Open Access Scheduling

Decrease waiting times and delays in the pediatric office

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FAQs

Would open access improve my life style as a pediatrician?
Yes! Implementing open access scheduling can result in less patient calls after hours, less emergency room visits and hospitalizations, and a more predictable schedule. When patients are able to see you the same day they want to be seen, they are less likely to call you after hours. Also, if patients are seen promptly on the day they call, they are less likely to go to the ER during normal office hours. A patient seen by an unfamiliar doctor in the ER is more likely to be admitted. Finally, one of the most frustrating aspects of being a physician is not being able to leave the office at 5 PM on time when the office closes. With open access, it is rare to have several "add-ons" or "walk-ins" to see at the end of the day. Patients who call for same-day appointments are placed in appointment slots during the regular scheduled day.

Will my staff benefit from open access?
Staff morale is high in practices where when schedulers and receptionists can offer patients appointments the same day. Why? Because patient satisfaction is generally higher and staff do not have to deal with angry parents who want their sick child seen when the schedule is full. Indeed, research has demonstrated improved staff satisfaction after implementation of open access.

Will my patients like having open access?
Several studies have shown improved patient satisfaction from open access. This is not surprising. Most patients are pleasantly surprised when they are offered same-day appointments. Some still prefer to book appointments into the future. However, you are putting the patient in the driver's seat. They decide when it is convenient for them to see you as opposed to the traditional model. Also, by having less "add-ons" or "walk-ins" without a scheduled time, you reduce waiting for the other patients, therefore, making your office more efficient.

My phones are already very busy. Will open access make them even worse?
Just the opposite happens. The phone system is usually a symptom of poor access. People call to make an appointment, but because the schedule is full, they are kept on the phone longer while they are being triaged. This causes a backlog and increase congestion on the phones. Very frequently it is the same people that call day after day to try to get in to see you. This adds to the volume of phone calls and ties up your phones.

In most open access practices, the phones improve as access improves. The phones actually get better with open access.

Can open access improve my bottom line?
Open access affects different practices in different ways. However, all practices can benefit from the reduction in no shows from Open Access - a consistent finding in research studies.

In capitated plans, there are a few benefits. By having more availability in your schedule every day, you are able to increase your panel size and thereby increase monthly revenues. Also, by encouraging continuity of care and having same day appointments, ER visits and hospitalizations are decreased making you eligible for utilization bonuses.

There are also several benefits for Fee-For-Service plans. One of the principles of open access is to maximize each visit. If a child is brought in for a diaper rash but needs a 4 month-old well child check, the preventive care is conducted and the diaper rash is assessed during the same visit. This increases the total RVUs per visit, thereby increasing your revenues.

Open access can also strengthen your practice's financial health by::

Do all appointments have to be scheduled the same day?
Patients can still book appointments in advance. When the patient calls, your receptionist should always offer a same day appointment. However, if the patient prefers to book the visit into the future for their convenience, it should be up to the patient. If you need a follow up visit, you can book that appointment since you know that patient is going to need to be seen in the near future.

Keep in mind that the amount of appointments booked into the future varies with the time of the year. In the summer, before school begins, the majority of visits are going to be well-child checks and sports physicals. These can be booked in advance. Thus, in the summer, your percentage of pre-booked appointments might be less. The opposite is true in the winter. Most of your visits are going to be sick visits. Your same-day appointments will probably comprise more of your schedule.

Can we still schedule well-child checks in advance?
Yes, but just how far in advance is something your practice needs to decide on as a group. In our experience, most pediatric practices find that booking further than 4-6 months in advance is not necessary if patients are assured that when they do call, they can get an appointment right away.

What if the patient calls at 4:30 PM and wants to be seen the same day?
Your practice needs to have a plan for this occurrence. In some practices, the patient is seen the same day regardless of the time they call. In other practices, anybody that calls after 4:30 PM or 5:00 PM is offered an appointment first thing the following morning. When doing "today's work today," your practice will need to decide when "today" officially ends.

I like this system, but there is no way I can convince the rest of the practice to do it. What can I do?
If you are convinced, start a small pilot study with just your patients. Explain open access to the rest of the group and measure outcomes before and after. After you have small successes with your pilot, it will be easier to spread these changes to the rest of the group.

This open access sounds great, but it looks like a lot of work to set it up, and I'm very busy already.
It does take significant effort, but with one or two hours a week you can probably implement many components of open access. It is most efficient if you work as a team with nursing and administrative staff in your practice. Start with a small pilot with maybe just one physician, and then spread the changes you have piloted to the rest of the group. The benefits will greatly outweigh all the time that you put in initially.

FAQs developed by Xavier Sevilla, MD, FAAP. Dr. Sevilla is the 2003 Honorable Mention of the AAP Steering Committee on Quality Improvement and Management Annual Quality of Care Award. Dr. Sevilla was recognized for effectively implementing open access scheduling in his migrant office in rural Florida. He has also assisted pediatric practices across the country with open access implementation.

Getting Started