Ambulatory care strategy – Right Patient at the Right Provider for the Right Appointment Length – No AI Required

Every ambulatory care clinic seeks to match the right patient with the right provider for the optimal appointment length to maximize revenue and improve patient access. Not much attention is usually paid to ensuring the right appointment lengths are used in the schedule templates. If the appointment is too short, then they are coded at lower levels (2 or 3 vs 4 or 5) and transition care and chronic care management codes are often overlooked. If the appointment is too long, then number of visits is compromised which in turn impacts patient access and providers are tempted to use the excess time for non-reimbursable activities. On the other hand, patients have evolving conditions requiring different levels of care. Some health concerns require specialist consultations whereas others require primary care consultations. Some visits are best suited for MDs whereas others are appropriate for NPs or PAs. Filling up provider schedules is not sufficient. Making sure the right patients are scheduled is equally important. No charge and post op follow-ups are better scheduled for NPs or PAs (or residents/fellows in academic health systems) with the specialist dropping in to ensure patient satisfaction. Consults requiring subsequent procedures or surgery should receive the highest priority as they are time sensitive and contribute favorably to hospital utilization.

It is straightforward to look back at a set of completed appointments and pick out the ones that were better suited to be scheduled differently. Though beneficial it does not solve the problem of getting the right patient to the right provider for the right appointment length. Common reasons why the problem exists are.

1)????? Sub optimal schedule templates. The actual interaction time between the patient and provider for all visit types and primary reason for visit is the key data element required for optimizing schedule slots. Most often this is not available from extracting EMR timestamps. This is best collected unobtrusively using sensors for accuracy, adequate sample sizes and elimination of Hawthorne Effect.

2)????? Lack of adequate support for providers. We must start with the premise that all providers are busy and the best way they can increase patient visits is providing them with adequate support to eliminate non-reimbursable activities. Takt time calculations are a valuable diagnostic tool to determine who needs support. A higher takt time is a clear indicator that the provider needs more support to increase their volumes. Team based pre visit planning, ideally one day in advance, is an essential tool to ensure the assignment of the right patient to the right provider.

3)????? Focus on maximizing visits/RVUs at an individual provider level rather than system wide optimization. To maximize service line productivity there is a need for at least one or two providers to set aside time to focus on building the right Epic templates, workflow, etc. as well as reviewing actionable data. They need to play an active part in implementing a frictionless referral management system that prioritizes the right patients instead of narrow-minded focus on number of visits. The individual productivity of these champions will necessarily be lower than their colleagues, but the overall service line will achieve better results through their efforts.

Every provider must be armed with data pertaining to the top 5 most desirable visit types, usage of CCM and TCM codes and leakage data to outside health systems. This will help them resolve conflicts and help them choose when tough choices are to be made.