Open access

From: "Michelle Eads" <michelle.eads@worldnet.att.net>
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Fri, 4 Feb 2005 19:44:22 -0700
Subject: [Practiceimprovement1] part time w/ open access
Reply-To: Practiceimprovement1@yahoogroups.com

Hi Stacey,

I opened my part time (19 pt contact hours per week, 46 weeks a year) practice July 2003. I’m in the office a little M-F, with essentially a full day on Mon, then tapers down to 2 hours on Fridays. This has worked out very well for myself and my patients. Previously I was in a group working 2.5 days (pt contact time), and was not seeing pts 2 days out of the typical 5 day work week. My new practice’s hours work much better for continuity of care, accessibility, etc, with me being in the office M-F. I’ve been using open-access from the beginning, and it has worked out well. I can almost always see someone same day if requested, but sometimes have to defer a day or 2 for routine things like physicals or follow ups if pt wants to be seen at a certain time of day, etc. I have seen a few patients outside of my normal business hours (maybe 4 since I opened up). Most people understand that I want to be a Mommy too, and have not had any complaints. I am certain to mention my hours when people are checking out my practice, and have it in m y practice brochure. The accessibility is also enhanced by my phone and email care, which many people love. This can help reduce the strain on the schedule of face-to-face communication if it is not needed. I would probably bring in more money if I did not do this, but it works well for me. It may be difficult to do open access if you are not in the office M-F.

Michelle A. Eads, M.D.

From: Larry Lindeman <llindeman@mac.com>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Sun, 7 May 2006 09:19:03 -0500
Subject: Re: [Practiceimprovement1] Patient internet use
Reply-To: Practiceimprovement1@yahoogroups.com

I think that many people are nervous about taking call 24/7 but it really is much easier than sharing call. I have 2 other docs who are available when I am out of town or if I'm in a situation where I really can't take calls but I think that I have signed out only once every 3-4 months.

I have been surprised how few people use appointment quest to make their appointments, maybe about 10% . I tend to have a younger computer literate group of patients who appreciate the e-mail reminders but prefer to call for appointments. I even offer a coupon for a free cup of coffee at the coffee house across the street to those who make their appointments online but that hasn't made a difference.

Larry Lindeman MD

From: Nancy Guinn <NGuinn555@comcast.net>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Sat, 6 May 2006 23:02:43 -0600
Subject: Re: [Practiceimprovement1] Patient internet use
Reply-To: Practiceimprovement1@yahoogroups.com

I want to offer you reassurance on the 24/7 question. Like most folks on this list, I've taken all my own call for 2 and 1/2 years now - except for a few weeks vacation and it is not arduous. I have a panel of over 1000, and I average about 3-4 after hours calls a week (including weekends). I don't admit to the hospital, but do discuss any patients I refer into the ER with the doc down there, occasionally go to the ER just to see how they are if I'm worried about someone, and also discuss all patients with the hospitalists and follow their cases closely. All of that adds up to about 1% of my work, I suspect, maybe less.

Nancy

From: L. Gordon Moore

To: Practiceimprovement1@yahoogroups.com

Sent: 10/20/2006 9:37 AM

Subject: [Practiceimprovement1] Advance/Open access

A pure open access system means you have the ability to offer and

appointment "today" with the pt's PCP. In our practices the issue of

continuity is moot.

Open access doesn't mean you have to see pts in the office 7 days a week

and 24 hours a day, but remember that for each day you cannot see

patients, you have to problems:

1: You have to screen demand based on urgency and triage the urgent to

some place for same day care

2: You have to make up the backlog of non-urgent demand on the day you

return to work.

Doing this elegantly is not that difficult. If you want to work three

or four days per week, just spread the time out. Don't take of Mondays,

Fridays, and weekends. Of course we'd all love a three or four day

weekend, but the burden of working the two issues above and the rightful

disgruntlement you'll get from your pts will make that a painful choice

in the long term.

One strategy that works very well is to work just a little bit in the

office at least 4 or 5 days per week. Load up Mondays with more office

time to catch up the weekend backlog. Give an hour or two on your

out-of-office days or if you live close to the office, catch messages

regularly and make a special arrangement to see the urgent pt in the

office (and remember to bill the extra code for coming in special! 99050

- this is on top of the E&M code).

There are definitely some patients who make for a difficult negotiation

for a visit. We try to accommodate, but we don't change our schedule.

I'll go to the office on a weekend to look at a kid's ear, but I'm not

going in 'cause that's the only time someone can come in for a HTN

recheck.

Gordon

From: Jean Antonucci <JAntonucci@fchn.org>
To: "'L. Gordon Moore '" <gmoore@idealhealthnetwork.com>,
"'Practiceimprovement1@yahoogroups.com '"
<Practiceimprovement1@yahoogroups.com>
Subject: RE: [Practiceimprovement1] Advance/Open access
Date: Fri, 20 Oct 2006 09:55:13 -0400
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and may I add to that of course brillianlty said, and on one of my

favorite topic email from GM , that

there is this formula I heard late into doing open access. That you can

expect about .75% of your panel to call that day for a vist.

That was helpful to me. You gotta look realisitically at your panaelsize and

how many you pre-book

I currenlty try to book not more than 1/2--3/4 of the day This leaves

enough open slots for the Day-callers. If I have booked too many- like in

t helast 3 weeks it is becasue I was away for a week and should have

either planned that better or I simply had MORE day-callers. I just made

up day-callers three seconds ago..In doing open access I think you have to

accept that some days like flu season you are gonna be there later and

osmedays you go home earlier That makes most docs nervous becasue we

think the dollar sign so much, and onthe days they leave early they could

view that as a sign of "not OK" I will testify that it works! It works

great!

One of my greatest joys frankly is haveing a slow morning worrying about

money only to catch up on cups of tea and paper work( hmm what do we call

t hat in a paperless system?) and then the lab courier calls and says at

5:30 are you still there I need this awful noseblled cauterized or I find

Jody in the waiting room saying "is there any chance you can see Kaitleyn

she's in the car" and I do not mind --these are not 1 hr visits , and they

avoid the ER and are cared for and happy ,and I get great satisfaction

and maybe relaly only leave 30 min later.

Can you tell I like this??