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Promoting Patient Access in a Productivity Compensation Environment

Hospital systems and healthcare organizations that employ physicians have struggled to promote patient access. Access issues may result from misaligned compensation and organizational goals, practice operations process or capacity issues as well as a host of other reasons. Compensating physicians on purely a productivity basis may be helpful from a billing and monitoring perspective, but it may not always equate to increased patient access. To improve patient access, leaders should consider implementing the following core foundational techniques to build the patient access strategy with a unified approach, rather than in silos.

Align Physician Compensation with Access Goals

Oftentimes after an organization has tried and failed to implement a patient access strategy, they find misalignment in compensation to incentivize the physicians to improve access. Leaders should start by comparing each physician’s Work RVUs, patient panel size, and volume of new vs. established patient visits to industry benchmarks. Understanding patient panel size will help compare those with high wRVUs but low panel sizes and/or low new patient volumes. This may indicate that the physician is focused on procedures and not necessarily increasing new patient appointments. Benchmarking the wRVU productivity by specialty will allow the organization to evaluate the current state to enable them to develop a strategy to move to a compensation plan that aligns with the organization’s goals.

Implement Scheduling Templates

Physician practices often have what is referred to as a “book of rules” that control the clinicians’ schedules. This unspoken term can cause large variations in the practice from clinician to clinician with the scheduling of patients and, in turn, productivity. To solve this issue, leaders should create standards across all clinicians. Scheduling rules to consider when addressing patient access include protected new patient and same-day appointment slots. The protected new patient visit slots could be released within 48-72 hours of the visit date to fill with a follow-up visit if it is not filled with a new patient.

Patients who have historically “No Showed” one or more scheduled appointments without notifying the practice ahead of time could be purposely double-booked to avoid gaps in the outpatient clinic schedules. The practice should establish defined criteria for a “High Risk of No-Show” patient and develop a plan to accommodate that patient should they and another patient arrive on-time for a double-booked time slot.

Expand Advanced Practice Providers (APP) Role – Align APPs with Supervising Physician

In a wRVU model, holding onto your patient appointment slots is sacred. Therefore, organizations may see a lack of capacity because the physicians are seeing follow-up patients instead of new or acute same-day patients. Educating the physicians on how new patients can increase their wRVUs can be a method to combat this common problem. The wRVUs associated with new patient visits are greater than those of the corresponding follow-up visits of the same level of complexity for medical decision making. Also, the new patient visits are likely to generate orders for additional testing or procedures, which results in even more wRVUs generated by that physician.

Leaders should also focus on expanding the patient panels of the APPs and rotate the APPs’ appointments with same-day and chronic management visits, which frees up time on the physicians’ schedules to see more new or acute same-day patients. This works well when APPs are aligned with a supervising physician because each patient develops familiarity, comfort, and trust with a care team of two clinicians, alternating follow-up visits at defined intervals with the physician and the APP depending on their progress. Typically, patient satisfaction increases when patients are scheduled with an aligned care team.

Understand Current Capacity and Market Share Potential

To grow patient access, you must understand the capacity to take new patients. Leaders can begin this by understanding the capacity by specialty and market. Once the capacity is known by the organization, a strategy can be developed to target new growth areas in the market. It is also helpful to understand where leakage is occurring within the current organization. As a point of reference, Blue & Co. has access to claims data that helps organizations understand the number of unique patients presenting to that organization for healthcare services, and within 30, 60, or 90 days being treated somewhere outside of the organization. If the organization can address any access gaps (i.e., services not offered, long wait times for appointments, etc.), this unique patient “leakage” could be captured by the organization.

Expand Incentive Opportunities to Promote Patient Access

In addition to physician education on various sources of wRVUs, organizations should consider additional incentives for physicians to help steer them towards compliance with a scheduling structure that promotes New Patient Access. To be the eligible for the additional incentives, the physician would need to meet the organization’s citizenship requirements, which should be clearly defined and closely monitored.

Contact Blue about Patient Access Solutions

If your organization is seeking assistance with Patient Access, Scheduling, or Physician Compensation, please reach out to your local Blue & Co. Advisor or a member of the Physician/Hospital Services team below.

Jake Lewis, MBA, Physician/Hospital Services Manager

Crystal Bingham, Physician/Hospital Services Manager

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