedback from a handful of physician practices but eventually sought input from hundreds of practices. “The liaisons helped us come to the conclusion that we needed to open up schedules and expand the use of centralized scheduling,” she says.

Open up physician schedules to enhance provider capacity. When reviewing each department’s scheduling templates, Kamenos and her team determined the clinical FTEs needed each week based on the budget. Then, they reviewed the scheduling template to determine if the department was seeing too few patients to justify the number of clinical FTEs. “If they were significantly under their clinical FTE target, there was no way they were going to meet their budget,” Kamenos says.

Physician practice leaders at UH decided to add more appointment times to the schedule to open up access and to ensure enough revenue came in to account for scheduled FTEs. Slots were reserved for urgent patients who needed to be seen within 72 hours. In some departments, UH also added medical assistants to reduce the time physicians spent on less important tasks during new patient visits.

Create a working group to streamline processes and simplify scheduling protocols. Representatives from central scheduling, IT, and the clinical departments collaborated to standardize and shorten “phone trees” in the call center. For example, the team streamlined the option menus that patients heard when calling in, which decreased the wait time.

They also standardized and automated the scheduling protocols that staff use to book appointments. For example, they created an electronic tool for schedulers to refer patients to the most appropriate specialist for their condition. This eliminated the need for call center staff to comb through lengthy documents that outlined different scheduling protocols for each physician and specialty.

Listen to patients. Kamenos and her team sought suggestions from UH’s patient and family council on how they could improve access. One of the suggestions was to offer patients the ability to schedule their own appointments, which UH has just implemented. They also surveyed more than 1,800 patients to track satisfaction and used a “secret shopper” to understand the barriers to access.

Since gaining the initial feedback, leaders at UH have added a phone survey that patients can take after they schedule an appointment through the call center. If a patient chooses to leave a message, a manager will return the call within 30 minutes.

Create a concierge program to improve scheduling at the point of service. UH’s electronic health record triggers an inpatient concierge team to make follow-up appointments for discharged patients. “Previously, residents and nurses did this, and it was not the best use of their time,” Kamenos says.

Concierge staffs also are located in the waiting rooms and lobbies of several ambulatory care centers to book tests and procedures for patients immediately following their office visits. UH also has a “telepresence concierge” in 26 medium-sized practices so office staff can chat electronically with concierge staff, in the event that patients have special needs.

Keep staff engaged with metrics. UH uses a web-based employee dashboard with access-related metrics, such as call abandonment rate, average speed to answer, and call volume. The dashboard also includes booking ratios, new patients by month, and appointment lag days (how long it takes for patients to see the physician after making their appointment). “All of these metrics can be drilled down to the department, division, location, and provider,” she says.

See related tool: University Hospitals Patient Access Dashboards

Leaders at UH also developed new incentive programs to reward staff for meeting specific productivity and access metrics. For example, when scheduling teams meet their weekly call targets, they are rewarded with dress-down days or fun events within the call center. Schedulers with positive customer feedback are rewarded with “UH Appreciates” points, which can be used to purchase products and services from an online catalog.

Anticipate resistance to change. “The biggest challenge was physician buy-in and change management,” Kamenos says. “Physicians are reluctant to have people outside their own office staff schedule for them, so we needed to involve them from the beginning and throughout the process.”

Look for early wins to keep the momentum going. “You have to find a way to track the ROI so people can see the value of what you are doing,” Kamenos says.

Over the past two years, cancellations and no-shows have dropped from 35 to 21 percent. The call abandonment rate has dropped from 14 to 4 percent. The average speed to answer is down from 99 seconds to 20 seconds. UH’s productivity has improved, with average booking ratios—calculated by taking the number of booked appointments divided by the total available appointments—approaching 75 percent across all physician practices.

The health system also has increased new patient visits by 3 percent in the past year. The concierge program has generated 3,800 appointments per month for the system (not necessarily all new patients to the system, but this does represent incremental new volume).

Based on this success, leaders at UH are pursuing the next round of patient access improvements, fueled by a heightened level of organizational engagement. “This initiative has changed the whole conversation about access across the organization,” Kamenos says. “It got people thinking about the patient experience in a different way and to think about how patients were getting to us in the first place.”

Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill., and is a member of HFMA’s First Illinois Chapter.

This article is based in part on a presentation at the HIMSS 15 Conference in Chicago in April 2015.

Interviewed for this article: Maria Kamenos is vice president of patient access services, University Hospitals, Cleveland, Ohio.

Discussion Starters

• What has been your biggest challenge in improving patient access?
• How can leaders gain buy-in for centralized scheduling from clinical departments and physician practices?
• What is the best place to start when trying to reduce appointment lag days?