Kyruus Blog

The Patient Access Paradox

Why is it that we as patients are told to wait weeks, if not months, to see a physician, when in fact many provider organizations are only operating at 50-60% capacity?

Our nation's healthcare system suffers from a mismatch between patient demand and provider supply, something that we refer to as the "Patient Access Paradox". Almost everyone has had a personal experience with the problem of long appointment wait times, which range between 3 and 30 weeks across the country for both primary and specialist care. Yet at the same time, our hospital clients experience as low as 50-60% physician productivity, struggling to "unlock" the capacity that is buried somewhere in their provider networks.  There can be many reasons for this inefficiency, including:

  • Overly-complex scheduling templates that make it difficult or impossible to find open slots for certain conditions, because slots are reserved for specific kinds of case types, even when volumes don’t exist for those case types.
  • Manual patient triage and scheduling tools that fail to provide visibility into the clinical expertise or availability of physicians across the entire provider network.
  • Cultural and/or regulatory barriers to incorporating non-physicians into provider networks who might be able to see less complex cases and reserve physician specialists to practice “at the top of their license".

Removing these barriers has the potential to significantly reduce the strain on our precious and limited physician resources that we as a country are facing today.

Think of Patient Access as a supply-and-demand problem - outpatient volumes are rising at a rate of 17%, with 20 million newly insured patients coming into the healthcare system in the coming months as the result of healthcare reform. At the same time, the supply of physician specialists is growing at a much slower 10%, leading to major concerns of a shortage. Further, many states significantly limit the amount of independent clinical work nurse practitioners can take on, thereby increasing the clinical load on physicians.

A real opportunity exists to take a data-driven approach to optimizing Patient Access, in a manner that:

  • Unlocks provider capacity through dynamic search, scheduling, and algorithms that incorporate ALL available clinical capacity, including physicians, mid-levels, and physical equipment.
  • Reduces misdirected referrals, so that patients get the right provider, in a timely manner, the first time.
  • Provides visibility through analytics into the areas of a distributed network of providers where there are deficiencies or surpluses in capacity, at the diagnosis or procedure level.
  • Maximizes the productivity of provider staff.

Our experience shows that the key strategies that hospitals, health systems, and accountable care organizations can employ to accomplish these goals fall into 3 categories:

  1. Organizational Alignment – Create a cultural focus on patient experience and provider productivity. Focus on aligning all teams (providers, administrators, schedulers, and executives) around a "solidarity metric", like reduction in appointment wait times for patients.
  2. Streamlined Operations – Invest in centralization, standardization, and cross-departmental coordination. Take inventory of all patient access settings to understand all the possible entry points, and assess opportunities to consolidate operations to streamline the patient intake and triage experience.
  3. Dynamic, Scalable Technology Systems – Deploy purpose-built technology solutions with dynamic patient-provider matching & scheduling, analytics capabilities, and provider engagement tools. Evaluate technologies on the basis of their ability to reduce your organization's administrative costs, unify and dynamically maintain multi-dimension provider and scheduling data, and measure the Patient Access "event stream" to generate quantifiable ROI.

A comprehensive Patient Access solution should address all of the dimensions above in order to drive impact that can result in tens of thousands of net new patient encounters, double-digit improvements in provider productivity and utilization, and recuperation of tens of millions in lost top-line opportunity.

Download our recent case study with Swedish Medical Center to see how a large hospital is using patient-provider matching software to drive better access.

Topics: Analytics Patient Access Provider Networks