Consumers can get same-day service in nearly every industry, but that kind of prompt action has not always been available in healthcare outside of emergencies. That’s changing with the growth of same-day scheduling.
Same-day scheduling sets aside appointment blocks for patients to see a doctor on the same day rather than needing to schedule days or weeks in advance. This type of scheduling gets patients seen quicker, improves patient satisfaction, brings new patients to physician practices, reduces patient no-shows and reverses lost reimbursement. However, smooth implementation requires adequate preparation and protocols to address issues like uneven demand and triage needs.
Patients often want to see their doctors on the same day if they’re not feeling well. Having to wait days or weeks to see a doctor leads patients to head to emergency rooms, retail clinics and urgent care centers — or even avoid care. Instead, same-day scheduling is getting patients to their doctors promptly.
Kenneth Hertz, principal of MGMA Health Care Consulting Group, told Healthcare Dive that same-day scheduling is benefiting both patients and physicians. Hertz estimates that practices that offer same-day scheduling provide about four same-day slots per provider per day.
“The patients feel taken care of and important, and the practice develops a reputation for being accessible and caring for their patients in a timely manager,” said Hertz.
The move to same-day scheduling comes as patients face longer wait times to see doctors. Americans wait an average of 24.1 days to get a new patient appointment in 15 major metropolitan areas, which is a 30% increase since 2014, according to a recent Merritt Hawkins survey.
You might immediately blame the Affordable Care Act (ACA) adding 20 million more Americans with health insurance for the longer wait times. However, a JAMA study published this year said the reason for long wait times is physician practice inefficiency. This inefficiency includes “ineffective office scheduling and high rates of patient no-shows,” according to the JAMA report.
One solution to this problem is providing same-day or even walk-in patients, said the report.
Why same-day scheduling?
The rise of same-day scheduling is not just about patient convenience. It’s also about a physician’s bottom line.
Physician practices lose out on missed appointments. The problem often arises when a patient books an appointment months in advance and then forgets the appointment. CrossCHX said patient no-shows can cost individual practices an average of more than $3,600 a week.
Having same-day appointments also reduces barriers to care. Patients are more apt to get care at a lower cost location, such as a physician’s office, if they can see their doctors on the same day. Otherwise, they might head to an emergency room.
“The patients feel taken care of and important, and the practice develops a reputation for being accessible and caring for their patients in a timely manager.”
Principal of MGMA Health Care Consulting Group
Doctors are also seeing same-day and open access scheduling as a defense against retail clinics and urgent care centers, which offer walk-ins.
“This is about improving access to care for the doctor’s patients. This can help alleviate lost productivity/wasted time. This helps ensure a flow of patients into the practice, and enables the practice to address existing patients more efficiently while opening slots for new patients — the lifeblood of the practice,” said Hertz.
Moving to same-day scheduling
Transitioning to a calendar system that allows for same-day appointments requires research, planning and physician buy-in. When exploring a move to same-day scheduling, Hertz said the practices need to understand the practice’s no-show and cancellation rates and how it’s affecting the business. They then need to assess their same-day scheduling needs, evaluate the provider fill-rate and determine how many open slots they should provide.
With that data in hand, leaders need to get buy-in from physicians. Hertz said many physicians understand that same-day scheduling is about helping the patient and improving productivity.
However, same-day scheduling is a change for physicians, especially those who are used to knowing their schedules weeks in advance.
When Allegheny Health Network looked to implement same-day scheduling, the network met with physicians in large groups and small advisory groups to discuss the issue and program. This included reaching out to each service line’s leadership, Kenyokee Crowell, senior vice president of clinical access, told Healthcare Dive.
Allegheny Health Network, a Pittsburgh-based system with about 1,700 physicians spread over more than 200 practices, launched same-day scheduling in October 2016 for primary care physicians (PCPs). The company didn't publicize the launch, so it could learn and tweak the program before fully launching same-day scheduling. Patients would find out about the same-day option when they called the call center.
Allegheny created a same-day appointment type in the Epic scheduling program and the same-day slots come online at 12:01 a.m. each morning. Its program offers same-day appointments to patients who call between 7 a.m. and 11 a.m. Monday through Friday. If they call after 11 a.m., patients may still find an open same-day appointment slot, but it isn’t guaranteed.
Patients must call to schedule a same-day appointment or request one online, and then a staff member calls them. Allegheny’s same-day process doesn't have an online or app way to schedule same-day appointments at the moment, but that may change in the coming months or years. In order to implement same-day scheduling, the health network hired additional call center staff and added mid-level support for the practices.
The health network, which provides care to the Greater Pittsburgh area, learned with PCPs before adding 20 types of specialties in January of this year. After a few weeks, the healthcare company launched a full marketing campaign about the same-day option and blanked the Pittsburgh area.
The system’s decision to offer same-day appointments was made to provide greater access for patients, but Crowell said it’s also a new patient driver. Nearly a year since the PCP soft launch, Allegheny Health Network has scheduled about 120,000 same-day appointments through August. About 8% of same-day PCP appointments are new patients and between 25% and 30% of specialists’ same-day appointments are new to the specialty.
Crowell said it’s resonating with patients. Patients have told Allegheny Health Network that same-day appointments changed their lives because they didn't have to delay care.
Allegheny is still fairly new to same-day scheduling, but One Medical has offered a similar program since it launched in 2006. Dr. Andrew Diamond, a physician at a One Medical location in San Francisco, estimated that about 30% of the organization’s appointments are booked the same day.
A major difference for One Medical is that patients can schedule online, through an app or by calling the company. One Medical also offers phone calls and video visits that don’t require an office visit. In addition, the healthcare company avoids booking appointments too far in advance to reduce the likelihood of canceled or missed appointments.
Diamond told Healthcare Dive that same-day scheduling solves one of the most frustrating aspects about healthcare — not being able to see your doctor promptly.
“People often need care today, not in three weeks,” said Diamond. “We saw that as a major problem we could fix.”
Same-day scheduling can lead to better patient satisfaction, and improved efficiency and revenue flow, but there can be speed bumps along the way.
“People often need care today, not in three weeks. We saw that as a major problem we could fix.”
Dr. Andrew Diamond
Physician at One Medical
One challenge involves creating protocols and a triage system for same-day appointments. Hertz said the systems that go to same-day scheduling need to figure out the parameters to determine which patient situation is deemed urgent, so they can get a same-day appointment.
“One of the keys is to develop a clear system/method for triaging the patients who want or need to come in to determine priorities,” said Hertz.
Crowell said Allegheny Health Network quickly learned it needed emergency escalation protocols, as well as knowing when to add same-day specialist appointments. Some days, such as after a holiday weekend, brings higher demand for specialists, so the system needed protocols and added same-day inventory on those days.
Crowell said another challenge is figuring out daily demand for PCPs. For instance, the system found Mondays have the highest demand for same-day appointments, while Tuesday, Wednesday and Friday are slower. So, Allegheny needed to provide more same-day slots on Mondays than other days.
One other challenge involves health insurance and referrals. Even if a practice has open same-day slots for a specialist, that doesn't matter if the patient has an insurance plan, such as an HMO, that requires the patient get a PCP referral before seeing a specialist. Crowell said Allegheny has found that’s a common issue for patients seeking a same-day specialist appointment.
Future of same-day scheduling
Same-day appointments are here to stay as healthcare slowly lurches toward consumerism, but the future is likely more online and in apps rather than call centers. An Accenture report predicted 66% of health systems will offer online self-scheduling by 2019 and 64% of patients will go online to schedule appointments. This will allow health systems to decrease call center staff and other resources connected to scheduling. Accenture predicted this will save $3.2 billion nationwide.
Healthcare experts expect same-day scheduling will expand in the coming years, as systems look to improve patient access to their practices and face more competitors.
“Access continues to be an issue for healthcare. As retail clinics and concierge practices increase, practices will need to move in a direction that simplifies and increases patient access to be competitive with the marketplace,” said Hertz.