Top 5 Inefficiencies in Hospital Operations

Posted by James Kanka on February 17 with 131 Comments

In the face of sweeping changes to care delivery due to the Affordable Care Act, concerns over hospital efficiency and access to services are unsurprising. Indeed, though more Americans are insured today than ever before, over 20% report that nonfinancial barriers have led to “unmet needs or delayed care,” with accessibility to hospitals cited as one of the primary reasons. That’s despite the fact that admissions are, in fact, continuing to go down.

So, what’s going on here? The answer is complicated.

Shortage of clinicians
The dearth of primary care doctors and nurses was anticipated, and solutions have been suggested and tested, including the greater use of physician assistants and nurse practitioners to handle lower-level care decisions. But by some estimates, the shortage will become even more pronounced in the next five years — upwards of 20,000 missing primary care providers by 2020, and as many as 90,000 by 2025.

With 16.4 million newly insured and sometimes chronically ill patients now covered under Obamacare, bottlenecks of quite sick people are likely to continue to occur in hospitals across the country. And a clinician shortage affects more than just efficiency. For obvious reasons, well-staffed hospital departments see lower patient mortality rates and higher care quality scores, too.

Poorly-managed patient flow
For over a decade, smooth patient flow has been recognized as one of the most critical factors in preventing overcrowding, delays in care delivery, and maintaining efficiency in hospital settings. Yet data shows that hospitals, particularly emergency departments, remain overcrowded and marked by lengthy average wait times. Part of this is certainly attributable to the ongoing provider shortage.

Lengthy hospital stays, or delayed discharges
Whether because patients aren’t being discharged as soon as they can be, hospital inpatients are sicker than ever before, or planning and coordination among specialists is poor, the length of the average hospital stay has been gradually increasing, standing in 2015 at just under five days. These longer stays aren’t just costly, running between about $1,800 and $2,300 patient per day — they also cost hospitals beds, resulting in fewer spots for inbound patients.

High readmission rates
Despite the provisions of the ACA’s Hospital Readmission Reduction Program, which implements Medicare payment reductions for hospitals with too many readmissions, the number of hospitals being penalized for 30-day readmissions were higher in 2015 than in prior years. What’s causing this “u-turn” or “revolving door” syndrome? According to a report by the Robert Wood Johnson Foundation, avoidable readmissions often occur because inpatient care quality and care coordination is poor.

Poor communication
At the root of poor patient flow, lengthy stays, and high readmission rates may well be inefficient communication among care teams. A survey from the Ponemon Institute of more than 400 providers found that poor communication is costing upwards of $11 billion industry-wide. What is causing communication breakdowns? Some point to shortcomings in or total lack of technology — inadequate pagers or wireless connectivity, for instance.

Others blame cumbersome processes, like those around patient admissions and transfers. The same Ponemon survey revealed, for example, that more than half of the amount of time required for admitting one patient (51 minutes) was wasted on communication inefficiencies. And it’s not just communication between doctors, nurses, and other medical staff that’s affecting the bottom line. Poor communication between patients and providers has been shown to lead to costly readmissions.

In the face of a multifaceted problem, where do solutions lie? One option may be found in focusing on the “handful” of conditions that are the costliest in terms of time and money to treat, the top five being septicemia, osteoarthritis, complication of device implant or graft, newborn infants, and acute myocardial infarction. Scheduling optimization, including the use of better tools to help schedule outpatient procedures and manage patient flow from department to department, presents another avenue of improvement. Regardless, options would be best sought quickly given the number of newly insured patients sure to enter the market in years to come.

To learn more about models of care efficiency and tools that can help improve care delivery, contact Everseat.

Fast Care Nation: Is Convenience King in Healthcare?

Posted by James Kanka on January 6

Now more than ever, patients expect and covet convenience from their healthcare providers, alongside quality of care and privacy. This is especially true among younger patients, who have become accustomed to on-demand access to all kinds of goods and services, thanks to web platforms ranging from Amazon.com to Open Table. In fact, patients under 40 are almost 50 percent more likely to not even have an ongoing relationship with a primary-care physician, relying almost exclusively on walk-in clinics and other nontraditional modes of primary-care delivery.

Is the focus on convenience good for patients? That depends on many factors. But the phenomenon is here to stay. And many hospitals and practices are coming to understand that inconvenient scheduling is increasingly a competitive challenge. Yet what many don’t realize is that it is also a factor in whether your existing patients will even show up for their scheduled appointments. Truth be told, I have no-showed at my own doctor’s office more than once. A simple phone call would have been nice, and I am not proud of being so inconsiderate. My experience and a little data tells me that I am not alone. One survey of patients who skipped their appointments at a large genetics practice, for example, found that “too busy” and “forgot” were the two most-common reasons given. And the longer patients have to wait for an appointment, the more likely they are to miss it.

Why is convenience rising in importance for patients? And what can you do to make your practice more accessible?

Walk-in clinics are becoming more common
They’re springing up everywhere: retail clinics associated inside big box stores and in freestanding pharmacies like CVS and Walgreens. And there are more to come: big retail pharmacies are investing more heavily in their retail clinic business, spurred by lessening profitability in the sale of medications, which means your competition for patients could be increasing. Indeed, CVS projects operating 1,500 clinic outlets by 2017.

Adding to the allure of visiting a retail clinic is the fact that many publish their prices for certain services outright on their websites — Target lists “convenient same-day care” by a nurse practitioner or physicians’ assistant for “treatment for minor illnesses” at between $79–$89.

And even though these clinics don’t claim to replace primary-care providers, the fact is that many patients simply find them more convenient for minor day-to-day issues, especially if they can’t get in to see you on short notice.

Americans feel more rushed than ever
With Gallup reporting that employed Americans adults work, on average, nearly six days a week, it should come as no surprise that we feel more rushed than ever before.

In fact, American moms, who make most healthcare decisions for their families, report having just 36 minutes of free time per day. With time this strapped across the board among parents and non-parents, full-time and part-time workers, it’s easy to understand why the need for convenience in all things, healthcare included, has risen in recent years.

So, knowing that patients want convenience, particularly as the out-of-pocket cost of healthcare continues to go up and people are feeling more and more rushed, what can you do to make your practice more convenient?

Put the power to book and reschedule appointments in patients’ hands. Self-scheduling is set to explode in the coming years. As many as 64 percent of patients will book appointments digitally by the end of 2019. Offering the ability to use a smartphone or tablet to jump in line to see the doctor — and to be notified immediately when an appointment is available — will help patients feel more in control, and that care is more accessible.

Keep track of repeat no-shows. These patients are inflating the wait time to see the doctor for everyone else. Track who often doesn’t show up or cancels at the last minute, and consider charging them (us!) for missed appointments or deploying a software solution like Smart Scheduling, for example.

Dedicate an hour of the schedule each day to walk-ins. By quarantining time in the regular schedule each day or week and advertising this time to patients as open for walk-ins, you let patients know that they have an option outside of visiting the ER or a retail clinic.

Now, more than ever, convenience is important to Americans in seeking health care. Coupled with accessibility of the doctor, digital services, and good communication, ease of getting an appointment is becoming more and more important to patients. Convenience may not be king all on its own but it has definitely taken a prominent seat at the table.

To learn more about putting the power to book appointments in your patients’ hands and making your practice more convenient, contact Everseat.

Missed Appointments Affect More Than Just Revenue

Posted by James Kanka on December 15

Most physicians and practice managers know that missed appointments are bad for business. How bad? Some experts say that these no-shows and late cancellations cost the American healthcare system more than $150 billion per year, and individual practices between $100 and over $1,000 per appointment, depending on specialty and location.

And these figures reflect just lost revenue, not the additional costs associated with lost staff time and sicker patients. Also hidden behind the numbers is the level of frustration experienced by patients who must wait longer to get an appointment because doctor schedules appear full, even though each day brings a few more unfilled seats.

Yes, last-minute appointment cancellations and no-shows drain your bottom line, but their implications lie elsewhere in your practice, too.

Patients don’t get the care they need
We’ve written before about the myriad of reasons why your patients may not be showing up for their doctor visits — money, nerves, or a lack of convenience or appointment availability all can play a role. And these missed appointments have very real, negative implications for their health.

The scope of the problem is enormous: Some 49 million adults skipped recommended care in 2012 because of cost alone.

Some studies have indicated no-show rates in community practices ranging from 5 percent to 55 percent. These missed sessions disrupt continuity and compromise quality of care for the patients who miss the appointments and for those who “would have been scheduled in those appointment slots,” according to Family Medicine.

Patient satisfaction takes a hit
It’s not just the cancellation or no-show who is negatively affected by a missed appointment — the health of other patients, not to mention their opinion of the practice, suffers too. That’s because every missed appointment could have been filled by another (potentially ill) person, increasing the length of time that patients have to wait to see the doctor.

Captain Kim Decker, chief of the Martin Army Community Hospital Healthcare Management Division at Fort Benning, Georgia, puts it succinctly: “An appointment missed by you is an appointment missed by two.” In other words, the person who misses an appointment is likely to need to re-book, and “whoever didn’t get an appointment initially is also still needing one.”

Frustration is more than understandable. The average cumulative wait time to see a family physician in 15 U.S. markets in 2014 was just shy of three weeks. One Consumer Reports survey of 1,000 Americans showed that “difficulty in getting an appointment when sick” ranked among the top five biggest complaints that patients have about their doctors.

Further, the problem may actually compound itself: some studies indicate that no-show rates increased and the “likelihood an appointment would be kept decreased” the further in advance an appointment was scheduled. In other words, missed appointments cause longer wait times, and vice versa.

Your staff loses valuable time
When patients do call to let a practice know that they won’t be able to make their appointment, the great scramble to fill the now-vacant appointment begins. If there is no good system in place to keep track of people on the waiting list hoping for an earlier appointment, the result could be duplicative phone calls, double-booking, or worse, patients could fall through the cracks.

Spending valuable time on a wild goose chase for patients is not cost-effective and takes front desk staff away from their other duties, including greeting and checking in patients as well as communicating with doctors and nurses about the status of the waiting room and more.

Interested in learning more about how to better manage your schedule and reduce missed appointments? Contact Everseat to discuss solutions available to you.

4 Reasons Your Patients Cancel Appointments at the Last Minute

Posted by James Kanka on October 15

The occasional missed appointment happens at every medical practice, and may even feel like a welcome break in an otherwise jam-packed schedule. But last-minute appointment cancellations and no-shows hurt your practice’s finances — and can even take a toll on your patients’ health. By some estimates, missed appointments and last-minute cancellations cost the U.S. healthcare system $150 billion per year. Another study found that, in family medicine practices, cancellations and no-shows represented nearly one-third of all scheduled appointments, with only about 60 percent of those appointments being filled subsequently by walk-ins.

The amount of staff time spent trying to fill last-minute cancellations adds to the high cost and interferes with other priorities, like greeting patients and managing check-in and check-out procedures efficiently. The bottom line? Cancellations hurt your bottom line. Key to reducing them is understanding why patients cancel in the first place. If your practice isn’t doing what it can to remind and encourage patients to attend their appointments, you may be just as culpable for cancellations as patients themselves. At a time when medical liability experts say that missed appointments pose significant legal risks for physicians, reducing cancellations isn’t just good for business — it’s an ethical responsibility.

So, what’s keeping your patients from keeping their appointments?

Nerves
Let’s face it: going to the doctor isn’t at the top of most people’s fun list. But for many patients, fear and dread of the doctor visit result in avoiding, delaying, or cancelling appointments altogether. It’s not hard to imagine the reasons. Doctors can bring bad news. They might tell patients something they don’t want to hear, or lecture patients for putting off treatment, not following medical advice, or engaging in unhealthy behavior. With procedures like colonoscopies, stress tests, and blood work, prepping for the procedure (fasting, for instance) or the procedure itself can be reason enough to call and cancel.

How, then, can you calm patients’ nerves? Understanding and empathy go a long way. Instead of lecturing patients, try to understand why the problem exists and work with them to address it in ways that make sense for their lifestyle. A friendly demeanor matters, too. As the independent research organization NORC at the University of Chicago found in 2014, patients consider listening, attentiveness, a caring attitude, and bedside manner among the most important factors in determining quality of care.

Money
In the first quarter of 2015, only 11.9 percent of Americans were uninsured. But being insured is no guarantee of good care. A late-2014 Gallup poll found that as many as a third of people in the United States say they don’t get the medical care they need because of the cost. In fact, 22 percent of the 828 people surveyed put off treatment for a serious condition due to the expense, up from 12 percent in 2001 and 19 percent in 2013, Gallup found.

The Great Recession might be over, but plenty of patients struggle or aren’t able to pay for medical care. What’s to blame? Rising out-of-pocket costs and employer deductibles, combined with stagnant U.S. wages, are common culprits. So when patients are strained financially, cancelling an appointment last-minute might look like the only option.

Convenience
Hectic work and family schedules can make for a packed day. Studies show, in fact, that U.S. citizens not only work more hours per week than people in any other developed country, we’re also working more than ever in our own history. When the repercussions of taking time out of the work day to go to the doctor feel more serious than the health problem itself, it’s easy for patients to prioritize meetings and tasks over the doctor appointment they scheduled — especially if they aren’t acutely ill. Add anticipated wait times in your waiting and exam rooms, and the motivation to keep appointments can dwindle further down the list of priorities.

Offering early morning, evening, and weekend appointments, your practice can offset the cancellations you receive from harried patients who, despite best intentions, can’t feasibly get there during the workday.

Availability
Is your practice’s waiting list growing? Do your patients have to wait too long to get an appointment? If so, know that these factors affect your cancellation rate. Sick patients frustrated by having to wait a long time to get an appointment will cancel and go elsewhere if another doctor can see them sooner. Practice loyalty flies by the wayside, especially if someone isn’t feeling well and needs urgent care.

Last-minute cancellations come at a high cost to both your practice and your patients’ health. By figuring out what barriers your patients face — and working with them instead of against them — you can take the first steps in creating a system that works for your practice and patients alike.

Want more help reversing the revenue loss and other consequences of last-minute cancellations? At Everseat, we’ve created a mobile and web-based application to solve the problem on all ends. Get in touch or sign up for a demo to learn more.

The Power of Partnerships: Transforming Healthcare Scheduling and Access

Posted by James Kanka on October 12

The idea of patient centered scheduling has arrived. Of course, many courageous advocates and innovative leaders have been there for decades. But a convergence of factors is giving the concept its best opportunity yet to become simply the way we all get the care we need, when we need it. There is no doubt that providers are holding the cards right now. There is also no doubt that no one party in the complex health care system can make this transition alone. It will take the power of partnerships.

A recent report by the Institute of Medicine has validated the argument that there ought to be one place any of us can go to get easy access to all of the providers that we rely on for our health care.

Not sure about this yet? Think about it this way:

The IOM report is titled: Transforming Healthcare Scheduling and Access: Getting to Now. It was requested by the Veterans Administration in response to the widely reported scandal involving scheduling delays that negatively affected the healthcare of more than 100,000 U.S. military veterans.

Among the IOM report’s Findings and Recommendations:

Healthcare in the U.S. must be “patient-centered care” and “timely.”
The consequences of our antiquated scheduling system include “negative effects on health outcomes.”
One of the causes of harmful scheduling delays in our current system is that it is built on “provider-focused scheduling” and not “patient-centered scheduling.”

What if, instead of using Open Table, all restaurants just told their patrons to look for table reservation times on their websites? Not a bad start, but not very helpful either. That’s how we feel about the tremendous progress represented by patient portals and better provider web sites. It is a step in the right direction but can you imagine managing your family’s care by juggling 5, 6 or 7 different provider portals or mobile apps? Good but not nearly good enough.

Here on Everseat’s blog – the Hot Seat – we will continue writing about ideas in “patient centered scheduling” that leading researchers, thinkers, patients and providers all over the country are developing. We are proud to partner with many of them.

This week we are pleased to announce the launch of our partnership with athenahealth and its “More Disruption Please” (MDP) program. Together, our two companies will work to connect athenahealth’s growing network of more than 67,000 health care providers with the capabilities of Everseat to offer patients easier scheduling access and real-time notifications about open appointments.

We look forward to working with any patient, provider or practice management organization on making people healthier by making patient access easier.

Thanks to our partners at athenahealth, we will be working with more providers and patients than ever. We look forward to helping everyone get better results.

Read more about Everseat’s partnership with athenahealth and about our capabilities that could make a difference for your practice or for your family.

The Patient Will Indeed See You Now – If You Really See The Patient

Posted by James Kanka on September 30

In the United States, the public still puts more trust in nurses and doctors than in any other two professions. But the patience of patients trying to get an appointment is wearing thin. We all know the feeling of relief upon hearing the words, “the doctor will see you now” but thought leader, physician and author Eric Topol stood those familiar words on their head in the title of his recently published book in order to make his point. The Patient Will See You Now, is a book he wrote to shed light on how the doctor-patient relationship is getting better for everyone involved, thanks to…smartphones.

Dr. Topol believes that mobile technology puts patients in the driver’s seat and can both save lives and dramatically improve lifestyles. As a physician he also knows that updating their way of doing business is very good for practice management and patient satisfaction.

There are many apps to enhance chronic care. Physician ratings sites are available at the tip of a finger. Telehealth has arrived too, bringing the exam itself right into the palm of your hand. Scheduling is joining the category and has much to contribute.

In The Patient Will See You Now, Dr. Topol acknowledges that scheduling appointments is one of many categories where a patient has long been expected to accommodate the needs and norms of a busy doctor and his or her office. Consider the original 1847 Code of Ethics of the American Medical Association, which Dr. Topol quotes from in the book’s first chapter:

“[p]atients should .. avoid calling on their medical adviser unnecessarily during the hours devoted to meals or sleep. They should always be in readiness to receive the visits of their physician, as the detention of a few minutes is often serious inconvenience for him.”

There is a growing consensus that getting a convenient appointment simply has to be made easier, given the computing and communication power most of us are holding in one hand. Serious studies including a June 2015 report from the Institute of Medicine are placing the blame for delays in access to care on scheduling systems that benefit providers more than they do patients.

Study after study about smartphones shows that almost everyone has one, and we almost always have them by our side. And smartphones may be the first technology to truly cross the digital divide, reaching equally high levels of penetration in traditionally underserved communities.

Why not tackle the challenge of scheduling appointments via smartphone if we are already using this technology to improve efficiency in so many other parts of our lives?

If you are developing a smartphone scheduling innovation agenda for your practice, clinic or institution, here are three things to think about while you finish Dr. Topol’s thoughtful book:

Don’t just put an appointment booking tool on your website (even if it has a mobile format option). After all, that merely carries the same old relationship and dynamic over to the internet and fails to turn the new technology into an opportunity for real improvement.
Think about allowing a patient to indicate the times she or he is available, and let your office respond rather than doing it the other way around? If the result is you are seeing more patients and seeing them at times more closely tied to the needs of their health, everyone is going to be pretty happy.
Don’t go it alone. There are discussions emerging among all of your professional groups about how to tackle the future of scheduling. Get connected to the conversation.

There are many new terms for this kind of thinking. Participatory care and patient-centric care are two you will see increasingly. Find the language that works for you and make it a part of your practice. Maybe you like the nice ring that Dr. Topol’s turn of phrase has: “the patient will see you now.”

Tag: patient-centric care