Solving the Access Problem in Cardiovascular Practices

Thursday, January 18, 2018 | Pat White

Is there one true driver for cardiovascular success? This is a question I get asked frequently. Or, sometimes, the question is about multiple drivers, depending on a group’s individual circumstances. In response, I often quote the unknown author, “When you have seen one cardiology practice, you have seen one cardiology practice.” It may not be easy to find, but common drivers do exist.

I was reminded of this when I listened to Dr. Tim Logemann, a cardiologist at Aspirus in Wausau, Wisconsin. I was impressed with his statement that he realized one day he had been treating symptoms— heart disease, hypertension, diabetes, and many others—when the real culprit was obesity. He treated obesity and impacted the symptoms.

Similarly, when thinking about a CV program, is there one driver that can be improved above all others, or at least given priority, that impacts overall success? The answer is “Yes,” and it is “access.” In fact, a survey of 183 C-suite health executives ranked it number one. Corroborating this finding, our consultants will tell you that a common problem among cardiovascular programs is access to services. Long waits for new and return patients is common. Some physicians are literally proud that patients have to wait two months for an appointment with the feeling that it makes them seem important. Unfortunately, long waits will invariably mean that you are losing business. And poor access for new patients means your practice is not growing.

The MedAxiom membership data clearly show a strong correlation between the number of new patients to the practice and high performance in many other important areas. Groups who see a large number of new patients tend to do better financially, have better Work RVU performance, and do more procedures (but not more procedures per patient seen – an important distinction). As new patients feed the practice, everything grows with it. And new patients will increase your panel size. Dealing in a population health environment where patients are attributed to you brings risk of having a few outliers, which can negatively impact your profile. The larger your panel size, the greater likelihood your profile will not be impacted as severely. In other words, there’s safety in numbers.

Twenty years ago we said that to satisfy your referral base, you had to think of The Three As: Ability, Affability and Accessibility. Our relationship with our referral base has surely changed. We don’t see them rounding in the hospital anymore so Affability is not as critical. And it’s safe to say that referring physicians likely assume that Board Certification in the given specialty is a decent indicator of Ability. So what sets a cardiovascular program apart is, increasingly, access. This explains the rise of easy access urgent care centers like the CVS Minute Clinic.

Let me highlight a great example of how improving access can make a difference. Minneapolis Heart Institute initiated a program to make access extremely convenient. They developed a phone app that is available to their referring physicians. A touch of an icon in the app results in a call to a cardiologist whose sole job for the day is to answer the phone, although they can read echoes and perform other duties during down times. The ease of access has resulted in a significant increase in business. And it’s not just more patients coming through the door, it’s also fewer unnecessary consults, transfers and procedures. They have saved a significant amount of money for the payers in their market while also capturing a larger market share. Are the referring physicians happy? You bet. And they vote with their referrals.

 Here is another example of one of our members, Karen Engelhardt, CEO, Louisiana Cardiology Associates, who tackled the access issue; this short video explains how her group used data to increase patient access, which they did by adding locations and staff. It’s definitely worth a watch.

What gets measured gets managed. It’s another old adage, but it’s true. And I hope you are measuring access. Many of our members measure access in terms of the number of days to a new patient appointment (typically the third or fifth new patient appointment).

Are you dedicating appointment slots for new patients? An easy but valuable calculation is to look at the average number of new patient appointments your practice typically sees in a week and then ask your scheduling department if they consistently have that many new patient slots available to be filled each week. You might be surprised how many weeks you fall short – possibly because your schedule is clogged with too many follow-up appointments or simply because you are not making new patient access a priority.

Do you have a system for handling urgent appointments? When a referring physician office calls for an appointment, are you simply offering the next available appointment or are you asking when the patient needs to be seen?

If you have measured your access and it is not good, how do you fix it? Hire more physicians? Hire more APPs? Both? That is where workforce planning comes into play, but let’s save that for another blog post.

The reality is that access is a multifaceted problem, and it often involves workforce planning, compensation redesign, scheduling process reform and a variety of other tactics. If you are in need, give us a call and we can schedule a practice assessment to help you find the root causes of your access struggles.

 

Pat White, MPH, President of MedAxiom, is a trusted leader and statesman. Pat has been in the health care management field for over 40 years. Prior to joining MedAxiom, Pat was in medical group practice management for 17 years. He spent 13 years with the Henry Ford Health System, including five years as the Administrator for the Department of Internal Medicine. He also served as the Executive Director of Michigan Heart, a 36-member cardiology practice in Ann Arbor.

Pat does senior consulting work and currently serves on the board of the Cardiology Advocacy Alliance. You may contact him at [email protected].

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