Open access works

Want to boost compliance rates for mammograms, colorectal cancer screening, pap smears, and other procedures? Would you like to improve patient satisfaction with your practice? How about enhancing your own satisfaction with providing health care? All of this may be possible by making it easier for patients to get an appointment - the same day.

Delayed physician access is the most important barrier to the appropriate delivery of care from the patient perspective, said L. Gordon Moore, MD, part of the American Academy of Family Physicians' (AAFP) Ideal Medical Practice Project. He blamed the perceived delay in patient access on the common perception that medical care is a scarce commodity.

"Patients don't just mean office visits when they talk access," he said at the AAFP Scientific Sessions in Chicago on Wednesday. "They mean 'Are you there for me when I need you - by phone, by email?'"

Eliminating that barrier to access creates a perception of abundance for patients, Dr Moore continued. Once patients realize that they can get in to see a physician the same day, demand for appointments actually drops. He reported that Kaiser Permanente saw a 40% reduction in appointment requests after instituting same-day appointments.

"If you throw up barriers, real or perceived, patients will avoid you and your practice," The ultimate gauge as to whether you are succeeding is the patient's perspective. If you think you are doing everything right and the patient thinks you aren't, you aren't succeeding."

The theory behind open access, or same-day appointments, is simple, he added. It is all about balancing supply-the time available to care for patients-and demand-the number of patients requesting appointments. The goal is to do today's work today rather than postponing it until tomorrow and backing up the office.

The practice is more complicated. Physicians who are habitually backed up and running late are trying to care for too many patients, Dr Moore said. The solution is to see fewer patients, which may mean closing the practice to new patients until attrition reduces the load.

"It is better to do a superior job with a few patients than to provide poor care for many patients," he said.

In rural Rhode Island, the solo practice of Jean Antonucci, MD, offers open access. She limits advance appointments to approximately one-third of her daily schedule. The rest of the day is reserved for same-day appointments.

"Demand for appointments is very predictable," she said. "I don't know who will call, but I know I will get more calls on Monday, more calls on Friday afternoon, and more calls the week after I'm away from the office. On any given day, you want to be able to see anybody who calls."

Dr Antonucci's practice, like many open access practices, has cut appointment types to two: 30 minutes and 60 minutes. Supply is based on the number of hours she wants to work, adjusted for non-patient care tasks. Demand is based on the number of patient visits in past years and the size of her patient population. Most practices can expect just under 1% of the total practice population to call for an appointment on any given day.

"You have to educate your patients," she cautioned. "They won't believe you at first when you say they will be able to see you the same day. You have to teach by example."