Advanced Access: a Winning Approach for Patients, Providers, and Staff

Access to the right medical care at the right time in the right setting improves patient satisfaction. It also attracts new patients, retains existing patients, supports safety, improves outcomes, and reduces cost. So why do so many medical practices still struggle to provide adequate access to achieve these goals?

Traditional approaches to improving access have focused on:

  • Recruitment--which may be costly, impossible, or too much of a long-term challenge
  • Partnering with urgent care centers or retail clinics which do not facilitate continuity or an ongoing relationship with your medical practice
  • Managing demand through triage, which has only led to greater patient dis-satisfaction
  • Holding a fixed number of appointments for patients (which are never the right number) needing to be seen the day they call, often called "carve-out scheduling"

Under any of these approaches, physicians and staff struggle to meet the needs of today, as well as those of patients who have waited days or weeks for appointment.

Access may be improved significantly through practice optimization, and by employing the principles of advanced access. Advanced access is appointment availability that reflects the real-time demand of patients and, therefore, reduces or eliminates queuing. It is a philosophy that focuses on “doing today’s work today.” However, it is more than just changing the schedule. It is an innovative way of thinking about patient care. It emphasizes improvement of the total care experience, from the initial telephone call to follow-up care. Advanced access works because it predicts demand and then focuses on maximizing daily capacity so that daily demand can be met. It also does not occur in a vacuum. It requires that the processes in a practice be reviewed and often modified. 

Here are five tried and true principles:

1. Understand Your Demand and Capacity

It is well known that Monday is always the day of highest demand for primary care providers (or Tuesday after a three-day weekend). Tuesday often has the second greatest demand, and demand on Wednesday through Friday is about equal. Most patients would appreciate some early evening and weekend availability too. We also know that winter flu season is the busiest time of year and that if a practice performs school physicals, July and August will have greater demand.

Does your provider capacity match patient demand?  Do you maximize provider availability for your high-demand hours?  You may find that you have too many physicians working mid-day Thursday and not enough on Monday morning. Talk with your providers about the mismatch of appointment availability to the known hours of patient demand. Let them work out a fair distribution within the parameters you give them. Most of the redistribution can often be accomplished voluntarily. Provider vacations can be managed to minimize coverage holes at times of greatest demand.

2. Decrease Appointment Types

Much inefficiency and unnecessary queuing results from the creation of too many appointment types. Many systems try to handle demand by creating more appointment types to “manage” the schedule, but that has only created additional complexity and limited appointment availability. Best practice is to reduce appoint types to two: a short and a long (with the long being twice the length of a short). You may decide to have 15 and 30-minute appointments or 20 and 40-minute appointments for instance. Relegate all patient needs to one of the two. This gives your scheduler much more flexibility to get patients in. Also, if you know that a certain patient always runs over, give them a longer appointment.

3. Manage Your Daily Appointment Inventory

Many providers clog up all their future appointment availability for those who are acutely ill by unnecessarily scheduling follow-up appointments. A protocol change, for instance, of seeing patients for blood pressure checks every quarter instead of every other month immediately creates capacity. The same is true for diabetics or anyone with a chronic disease. Of course, different patients need to be seen on different intervals due to the severity of their disease or their compliance with treatment. The point is to be mindful of that need rather than rescheduling routinely in a pattern that limits future availability.

Use a morning and afternoon huddle with your medical assistant to review the schedule and plan for the day. Identify patients whose needs could be met by a phone call to free up space on the schedule. If someone being seen today has a future appointment, take care of both issues during the first appointment if possible.

4. Create Contingency Plans

Create provider care teams to ensure that vacations, sick time and temporary absences do not significantly impact same-day appointments. Proactively develop plans to handle peak demand such as flu season and school physicals.

5. Measure and Monitor Access on an Ongoing Basis

Unless access is routinely measured (third available appointment), it is easy to fall into old habits and slip into postponing work until tomorrow. When contingency plans are implemented, they need to be monitored to identify what is working and what is not so that problems can be quickly identified and resolved before backlog creep occurs.

Advanced Access Is Win-Win

Everyone wins with advanced access: patients, physicians, staff, and management by:

  • Increasing patient satisfaction
  • Improving clinical outcomes for patients through better continuity of care (patients now see their own doctor) and greater emphasis on prevention
  • Enhancing quality of practice life for physicians and staff
  • Increasing efficiency in patient flow
    • Fewer no shows
    • Less phone calls
    • Minimizes re-work
  • Decreasing costs through decline in ER and urgent care visits
  • Potentially increasing in net revenue
    • More new patients
    • Ability to do more for patient through max-packing