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Elaine Hardman, MBA, Chief Operations Officer Jackie Fantes, MD, Associate Medical Director The Providence Community Health Centers Providence, Rhode Island.

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Presentation on theme: "Elaine Hardman, MBA, Chief Operations Officer Jackie Fantes, MD, Associate Medical Director The Providence Community Health Centers Providence, Rhode Island."— Presentation transcript:

1 Elaine Hardman, MBA, Chief Operations Officer Jackie Fantes, MD, Associate Medical Director The Providence Community Health Centers Providence, Rhode Island August 16, 2013 Health Choice Network Quality Institute

2  To reduce scheduling barriers for under-served patients for improved access to care  High no-show rate (40%) ◦ Tried multiple ways to reduce  Reduced provider productivity/idle staff resulting in inefficiencies  The work of tracking down patients that no- showed  Patients did not get care if they did not show up  Eliminate the perception of “too much” demand  Improve provider and staff satisfaction  The organization was ready to commit

3  Do today’s work today  Access is a key determinant for consumers choosing a health care provider (something all of us CHCs will need to consider with ACA)  6 high level changes ◦ Match demand and supply daily ◦ Reduce backlog ◦ Simplify appointment types and times (apply queuing theory) ◦ Create contingency plans ◦ Reduce demand for unnecessary visits ◦ Optimize the care team (no easy task!)

4  Provider and staff resistance  Implementation takes up to 3-6 months due to fluctuations in demand  Tracking demand – initially and constantly  Finding hidden capacity  Longer staff hours to reduce backlog  All staff need to work at their highest level  Disparity between efficient and non-efficient providers

5  Pre-work  Baseline Data  Establish a Call Center  Educate Patients  Work Down the Backlog  Reduce the Demand  Revise Schedule Templates  Staff Cross-training  Establish Safety Net

6  Identify a team  Training staff on Advanced Access concepts  Establish timeline ◦ Generally 3 months out  Baseline Data: ◦ No show rate at each site ◦ No show rate for each department ◦ Panel size by Provider ◦ 3 rd next visit for each Provider ◦ Patient Satisfaction Surveys ◦ Measure demand  Measure demand vs. capacity for each day of the week for each provider

7  Worksheet for appointments  Sample of appointment capacity vs. demand ◦ Pediatrics, Internal Med, OB/GYN  Sample of no-show rate  Need to tracking phone calls  Worksheet for tracking unmet demand






13  Phones open 1 hour before start of appointments  Phones routed to central area of clinic where triage RN would also assist  Measure call volume by each hour of each day ◦ Sample Queue


15  For each patient that arrived for their appointment, we provided them with a instruction sheet on advanced access ◦ Open Access is coming ◦ Call us the day you need appointment ◦ Call center opens at ….

16  Approximately 3 months  Providers agreed to work extra hours to see today’s demand  Guidelines on booking out into the future ◦ Transportation issues ◦ Special interpreter needed ◦ Patient insisted ◦ Brittle patients that we needed to track more closely or at risk to fall out of the system  At end of visit patients were given provider’s card with his/her schedule and the date when they should call for next visit

17  Increase visit intervals  Have providers see their own patients ◦ Improved efficiency to see own PCP  Give as much phone advice as possible for the short period of time when many appointments already pre-booked  Max-packing visits

18  Simplify appointment types ◦ 4 visit types  Pre-book Long (30 minute appointments)  Pre-book Short (15 minute appointments)  Open Long (30 minute appointments)  Open Short (15 minute appointments)  Schedules 30% pre-book and 70% Open ◦ Pre-Intergy open appointments could be set as unavailable until the day of the appointment but Intergy will not allow this feature

19  Developed the roll of the Health Center Assistant ◦ Allowed more flexibility to assigning staff from call center to clinic support ◦ Allowed flexibility with vacations and variability in volume

20  Example of Hot List (get new one)  Scripts and Tips for Making Appointments  Recall and Reminder Policy ◦ Had difficulty re-establishing in electronic environment ◦ Copy of our recall and reminder policy for everyone



23  Need to manage the impulse for providers to pre- book (providers that do not pre-book many patients tend to see the patients of providers that pre-book a lot – need to have clear guidelines for the call center)  Develop a good recall and reminder system especially for chronic care and well child care  Manage panel sizes  Need to have a good system for tracking chronic care and well child care ◦ Amalga can help, but no pediatric view yet ◦ Need to track immunization  CLEAR can help ◦ Audit cancellations  If patients < 18 months of age cancel their appointment then it needs to be rescheduled, not asked to call back another day

24  Demand management for sudden or prolonged provider absence or big projects like implementation of the EHR or seasonal fluctuations in demand (for example, H1N1)  Managing unmet demand  Maxpacking is a great idea but the provider “spirit” cannot handle 18-20 maxpacks daily which can be difficult in a CHC setting  Need to have a very robust call center  Manage quick saturation of appointments ◦ All sick visits do need to be handled today (HC vs. Express) ◦ Well visits should be put on unmet demand list  Need a detailed training for new providers


26  No-show rate has dropped – was 40% ◦ Pediatrics < 10% ◦ Adult Med 10-12% ◦ OB/GYN 14-16% (OB greater than GYN) ◦ Pre-books tend to no show greater than open appointments  Improved access for patients  Improved productivity  Improved revenue

27  Once the providers better understand the recall and reminder system, their resistance decreases  PCPs get to see their patients when the patient needs them and especially for acute needs which in a traditionally packed schedule acute patients often get sent to urgent care or ED and the provider is left doing a full day of chronic or preventive care

28  Elaine Hardman ◦ ◦ Office: 401-444-0400 Ext 3112 ◦ Cell: 401-226-3957  Jackie Fantes ◦ ◦ Office: 401-444-0400 Ext 3374 ◦ Cell: 401-864-1951

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