Why technology isn’t solving patient appointment issues

Information technology is playing an increasing role in enabling faster patient scheduling for physician appointments, but a recent study suggests that other human factors intervene, actually slowing down the process.



The findings suggest that workflow and attitude adjustments also are important in speeding the appointment process, which is likely to become more important as providers take on more risk for patient care—treatment delayed, in many cases, is believed to drive up care expenses as the conditions of patients worsen over time.

An article in the New England Journal of Medicine concludes that information technologies, such as scheduling applications, secure messaging and telehealth visits, can play a role in speeding up appointments. However, other factors, including old-school physician beliefs, can contribute to long waits by patients, who may suffer physically and emotionally from delays.

For instance, physicians often cite that long wait times for appointments are indicators of their professional excellence, say authors Jaewon Ryu, MD, executive vice president and chief medical officer at Geisinger Health System, and Thomas Lee, MD, chief medical officer at Press Ganey and a Geisinger board member.

“Physicians and practice administrators rationalize delays by noting that they’re already working flat-out and demand for their services is simply too great,” the authors say. “Most deny that they like having long waiting lists, but when their lists shorten, they worry that competitors are taking their business.”

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Physicians also are likely to believe that the existing fee-for-service payment structure means open slots on the schedule translate to no revenue coming in, while they see their expenses mounting, especially if their practice isn’t busy.

But on the flip side, the longer patients wait, the more likely they won’t show up for the appointment. Physicians may then double-book appointments, but that can backfire if everyone shows up. A long wait for an appointment also can result in a patient getting sicker and winding up in the hospital at far greater cost to the healthcare system, the authors note.

Data collected at Geisinger found that longer waits for specialists led to higher costs for Geisinger Health Plan but higher revenue for providers. Healthcare managers would not deliberately allow patients to wait and get sicker to enhance revenue, but when resources are scarce, it’s difficult to invest in projects that appear to have a negative return on investment, which could include information technologies that automate or otherwise improve appointment processes.

“The painful reality is that the fee-for-service system rewards long waits and overbooking to squeeze in sicker patients,” the authors argue. “The system does not reward providers who organize care to reduce waits for all patients, even though that might keep some patients from becoming sicker. And that may be why most providers have been slow to invest in systems that might reduce waiting time.”

But some organizations are adopting other strategies even if the return is negative to gain a competitive advantage, Ryu and Lee contend. “When the Cleveland Clinic started offering same-day appointments in 2011, other providers quickly realized that they risked losing patients if they didn’t offer more timely access.”

Now, that dynamic is changing again with the advent of value-based payment models that reward providers for timely access and care. And, preventing a $15,000 hospitalization through early intervention is satisfying to clinicians, Ryu and Lee remind their peers.

The article is available here.