Can’t get an appointment with your doctor? Some hospitals are trying to fix that

This article originally published January 9, 2018.

People often gripe about how difficult it is to get a doctor’s appointment.

Now, facing competition from increasingly popular urgent-care centers and a patient population used to receiving on-demand services like Amazon delivery or a Seamless food order, some hospital networks and medical practices have started to offer same-day appointments.

“Healthcare has been a given a bit of pass in how we engage with customers,” said Kenyokee Crowell, SVP of clinical access for Allegheny Health Network, a hospital system based in Pittsburgh, Penn., that started guaranteeing same-day appointments in early 2017.

If you want to get your oil changed or your tires rotated this week, and someone tells you to come back in March, “you would tell them to pound salt and go somewhere else,” she noted.

Why now?

In 2016 only about 20% of medical practices used open-access scheduling (another way to describe same-day appointments), and just 56% offered evening and weekend appointments, according to data from the National Study of Physician Organizations.

The concept of open-access scheduling was until recently “a cool idea,” Dr. Ateev Mehrotra, associate professor of healthcare policy and medicine at Harvard Medical School, told Health Affairs last month. “Now I’m hearing a lot from a more competitive pressure perspective.”

A number of factors are pushing healthcare providers to reconsider their scheduling practices. This includes the rise of telemedicine, growth in the urgent-care and retail clinic market, and longer delays for patients waiting to see a primary-care doctor. (The Health Affairs article said patients waited an average of 29 days in 2017 for a routine physical. In 2009, it took 20 days.)

In the case of Allegheny, the hospital system operates in Pittsburgh, one of the most competitive healthcare markets in the U.S. Starting in January 2017, it ran a marketing campaign using radio, bus wraps, and TV ads to promote its guarantee for access and in many ways defend its turf.

All doctors in the Allegheny system have access to a patient’s electronic health record, so a same-day appointment, even if it’s not with the patient’s regular doctor, still means continuity of care, Crowell said.

That’s a similar stance for One Medical, a concierge medical practice, that also offers same-day appointments. “It allows patients to meet with their primary care physician (or an One Medical provider) rather than use ER or urgent care,” a spokeswoman said in an email. “This gives patients a more seamless experience.”

"One Medical’s same-day appointments allow our members to meet with an One Medical provider rather than use ER or urgent care,” Dr. Jeff Dobro, One Medical’s chief medical officer, said in an email. “All of this provides our members a more seamless experience.”

Geisinger, a hospital network and health plan based in Danville, Penn., is actively pushing for more same-day appointments. Nearly half (29,000) of all 63,000 primary-care appointments in October were scheduled the same day. “We know that delays … have bad financial consequences,” Geisinger CFO Kevin Brennan on Monday told investors at the J.P. Morgan Healthcare Conference in San Francisco.

How are hospitals setting up same-day scheduling?

At Allegheny, the health network sets a few ground rules. From 7 a.m. to 11 a.m. each day, patients can call in, and the hospital promises to provide an appointment sometime that afternoon. That doesn’t mean a patient gets to see his or her doctor or pick what time works best. It means that there will be a doctor, a nurse practitioner or a physician’s assistant, depending on the reason for the appointment, ready to see him or her.

What happened?

Total call volume increased 25% in 2017, and calls to the network’s appointment line—412-DOCTORS, a number used in its promotional materials—jumped 164%. Crowell points out that while not all of that call volume could be attributed to same-day scheduling, the hospital system did schedule 154,000 same-day appointments in 2017, the same year the program launched.

“People have accepted that, to get a good doctor or good care, you have to wait for it,” Crowell said. “If you change that mindset, you can show patients that it can be done differently.”