The access imperative

Long patient wait times, frustratingly high no-show rates, lack-luster call center performance, and under-utilized physicians—do these traits sound familiar? Although a small set of provider systems have boldly declared that they will guarantee same- or next-day outpatient access, the more common experience across the United States is long wait times and poor access to care. Given the pressures that reform and other industry changes are bringing about, including the shift of service volumes to the outpatient setting and increasing customer expectations, the ability to provide timely, consistent, and convenient access to outpatient care is becoming an increasingly important differentiator for providers. Furthermore, the transition to risk-based payment models requires timely access to outpatient services to ensure that patients are seen in the right setting at the right time.

Many provider executives believe that improving outpatient access requires substantial investments in clinicians, technology, infrastructure, or all of the above. However, our experience suggests that many systems can achieve substantial improvements with their existing resources and, as a result, can generate both significant near-term financial returns (often, a 10- to 20-percent improvement in outpatient profitability within 6 to 12 months) and improved customer satisfaction.

However, capturing this opportunity requires two distinct shifts that the typical employed-physician group could find both culturally challenging and operationally difficult to achieve: a change from provider- to patient-centricity and a move from highly variable practice operations to the disciplined adoption of best- practice operational standards. To succeed in the future, physician practices will need to have the customer orientation of a five-star hotel and the operational discipline of a factory floor.

Why access is important

Three dynamics are unfolding that make good outpatient access a top strategic item for provider CEOs:

1. The need to transform outpatient performance to enable future growth. Most provider systems lose large amounts of money on their employed-physician groups. (For example, the Medical Group Management Association has estimated that the median loss per employed-physician FTE is about $170,000 per year.¹ ) The losses are due, in part, to a decline in physician productivity post-employment. Although these losses are often offset by referred inpatient volume, they make it difficult for systems to fund future physician practice growth and capture new patient volume. Improving outpatient access can be part of the answer— our experience has shown that better performance on access often facilitates improved clinician productivity (particularly in utilization, in which we have commonly seen improvements above 20 percent).
2. Increasing consumer expectations and choice. Consumers today are making a growing proportion of healthcare decisions on their own. For example, a recent consumer survey found that about 55 percent of respondents switched providers between instances of care, without a recommendation from the original provider.² As reform further stimulates consumer expectations, access will increasingly become a source of differentiation. Consumers will demand that provider systems offer them both good basic access (short or no wait times) and more advanced amenities (e.g., convenient online booking, “concierge” access services).
3. The coming shift toward risk-based models that link payments to cost, quality, and patient satisfaction. Some provider systems are already moving toward care models that require them to take on the risk for managing total patient costs and quality of care. Maximizing the use of existing capacity to offer rapid (e.g., same- or next-day) access to outpatient care is important for keeping patients out of high-cost care settings. Furthermore, successful implementation of patient-centered medical home (PCMH) models requires providers to offer same-day visits, 24-hour nurse lines, and after-hours clinics.

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