Many of the medical groups we work with are concerned about patient access. In preparing for our latest national meeting series, we took an in-depth look at strategies to expand access–starting with ways to match the efficiency of existing practice sites. One of the most popular tactics we profiled came from Aurora Medical Group, a 1,600-physician group based in Milwaukee.
Infographic: 4 foundational steps to prepare for cross-network scheduling
Aurora faces an acute access challenge: the group forecasts that 70 of their primary care physicians will retire in the next few years.
In the face of this looming primary care shortage, Aurora created a new scheduling process focused on increasing their practices’ capacities and improving physicians’ workflows.
Inventing the 'scheduling wheel'
Aurora conducted a comprehensive assessment of how different practices were managing their schedules and workflows. First, they aggregated data across the group to identify the average recorded appointment length by specialist and visit type. Next, they went into Aurora’s practices and observed actual visits to understand how much of a patient’s time in the office was actually spent with a physicians and a typical clinic workflow.
Using this information on providers’ historical performance and observed workflow patterns, Aurora created several standard appointment types: new patients or physicals, same-day appointments or walk-ins, and flexible visits for either new patients or walk-ins. The schedule template that would repeat cyclically at one- or two-hour intervals. They called this template a "scheduling wheel."
Channeling Chipotle with 'have it your way' scheduling
A closer look at the wheel
Aurora created three scheduling wheel options based on the data they collected on providers’ historical performance and observed workflow patterns. The scheduling wheel would be specialty-agnostic and providers would be able to choose between three standard templates:
- Physician A: 15-minute visits for three patients per hour; reserves 15 minutes for administrative tasks
- Physician B: 10-minute visits for four patients per hour; reserves 20 minutes for administrative tasks
- Nurse practitioners: 20-minute visits for two patients per hour; reserves 20 minutes for administrative tasks
In the sample wheel for Physician A shown below, you can see that every hour of a physician’s day is broken into four 15-minute sections.
- The first period is reserved for new patients or physicals
- The second period is reserved for an acute visit, typically a walk-in or same-day appointment
- The third period is flexible and able to repurposed based on daily demand
- The fourth period is blocked time that physicians can use for dictation, documentation, follow-up, and other administrative tasks. It also frequently serves as a buffer to accommodate for visits that run over and other workflow adjustments.
Wheel Standardizes Workflows, Allows Flexibility
Nurses act as the "gatekeepers," ensuring that the practice stays on schedule. The nurse rooms the first scheduled patient before the top of the hour, initiating the scheduling wheel. At the end of the hour, nurses also ensure that physicians complete documentation, dictation, and related phone calls.
Reaping benefits from the scheduling wheel
When Aurora first introduced the wheel two years ago, the group allowed existing providers to opt-in, but made the template mandatory for new providers. Though some providers initially resisted the standard scheduling template, the group has diligently shared positive results from providers who operate on the scheduling wheel. Today, more than 100 providers use the wheel.
From our national meeting: The New Access Standard
In the practices that have adopted the scheduling wheel template, the transition has been painless for providers and profitable for the group. Three main benefits include:
- Growing practice capacity. At one early pilot site, implementing the new scheduling template allowed clinicians to see 30 percent more patients during their office hours. This resulted in 69 extra visits per month at the practice and an additional $13,000 in monthly revenue.
- Achieving network efficiency. Practices have increasingly adopted the scheduling wheel, enabling existing primary care clinics to accommodate additional same-day visits. As a result, Aurora has closed several of their walk-in urgent care centers, which primarily existed to provide immediate access.
- Improving physician engagement. According to Karen Bowman-Dillenburg, Manager of Operations Improvement at Aurora, physicians now tell her, "I know I’m seeing more patients, but it feels like I’m seeing less." Two characteristics of the wheel particularly appeal to providers: predictable daily workflows, and accounting for documentation and other administrative tasks that they otherwise would complete after "normal" hours.
Would your medical group consider adopting Aurora’s scheduling wheel? Why or why not? Let us know in the comments below.
Access to Care,