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    Improve your practice: Facilitate patient access

    As patients abandon their medical homes for retail clinics and telehealth visits, let's remove the obstacles that hinder patients’ access to our services.


    Open Access Scheduling

    The OAS system was invented by Mark Murray, MD, MPA, and Catherine Tantau, BSN, MPA, at Kaiser Permanente in Northern California in the early 1990s. The essence of this system is scheduling patients on the same day they call, no matter what type of visit is requested. So, rather than having wait times in the order of 50 days to see a patient’s PCP, OAS changes this to a system that facilitates same day visits with PCPs!

    Under the traditional model, a provider may be fully booked on any day, and if no same-day slots are kept open—and overflow patients must be seen—the provider becomes double booked. This overwhelms providers and staff. The alternative model is a carve-out system in which at least 50% of visits are booked ahead of time, with the remaining number of slots kept open dependent on the day of the week and season, as well as the capacity and work habits of the PCP.

    Under the OAS model, the number of prebooked visits falls to around 30%, and these represent recently booked patients who prefer not to be seen on the day they call. To make OAS work, providers need to clear up any “backlog” of visits, most notably preventive health visits, which can take some practices weeks or months depending on the willingness of providers to pitch in and work extra hours. Practices that wish to implement an OAS system can consider adopting scheduling portals such as Appointment Quest (www.appointmentquest.com/), which enables patients to book their own appointments without calling.

    More: Is patient satisfaction a true marker of quality care?

    Practices that have implemented the OAS model, once fine-tuned, rave about how it expedites care and pleases patients. When patients call, the staff first ask who is their PCP, and secondly if they would like to come in for a visit that day. According to Mark Murray, in the open access system “providers do today’s work today,” rather than chipping away at a backlog of work. This model is particularly relevant now, when patients are seeking care at retail-based clinics because they can’t get in to see their own physicians.

    Panel size matters

    If you wish to consider adopting the OAS model discussed above or just want to make your present system work better, you need to realize that physicians have a limit as to the number of patients they can accommodate in their panels. To function as a PCP, one must attend to all the needs of patients, not just see patients for preventive health and ill visits. This involves calling patients to address concerns, generating referrals and school forms, refilling medications, and more.

    Panels sizes have been extensively analyzed by experts, who have developed complicated algorithms for computing ideal panel sizes. Long story short, however, a full-time pediatrician’s panel typically caps out at 1500 to 2000 patients, depending on the complexity of patients, number of daily available appointments, and number of support staff. It is unfair to the patients to bloat panels beyond that which the practice can handle. Once a provider panel gets to a critical size, it should be closed and patients directed to other providers in the panel, or additional providers should be hired.

    NEXT: Direct Primary Care

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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