The future of physician waiting rooms

Medical Economics Journal, Medical Economics September 2021, Volume 98, Issue 9

The COVID-19 pandemic led to a near-overnight revolution in many parts of health care, and nowhere was this seen more than in the waiting room. Now that things have changed, what does the future hold?

The COVID-19 pandemic led to a near-overnight revolution in many parts of health care, and nowhere was this seen more than in the waiting room. Now that things have changed, what does the future hold?

Medical Economics® sat down with David Berg, president and co-founder of Redirect Health, to discuss the revamped waiting room. The following is a transcript of the interview, edited for length and content.

Medical Economics® (ME): Is there a need to rethink the waiting room?

David Berg: It always needed to change a little bit because it’s hard to manage a waiting room. It’s hard to manage the volume. Sometimes it’s too full. Sometimes it’s too empty. Sometimes you wait too long. It wasn’t always an easy thing to manage. When COVID-19 hit, it had to change. We had no choice. If it was once just an annoying or irritating place to be, the waiting room became a dangerous place to be. We didn’t have the option of ignoring that at the beginning. If you go back to March 2020, when COVID-19 first started, it was really pushed on us overnight. Literally, over a weekend, we had to change the waiting room. [If] we didn’t have COVID-19 in that severity of danger or the concern and uncertainty, I don’t think we would have changed at this point, at least not to the degree we have.

ME: What are some of the issues with the traditional waiting room?

Berg: You’ve got to keep it clean. You’ve got to manage the volume in it. And, if doctors are on time, it usually works well. But if you get a doctor or two that are behind, then that means that they might have two or three patients up, maybe four, maybe five, and that also affects the parking lot.

There are rules around how many parking spots you need per 1,000 square feet of clinic space. , they don’t have the same rules for waiting rooms, but it’s the same issues. You’ve got to manage the cars coming in and cars going out. The longer people wait, the more parking spaces you need, because you don’t turn over the parking space. So there’s a logistical challenge to waiting, whether it’s waiting for a parking spot or waiting in a waiting room, and COVID-19 significantly simplified that because people could not wait in the waiting room any longer. But what’s interesting is that the parking lot became part of the waiting room. So the waiting room got bigger. But there was a new uncertainty because we’d never had to manage our parking lot in real time before.

ME: How else has COVID-19 changed the way a patient waits for their appointment?

Berg: The way I like to think about it, and I think it’s a way that most medical doctors or medical personnel think about it with their own families, [involves] the entire journey of health care, from start to finish. The waiting room is just one thing in between. It’s one out of 50 things in the middle of it. We’ve got to continue to have the health care journey go from end to end.

Even if we must change one component of that journey — the medication could be a component, the waiting room can be a component, the parking space can be a component. If we think about the office visit, in all its parts, there are easily 50 parts, depending how granular we want to get ‚ so, changing the pieces, the parts where necessary. But we didn’t want to stop where the finish line was; people getting the right care using their benefits and not having to pay too much money. The finish line didn’t change, but how we got there had to.

The biggest way we had to change is we had to figure out [which] parts we could do virtually or remotely. We had to figure out how we could do those and separate them from the office visit. For instance, when you walk up to the front desk and you want to ask what your copay is, or you want to pay your copay, there’s no reason that can’t be done over the phone from your home. When the nurse or the medical assistant is confirming your medication list to make sure that they have it right in the chart and the whole chart is prepared correctly, that doesn’t have to happen in the office. That can happen at home over the phone.

There are many parts of the in-office visit that, if we segment it appropriately, can be done beforehand at home. Whether it’s chart prep, taking history or verifying meds, like I mentioned, or even just knowing the problem. “What are you worried about today?” Well, that might not be in the chart. We can do all of that at home. If you think about it, exam rooms and waiting rooms expanded to include your home, your car or your office. So many things we used to do in the exam or waiting room now can happen on your drive in to see us, at work or the day before at home.

We’ve all heard of drive-through COVID-19 testing, which really didn’t happen before. I got my vaccination sitting in my car. I mean a year and a half ago, before COVID-19, both of those things would have been considered highly unprofessional. But it became highly necessary when the exam rooms and waiting rooms became dangerous because of the risk of infection and the uncertainty of it that we are dealing with.

We’re a lot more certain about COVID-19 today than we were a year and a half ago, when it started. There are things we know about it today, even though there are different variants, we are more certain about what we need to do than we were in March 2020.

ME: What can doctors do to make the waiting room experience better for their patients?

Berg: The obvious [thing] is to eliminate the amount of time in it. An easy way of doing that is letting people sit in their car until you’re ready for them, and then ping them and let them walk up a couple minutes before and take them right back, in which case the car becomes the waiting room. Why is that advantageous? Well, some people like to work while they’re waiting, and it could be easier to be on a phone call in the car than in a waiting room. Some offices don’t even like people talking on cell phones in their waiting rooms, but in the car, you’ve got a lot more freedom to do the things that you want to do. Similarly, at home, you’ve got a lot more freedom to do the things you want to do.

Now that people have gotten used to not waiting for doctors, without being able to replace that waiting with something else valuable or necessary in their life — call it emails or texts or phone calls — I don’t know that people, especially young people, [will] ever go back. Now they’ve got a little taste of that convenience and that freedom; I don’t think they will go back.

The other thing I will tell you is that pre-COVID-19, the number of people who were in doctors’ offices was disproportionately older than younger. When I say older, I mean older than 40. We were used to going and seeing a doctor when we needed something. Millennials and even younger, they’re used to getting a lot of things, whether it’s pizza or [an] Uber from their phone, so it’s just a normal way of doing things. Younger people never had to use health care to the same degree that older people did pre-COVID-19. When COVID-19 hit, now all of a sudden, they don’t really have the choice of not seeing doctors because of the need for testing for COVID-19 or vaccinations or just dealing with it.

We took care of them, for the most part, virtually. There’s very little with COVID-19 you can’t start at least on the phone, a video or virtually. Now, of course, if you want to test it, you’ve got to put this swab up their nose. You want to vaccinate them, you’ve got to put a needle in their arm. You can’t do that over the phone. But you can be pretty sure what the next steps are after you talk to somebody on the phone because of the symptoms, especially if they say they lost their smell. Not many other things cause you to lose your smell as a young person. There are a lot of things we could do for them at home, so they never even have to come into the office. Younger people who have been forced to use the health care system because of COVID-19 have experienced a more efficient health care journey, if you will, including the waiting room, the exam rooms, the decision-making and the prescribing. They just experienced a much more efficient delivery of health care than existed two years ago for them or anybody else.

ME: Can the in-office physician learn anything from telehealth regarding their waiting room?

Berg: The first thing I would say is to unlearn what you learned before. Unlearn how things happened before and start all over again, but start with what already makes sense to you. How do you already take care of your kids? How do you already take care of your family? How do you already take care of your neighbor’s family? How do you already take care of your family that’s out of state? Look at how you already take care of these people, and you will quickly recognize that very rarely do you ever tell your spouse, “Hey, just make an appointment with me and I’ll see you in two weeks.” It just doesn’t happen.

Start to segment the parts of the office visit into the parts that could be done virtually and the parts that must be done in office. What you’ll learn is that about 70% of the time, you can do all of it virtually and only need to follow up in the office if it didn’t work. There are other things that are more obvious. Maybe you want to listen to the heart [or] the lungs; there’s technology coming out that allow you to do that from your home. It’s not easily available, just as fax machines needed both parties to have all the equipment for it to work. That stuff [is] not there yet, but the capability is there; we just don’t have the network effect of everybody having the equipment at home. But it’s not that far down the road where we could take care of a lot more things from the home using technology.

I would recommend that doctors separate the office visits into what can be virtual and what doesn’t have to be, and do everything they can to front-load the virtual visits. The challenge is that a lot of the business models that are in play are based on fee-for-service, which means there’s not a payment mechanism in the business model for that. But let’s put the business model aside because there will be one soon, and many of the insurance companies and payers are wising up to this and are rewarding doctors for taking care of people outside of their office.

Up to two years ago, that was not a situation. If you didn’t turn the doorknob and come in my office, I couldn’t get paid. That meant that every time I helped you over the phone, I was doing it for free and probably with an expense; it actually cost me money. The business model has had the chance to change, and COVID-19 has helped that.

ME: What do you see the waiting room looking like in the future?

Berg: I think it’ll be a lot smaller and a lot easier to manage because if we get full, we can always use technology to say, “Hey, just wait in your car and we’ll call you as soon as we’re ready.” We may say the waiting room [is] full [or] maybe we don’t, [and] maybe we say we’re running behind, but we can extend the waiting room into the car. That technology was always there, but now it’s being used by everybody.

In our offices, in Phoenix, every single one of our patients is used to the ability to wait in their car. We ping them through a text and they come right [in], and we’re waiting to take them right back to the exam room. They bypass the waiting room except for walking through it. I can’t see how that’s not going to be the way of the future — just eliminating how long you’re [in] the waiting room or maybe even the size of the waiting rooms. We’re starting to see some innovative concepts today where people with self check-in, where I don’t even know that’s really a waiting room. It’s blurring the lines between the waiting room and the exam room. When you start considering what you can do over your phone from your car sitting in the parking lot, we’ve really blurred the lines.