Changes in Patient Access

Written on April 27, 2016

Physicians have struggled with the impact of the Affordable Care Act since its passage March 23, 2010, but there is a new, more powerful and insidious change underway which will have dramatic impact on all medical practices. The free enterprise system together with an emergence of the Millennium generation has begun to break medicine of some traditional bad habits.  Historically, a medical practice could take patient phone calls when it had time, book patient visits at the convenience of the physician and permit patients to sit in the waiting room well after the scheduled appointment time before seeing the physician. The Millennium generation population, which now exceeds the Baby Boomers in our population, has not been raised to wait patiently on service providers. They reply to texts while waiting for their name to be called for a customized coffee order.  When the texts are handled, they are ready to move to the next multi-tasking activity. The prospect of sitting for two hours in a physician waiting room is not acceptable to them. Our nation’s capitalist system is eager to respond to this high value placed on personal time by the Millennials.  Several developments signal the opening of care access alternatives.

The appearance of urgent care facilities was the initial sign of changing times.  These care delivery offices are now in many cities, and are as near to each other as fast food sources in some locations.  Urgent care facilities are a way to avoid the cost of a parking deck, eliminate the need to navigate a physician office building and avoid waiting long past a scheduled appointment time to be seen.  Patients expect to pay out of pocket for the ability to obtain quick care and return to their busy schedules.  Traditional office based physicians might be surprised to know how many of their longstanding patients are seeking more convenient help at urgent care facilities.

Patients who want greater convenience can be seen in the comfort of their own home.  Several states have this “Uber” healthcare service, as it was called in a recent Wall Street Journal article. The healthcare service commits to have a physician or mid-level provider to the home within a short period of time. In Colorado, a home health provider is also dispatched in response to some 911 calls and if the situation can be treated in the home, insurance pays the $300 cost per call rather than incurring the $3,000 ambulance transport cost.  Certainly, the $100 fee for these normal house calls is affordable by only the more affluent families, but these are exactly the families a medical practice most needs to retain because they can pay for their care out of pocket.

Telemedicine is the next game changing element in the provision of care. Hospitals are offering telemedicine consultations for certain specialties rather than paying MDs to be on call weekends and nights.  Insurance providers offer telemedicine consultations for $10 per consult and this service is available 24 hours a day, every day of the week.  These consults may be limited to the more simple medical issues, but these matters enable physicians to generate the incremental patient volume which produces year end profit and bonuses.  When this group can receive their prescriptions via a telemedicine visit at night, physician practices are left with the more complex patient problems and limited ability to bill more for the increased time to treat.

What do these easier points of patient access mean to medical practices?  If you want to keep your entire patient base, it is time to make certain that care at your practice is eagerly being offered to your patients.  Phones should be answered within three rings.  Call your main office line from another number and see how many rings your patients hear before an answer.  Listen for the tone with which the phone is answered.  Is it tired and bothered, or happy to take the call?  Once a call is answered, how soon can the patient be seen?  A sick patient might accept an appointment 10 days out, but they will likely heal or see an urgent care facility before the 10 days passes.  That means you will find out in 10 days that you have another no-show on your schedule.  When a patient wins the appointment lottery and gets an appointment tomorrow, how long do they have to wait past your promised time to see them? Be careful about long wait times.  Most of our population are multi taskers and have something on their schedule for after this office visit.  Some will even leave before being seen. Most will say nothing about their displeasure, and simply not come back.

In short, the growing medical practices are treating patients like they are being served by a luxury hotel.  Your practice is either growing or suffering atrophy.  Look at your new patient numbers by month for the last 24 months and see into which category you fall.  If you know your group needs to improve, contact one of our healthcare team members for ways to become a survivor in the new world of patient access.

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