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6/21/2018

Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

Emerging evidence shows that it’s now become the norm in many parts of the country for patients to endure lengthy wait times to see a physician, particularly in primary care but also for specialists. This includes patients who have private insurance, as well as those with Medicaid or Medicare.

According to a recent MGMA Stat poll that asked healthcare leaders, “Does your organization utilize a patient wait list for next-available appointments?” the majority (61%) responded “yes,” 29% responded “no” and 7% said they are “considering it.” The remaining 3% were “unsure.”

Respondents noted that they are using a number of methods to help reduce wait times for patients. Multiple MGMA Stat users noted their EHR or practice management system provides a recall feature or other similar functionality to prompt a call to a patient waiting for an appointment. Some practices that have embraced the Patient-Centered Medical Home (PCMH) model keep at least 30% of appointment slots open for same-day appointments.

According to the 2017 MGMA DataDive Practice Operations:

For primary care single specialties, the median wait time for third next-available appointments for new patients is 6 days.
For surgical single specialties, the median wait time for third next-available appointments for new patients is 6.3 days.

According to a 2017 survey on physician appointment wait times by Merritt Hawkins:

Average new patient physician appointment wait times have increased significantly. The average wait time for a physician appointment for the 15 large metro markets surveyed was 24.1 days, up 30% from 2014.
Appointment wait times are longer in mid-sized metro markets than in large metro markets. The average wait time for a new patient physician appointment in all 15 mid-sized markets was 32 days, 32.8% higher than the average for large metro markets.

In reviewing this data, what is an acceptable wait time for an appointment?

The Department of Veterans Affairs, which has been criticized in recent years for long patient wait times at its hospitals, is one of the only healthcare systems in the nation that openly tracks waiting times and sets standards. Although there are no standard benchmarks for wait times in the private sector, they should be addressed on a practice-by-practice basis.

How you manage the waiting list is a reflection of your service to patients and their families. Waiting times are significant because:

The patient's condition may deteriorate while waiting and in some cases the effectiveness of the proposed treatment may be reduced.
Waiting can be extremely distressing for the patient.
The patient's family life may be adversely affected by waiting.
The patient's employment circumstances may be adversely affected by waiting.

Patients should be called from a waiting list in order of clinical priority. Therefore, having a standard format that includes patients’ concerns and conditions is imperative to prioritize clinical importance. Patients should know any warning signs that would necessitate a same-day or emergent visit.

Patients with similar clinical priority should be seen predominately in the order of the longest-waiting patients first.

Provide patients with clear guidance such as notifying the practice of any changes in their condition, contact information or availability for treatment.

Patients should be kept up to date on their expected waiting time. Giving them updates about when they might expect to be seen eases anxiety and allows them to anticipate being available at a certain time.

If your practice has alternative availability, such as other offices or new providers, offering these alternatives will go a long way in improving patient satisfaction and patient safety.

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References

“2017 Survey of physician appointment wait times.” Merritt Hawkins. Available from: bit.ly/2MEti4J
“The health care waiting game.” New York Times. July 5, 2014. Available from: nyti.ms/2K36cXf
“Mirror, Mirror 2017: International comparison reflects flaws and opportunities for better US healthcare.” The Commonwealth Fund. July 2017. Available from: bit.ly/2MbXLWY

Written By

Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.