Kentucky PCA Annual Mee0ng October, Coleman Associates. The Hub of the PCMH Coleman Associates. Let me in!

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1 Improving Patient Access By Revamping Your Schedule and Managing Your Pa0ent Popula0on 1 The Hub of the PCMH 2 Let me in Give me the best What Pa6ents Want Don t waste my 6me Figure me out & fix me Care about me more than I do Let me in! The Access System 3 What Pa6ents Want Let me in Website Health Info Just say YES Pa6ent Portal Tex6ng Access Visits Phone 1

2 Where Are We Now? 4 Schedule is full! Lots of no shows Pa0ents can t get in When they do get in, they have a long list Lots of triage going on (phone and in person) Lots of pa0ents calling on phone (they want appts.,rx refills, advice) The schedule is basically broken! Packed Schedules But are we really seeing all these pa0ents? 5 Why is Schedule Full? We make it so! 6 2

3 Kentucky PCA Annual Mee0ng October, Lots of No Shows ì And slots go by unfilled 8 ì Patients Can t Get In Why? Triage, scheduling system, late policies, last minute clinic cancella0ons 9 ì 3

4 Kentucky PCA Annual Mee0ng October, Clinic Phone is Ringing Off the Wall ì Pa0ents can t get in the door, so they try the phone 11 The Schedule is Broken Narrow appointment types Not enough same day slots Double booking Scheduling WAY in advance Clogged with 0cklers as appointments Too many rules Staff and pa0ents have to work the system to get in But others are encouraged to lessen the load 12 What is the Impact of Poor Access? Unmet health needs Delayed care Hospitaliza0ons that could ve been prevented Poor sa0sfac0on for pa0ents and poor staff morale from saying no a lot 4

5 How Can We Improve Our Access? 13 Clean out or scrub the schedule Change the structure of the schedule to be simpler and with less rules Drive down the no show rate Get your pa0ents in! But how? Fit pa0ents in through same day access and tetrising Start managing pa0ent care proac0vely Establish a culture of YES Scrubbing the Schedule 14 Look for: Duplicate appointments Delayed acute care Appointments for services not yet due Unnecessary habit follow up appointments Appointments that could be handled by a different method (phone, nurse visit, educa0on visit) Scrubbing Getting Started 15 Print out schedules for 6 weeks and be in front of your computer Look at each appointment What is pa0ent coming in for? Are they due for this service? Have they come in as a walk in and goden this issue addressed already? Does pa0ent have any duplicate appointments? Was this appointment made a long 0me ago and possibly not needed anymore? Are they scheduled with the right provider? Do they really need to be seen for this or could issue be addressed differently? (Nurse visit, phone call, ) If you have any doubts, ask provider or call the pa0ent and ask them if they want or need to come in 5

6 Kentucky PCA Annual Mee0ng October, Simplify the Schedule Reduce appointment types down to Regular and Same Day All appointments are 15 minutes No double booking Huddles are built in to the schedule before each clinic session 4 Appointment Slots per hour 2 Regulars 1 Same Day 1 Block 17 Simplify the Schedule cont d 18 SPS Getting Started Before changing the en0re template, you ll want to mimic SPS Select a pilot provider to change their schedule Build in the huddles first. If you have a pa0ent in that first slot in am and pm clinics, see if you can move them to the next slot Reduce any longer appointments down to 15 or 20 minutes (this will create some regular appt. slots, same day slots, and blocks) If you previously double booked any slots, move them to the newly opened slots If any pa0ent s appointment is moved more than 30 minutes from original 0me, call pa0ent to inform them of new appointment 0me 6

7 Drive Down the No Show Rate 19 Why pa0ents don t show up: Don t understand scheduling system Don t know the importance of why they need to come Forgot Couldn t get off work Transporta0on problems Felt beder Felt worse and stayed home instead Perceived disrespect Emo0ons scared to get bad news 20 Driving Down the No Show Rate Getting Started Aher scrubbing the schedule thoroughly, start doing Robust Confirma0on Calls This is more than just a appointment reminder, it s the beginning of establishing a rela0onship with the pa0ent and gathering intel for visit. The ques0ons you ask are important! Pack your own parachute! When making return appointments: Educate pa0ent as to why they are coming back and why it s important Also ask them when THEY want to come back (which day and 0me works best, will they have transporta0on, will they call if they decide not to come). And don t forget to tell pa0ents they will get a confirma0on call and what phone number and 0me works best to call them Educate pa0ents as to what happens in clinic when pa0ents don t show up (you are impacted and access for others is impacted). Provider should do this! Sample Confirmation Call Script 21 7

8 Kentucky PCA Annual Mee0ng October, How to Get Patients to Come In? Talk to them! Give pa0ents appointments WHEN they want them! Explain to them why they re coming in Ask them about their challenges in gelng to clinic and see if you can help them (transporta0on, bus schedules) Follow up with them when they no show Do robust reminder calls to pa0ents - LIVE versus automated 23 Be Nimble and Tetris! Remember, the schedule is only a plan Pa0ents come in earlier and they come in later than expected How can you get control of the schedule and have it reflect the reality of how pa0ents are coming in? Tetrising! 24 Tetrising Getting Started Tetrising Calls: Staff call pa0ents minutes before their appointment to find out their status: Hi, we re calling to see if you are s0ll going to be able to make it to your appointment. If so, what 0me can you get here? If not, we can reschedule you. This can then be a chance to educate pa0ents to let you know if they won t be coming in or that they ll be late in the future 8

9 25 Tetrising Pa0ent Arrivals: Move pa0ents mindfully (as in previous screen) and try to fill all of your capacity (whether it s with walk ins or same days) Con0nuity is priority, but if not possible, access is king! 26 Manage Patient Care Proactively Take control of your schedule by proac0vely managing pa0ent care Rather than filling your schedule with 0ckler reminders that prompt you to follow up with pa0ents, start using your recall features of your EMR Set up recalls for well child checks, paps, diabe0c checks and any periodic appointments and call pa0ents the month they are due for these services to set up appointment versus scheduling it months in advance You know when refills will run out, coordinate appointments to occur right before meds run out (make sure pa0ents know this!) Instead of scheduling lab follow up appointments for everyone, call pa0ents who have normal labs and only bring in pa0ents who really need follow up care Instead of giving appointments for all specialty referrals, track your referrals to specialists and only make an appointment for pa0ents who had abnormal results and need follow up care 27 Managing Care Proactively Getting Started Follow up with no shows Start managing non- compliant pa0ents Work with pa0ents given new medica0ons or new diagnoses Offer phone follow ups Start using you EMR registry features Reach out to hospitals and specialists to arrange more seamless care for your pa0ents Start tracking referrals Print out pa0ent care plans and go over them with pa0ents U0lize behavioral health professionals to manage 2014 Coleman pa0ents Associates 9

10 Establish a Culture of YES 28 A culture of yes means that efforts are now focused on how you can get pa0ents in instead of how to control demand Means abolishing unnecessary triage if a slot is available, it s game! Means elimina0ng the late policy Means gelng rid of so many scheduling rules and control over the keys to the schedule Culture of Yes Getting Started 29 Message needs to come from the top! Start a campaign of yes and let your pa0ents know you re opening up access Give permission and protect staff as they start lelng pa0ents in (tetrising, scheduling) Set access expecta0ons (TNAA goals and produc0vity goals) Follow data daily to see if you re using all of your capacity and if you re not, find out why Huddles 30 Minutes 30 What can you start doing now to open up access? What will you tackle first? Scrubbing? SPS? ê No shows? Communicate with pa0ents (robust conf calls)? Tetrising? Managing care proac0vely? Establishing culture of yes? Break out into workgroups and put together a plan for the coming week to get started 10