Open access: Being there for patients without burning out

Jean Antonucci, MD

Jean Antonucci, MD

Patients want access: Can they get health care when they need it? Jean Antonucci, MD, provided an overview of ways to lessen roadblocks to care during the CME session "Tools for Improving Access and Continuity" on Friday at FMX.

Antonucci who operates an innovative family practice in rural Maine, touched on several concepts during Friday's presentation, including open-access scheduling in conjunction with methods such as e-visits and nurse care coordination, that have made her practice more accessible.

Open-access scheduling is at the heart of improved access—when a patient calls and wants and appointment that day, it's available.

"I have seen every patient (who asks) the same day for 12 years," she said. "There are some exceptions, but not many. You can do this. It makes staff happy, it makes patients happy, and it makes doctors happy. I don't know of anything else, other than maybe chocolate, that does that."

If a practice wants to start open-access scheduling, Antonucci said, it begins by determining how many scheduling calls come in each day. Next, find an open future date with a low number of pre-booked appointments. Reserved appointments for that day can continue, but the number of slots left open must match the usual number of scheduling calls. On that day, when people call in to schedule an appointment, they are asked if they want to come in the same day, or they can pre- book for a later date.

"You have to be willing to flex a little bit," she said. "You will have days doing open access where there are gaps in the schedule. MBA's don't like empty slots in the schedule. You know, the phone will always ring again. You can catch up."

Those working for employers will likely face implementation barriers, Antonucci said, but the biggest barriers are the mental ones providers create themselves. Training to improve overall office function is a must she said, as is quality receptionist to handle the scheduling and provide a smooth first contact with the patient.

Unfortunately, open access is still a work in progress.

Antonucci said reported practice outcomes have been mixed because most open- access practices haven't achieved full implementation. Additionally, some studies report decreased patient satisfaction resulting from those patients not getting to see their own care provider.

"Open access does not mean giving them an appointment just to give them an appointment," she said. "You want to give people an appointment they want."

Antonucci advises not having too many different types of appointments. Offer a standard 15-minute visit and perhaps something longer for a well-child visit, for example. She also recommends controlling the size of the patient panel. If the panel size is tough to manage, she said extending the period between revisits is a useful trick.

"How often you bring people in is not cast in stone," she said. "You can do visits with the nurse in-between. You can do phone calls."