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Thursday Jul 18, 2019

Three myths about patient access

Research has shown that one of the most effective ways to improve outcomes and reduce costs is to improve patients’ access to primary care.1 But many practices are going about access improvement all wrong. If your practice defines optimal access in any of the following ways, it may be time to rethink your approach.

Myth #1: Optimal access looks the same for all patients.

Fact: Optimal access means different things for different parts of your patient population. The kind of access a healthy patient requires isn't the same as what a patient with multiple chronic conditions or advanced illness requires. You need to identify and creatively engage these latter patients so that you can reduce their access barriers and their potentially high costs. For example, to reduce hospital admissions due to uncontrolled chronic disease, try offering these patients more frequent access such as e-visits or phone visits with a nurse to improve their care management services. For frequent visitors to the emergency department, emphasize the availability of same-day or weekend appointments and alternative ways to communicate with the practice (e.g., portal messages).

Myth #2: Optimal access requires a visit with the physician.

Fact: Not every patient request or problem needs a face-to-face visit or contact with the physician. Instead, practices should offer patients a variety of access options depending on their needs:

  • Office visits with the physician,
  • Office visits with a nonphysician provider,
  • Office visits with other advanced primary care team members (nurse, care manager, pharmacist, health coach, social worker, behavioral health specialist, etc.),
  • Phone encounters,
  • Online asynchronous encounters (email),
  • Online synchronous encounters (tele-health visits),
  • Gap management (team engagement with the patient present or not).

Myth #3: Optimal access requires complicated rules and scheduling systems.

Fact: In general, reduced complexity makes for a better scheduling system. That means using fewer appointment types and lengths so that any patient can have any appointment slot. Advanced or open-access scheduling allows for some appointment slots to be filled in advance due to patient preference or clinical need, but the majority of appointment slots are left open to meet the day’s demand.

1. Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Aff (Millwood). 2004;23(suppl W4):184-197.


Read the full FPM article: “How to Excel at Access — and Why It Matters."

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Posted at 07:00AM Jul 18, 2019 by FPM Editors

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