Is Open Access/ Advanced Access for you?

There’s a big push to do a different kind of office scheduling, called “open access”, or “advanced access.” In essence, the idea is to be able to see ALL of your patients that call in on Tuesday, on that Tuesday. That’s ALL. Physicals, immunizations, emotional crises.

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Is Advanced Access/ Open Access for you?

Dean Gugler via Compfight

At least, that’s in its purest form. Many do a mix of booked appointments, and open access. This is one of those techniques that you may be able to introduce to your practice to impact wait times, ER presentations, and even admission rates to hospital.

One of the most important aspects of this technique is the effort to pack as much into the visit as possible, thereby eliminating the need for another appointment. See the power point presentation appended below for details. In essence, if a person comes in for their sore throat, you do their blood pressure, reorder their pills, check if lab work is needed, and order a FOBT. If a woman comes in for that sore throat, and it’s 4 years since her last pap, it’s pap time.

Right then.

It’s a bit shocking for some folks. We’ve all worked with associates that have a one problem per visit policy. These physicians are where this technique will work the best. Physicians that have been unintentionally churning visits by artificially fragmenting the health care experience into thousands of jigsaw puzzle pieces will see their demand drop precipitously: a patient that used to have to use several visits to get everything done will be all polished up in one.

See Dr Paul Cano’s experience, below. This experienced physician with a moderately large practice was able to hack down wait times, and actually end up freeing personal time by doing this technique.

You’ll see that it requires “buy in”, by not only patients, but staff. He leads you through how he got the job done, the prep work, the letter he sent out. The presentation below appears long at over 80 slides, but many are photos, or graphs, or shots of day sheets (it’s all been appropriately semi-obliterated to protect privacy, don’t worry). The slide show has to be that long to appreciate the gritty detail.

Reading this presentation again, as I put up this blog, almost made me want to jump on the open access/ advanced access bandwagon again! I tried this for over eighteen months a year or two ago, and found it a dismal failure for myself. My practice is a bit larger, and I have always been one to try to “multi-pack” a patient visit. Despite a great deal of understanding from my family, and support from my office staff, my days swelled to thirteen, or fourteen hour affairs. Often I missed dinner, a huge trauma for someone as food oriented as yours truly… I wrote a bit about this before, see my blurb on PLCs

But that doesn’t mean it won’t work for you! This really does make a terrific amount of sense, as you can infer from my year and a half trial. The theory goes that if you just keep multi-packing, if you just keep seeing every patient that calls that day, that the volume will drop. It did for me, also, but it took several months. After several months, if I kept to my five full office days a week, I could get home for dinner. Usually. However, any holiday was traumatic… It was back to 13, 14 hour days for a couple of weeks. Eventually, I, and my family, just gave out.

If you’ve got a bit of a smaller practice, if you’re young and starting out, this may just be the ticket for you. A couple of months of heavy hitting will likely lead you to a shorter work week, and happier, healthier patients.

Please give the power point below a look:

Advanced Access, SRPC May 2011

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