Same-day care, capacity key to managing flu season

September 10, 2013

Last year’s flu season brought chills to some providers; experts say planning, education are even more critical now

Last year brought one of the worst flu seasons in 10 years,  resulting in approximately 100 million doctor visits and Americans spending $7.7 billion on additional medicine and treatments. The National Institutes of  Health estimates that colds and flu absences from work and school costs the economy more than $30 billion annually. The pressure on medical practices to provide quick, efficient, and effective treatment is stronger than ever.

Fortunately, physicians can prepare in advance for an onslaught of patients who want advance or same-day care surrounding their cold and flu symptoms. Going into the season without a plan does a disservice to your patients, which could be an invitation for them to go to retail and urgent-care clinics for services you could provide. Last year, Walgreens administed 5.5 million flu shots and made millions more selling other cold and flu treatments.

“A low level appointment might be $60. Missing 10 of those a day over two and a half months is a lot of money,” says Gray Tuttle, principal in healthcare management for Rehmann in Lansing, Michigan. “The key opportunity is having the capacity when flu season hits.” Preparation is the key to managing this hectic season.

Prepping for flu immunizations
An advantage your practice has over retail clinics is education. Make sure you and your staff are communicating with patients about the right time to get flu shots, and set up times for them to get them. “Ask patients to refrain from obtaining the annual flu immunization until the appropriate time so that it provides maximum protection,” says Robin Diamond, MSN, JD, RN, senior vice president for The Doctors Company. “Many drug stores and other retail outlets offer the flu immunization too early, and its protection wanes by the height of flu season.”

Check to see what payers fully cover flu vaccinations, and consider having clinics that cater to those patients at convenient times. If not fully covered, make sure to let patients know in advance how much flu shots would cost them out of pocket, so that they are prepared.

Setting up flu vaccination clinics after hours or on weekends, and allowing for walk-in vaccinations will certainly capture patients who might go to retail clinics, Tuttle says. “If patients can come in unannounced for flu shots that are fair and competitively priced, pharmacies won’t be able to compete,” Tuttle says.

Consider partnering with area businesses to offer flu clinics to their employees. This also provides an opportunity to offer tutorials about standard precautions against colds and flu, and market your business to new clients.

There are certain factors that are out of your control, like vaccine shortages.The Centers for Disease Control and Prevention (CDC) projects that manufacturers are producing between 135 million and 139 million doses of flu vaccinations for this upcoming flu season. Early communication with patients is key to making sure they look to your practice for information regarding changes in the flu season, vaccination availability, and dates and times of clinics, especialy for immuno-compromised patients.

Using EHRs to market seasonal care
Depending on the type of electronic health record (EHR) system you have, you may be able to look across several date points to aggregate your most vulnerable patients for flu vaccinations, says Tim A. Sayed, MD, a member of the Healthcare Information and Management Systems Society EHR Association executive committee.

“You can create alerts based off of diagnoses entered by the doctor. So if a patient has a high risk of pneumonia based on age or had the flu before, the EHR system can alert them a month before flu vaccinations are available,” Sayed says. “It will be important to get the word out in compliance with privacy laws, but in digestible ways patients can use it.”

Sayed says eventually with stage 2 of meaningful use, there will be opportunities for practices to look at patterns across geographic and other demographic patient populations to see what trends there are in flu outbreaks and what treatments are and aren’t working.

Same-day care is essential
Tuttle says that by not providing opportunities for same-day appointments, practices are pushing their patients into urgent care and retail clinics.

For solo practices, Tuttle suggests that practices should leave an hour in the morning and in the afternoon for patients with flu symptoms. “Providing the promise for same-day service is a huge practice builder,” Tuttle says.

With small practices, he has seen success when physicians rotate being the “duty doctor” for a day during the height of cold and flu season. This doctor schedules minimal appointments, and is primarily open for walk ins. Tuttle says that he has witnessed one doctor seeing 80 walk-in patients in a day under this model.

“For no or little additional costs, there’s a lot of added revenue to this model,” Tuttle says. “Use this as a marketing tool. Quick visits are great for the patient and yield good economic results.”

Keep a light schedule on Monday mornings when patients who were sick over the weekend are most likely to call in. Consider opening early on Mondays, not only to call patients who left messages and schedule appointments, but to see patients or their children before work or school.

Special staffing considerations
The cold and flu season runs next to  many winter holidays, another difficult time for staffing. Your staff may be scheduling vacation time or may even get sick themselves.

“You shouldn’t have to hire seasonal help if your nurse practitioners and physician assistants are well trained,” Tuttle says. “You may need additional front-desk support if you are already short staffed and considering longer hours.”

Consider tapping a temp agency early in the season to identify candidates who can fill in early mornings, evenings and weekends. Also consider temporary workers who are willing to work the days before and after holidays, if your staff members have vacation scheduled and your office is open.

Repurposing space and resources
The Centers for Disease Control and Prevention suggest that a portion of your waiting area be sectioned off for patients with respiratory infections. If this isn’t possible, consider a station that processes cold and flu patients so they can move through the waiting area quickly.

“Isolate patients who are sneezing or coughing by immediately having staff escort them to a treatment room where the patient should be asked to wash their hands for at least 20 seconds,” Diamond says, adding that tissues, masks, and hand sanitizer should be available at your check-in station.  

Ralph E. Holsworth, DO, medical director of Southeast Colorado Hospital in Springfield, Colorado, suggests that doctors keep bottled water in waiting areas during flu season for both patients and staff. “It only takes a 1% to 2% drop in body fluid to experience mild signs of dehydration. Staying hydrated can help individuals avoid a trip to the doctor or emergency room for dehydration, and help physicians reduce the number of office staff sick,” Holsworth says.