Innovative Scheduling Models

Providing high quality care does not count for much if it cannot be readily accessed. Ensuring that patients and families can access the care they need, when they need it, is an important part of providing a medical home.

The most common scheduling methodologies are fixed appointments and modified wave scheduling. These formats apply to the timing of appointment scheduling. There are also open access and modified open access—these apply to the style of scheduling (also refer to Setting Office Hours and Best Practices). 

Open Access/“Same-day” Hours 

​Open Access Scheduling is also known as “same-day” scheduling. These appointments are scheduled for the same day that the patient requests an appointment. Each provider’s schedule should have a reserved block of time on their daily schedule to accommodate a specific number of open access appointments. In addition, open-access appointments should not replace visits with the patient’s primary care provider.    

Benefits to open access scheduling can include:  

• Decrease in appointment no shows and cancellations   
• Appointment reminders are not required  
• Patients and families are happier because they can be seen quickly  
• Average appointment times tend to be shorter due to the visit focusing primarily on main issue  ​ 

The Agency for Healthcare Research and Quality outlined implementation steps for Open Access Scheduling in their CAHPS Ambulatory Care Improvement Guide. These steps include:  

• Measure supply and demand as precisely as possible
• Establish a test team of providers who are willing to try the system out 
• Reduce the backlog of appointments. This may take 6 to 8 weeks of extra work. To facilitate this difficult task, practices may want to set a target date and agree that visits will not be pre-scheduled beyond that date. Another useful recommendation is to apply the concept of “max packing.” The idea is to reduce the demand for ​future visits by taking care of any upcoming preventive or screening needs whenever the patient comes in for a necessary visit regardless of the reason for that visit. Simplify the appointment types and make them all roughly the same length. One recommended tactic is to minimize complexity by limiting the practice to three appointment types: (1) personal, where the patient is seeing his or her physician; (2) Team, where the patient is seeing someone else on the clinical team; and (3) unestablished, where the patient does not yet have a specific physician. Appointment times can also be specified as either short or long, where the long appointment is roughly equivalent to two short ones.  
• Develop a contingency plan for days (or parts of the day) when demand far outstrips the availability of physicians. This plan should identify who can supplement or substitute for each physician, if and when needed. Also, the group should be proactive about planning for those times when they can predict increases in demand, such as visits for school physicals or flu shots. 
• Reduce demand for one-on-one visits with patients. One helpful tactic is to identify and address sources of unnecessary visits based on outdated clinical protocols, such as routine follow-up for urinary tract infections. Another approach is to implement group visits to better manage care for patients with the same chronic condition. Finally, clinicians can use the phone and email effectively to address concerns that do not require a visit.
• Once the practice is able to offer same-day appointments, it should assess its effectiveness by measuring appointment availability on a daily basis (e.g., third next available appointment).

Walk-in/On-demand Hours

Walk-in or on-demand hours are just that; times during the day/evening when the practice allows for patients to walk-in and be seen by a provider without a scheduled appointment. Patients are typically seen in the order in which they arrive or based on the severity of their medical needs. Walk-in patients are typically assessed first by clinical staff (eg, triage nurse, medical assistant) to evaluate the medical need prior to seeing a provider. It is important to note that the patient wait times will also depend on the volume of patients at any given time. As with open-access/same-day hours, walk-in visits should not replace visits with the patient’s primary care provider. Some practices even reserve walk-in hours for new patents to generate more business.

Extended Office Hours

Extending the hours of operation can help alleviate unnecessary patient visits to the local Emergency Department, Urgent Care Center or retail-based clinics for minor medical issues. In addition, offering extended hours can assist in retaining current patients as well as attracting new ones.  

Consider the following six key questions when deciding if the pediatric practice should offer extended office hours: 

1. Understanding the Patient Population –  Is there a patient need for extended office hours? Are the later afternoon appointment slots (ie. after school hours) filled well in advance? 
2. Understanding the Marketplace – What are local competitor’s offering? Do they provide early bird, evening and/or weekend (Saturday/Sunday) hours? 
3. Cost/Overhead –  If operating out of a rented office space, will the building be open for patients to gain access to the practice? If not, will the building allow and charge an additional fee for extending the hours of availability?
4. Breaking Even – How many patients would need to be seen to break even? 
5. Marketing – How would extended hours be marketed (eg social media, print, office signage, on-hold messaging, etc)? What will be the cost associated with advertising? 
6. Adequate Staffing – Are there enough providers and support staff to facilitate the additional hours, or would a shift in staff schedules or extra support be required? If more staff are required, how many would be needed and how much would it cost? 

Staff should be given clear guidelines on scheduling during extended hours. Factors to consider include: 

• What method will be used to schedule patients (eg clustering, wave, modified wave, etc). 
• Will new patients be seen during extended hours, or just established patients? 
• Will some appointment slots be left open to ensure same-day access?  

Extending the office hours not only has the potential for increasing satisfaction among patients and families, office team and physicians, but can also improve practice revenue.