The massive disruption to ambulatory care brought about by the COVID-19 pandemic provides the opportunity to revisit how ambulatory care is delivered and to shine a light on workflows long considered entrenched, which may not serve practices and patients as well in the future.
Many primary care offices have worked very hard to expand patient access hours. Doctor’s office hours of 9 to 5, Monday through Friday are perhaps the most obvious example of how clinical need and patient preference diverge from how care is offered in many ambulatory clinics. Data from the past decade shows the explosive growth of urgent care centers, retail clinics and use of the emergency room for primary care needs as patients sought access to care from providers other than a traditional primary care practice. Between 2007-2016, the utilization of urgent care grew 1,725%; outpacing the growth in emergency room care (229%) by seven times1. When asked, many patients cite the convenience and non-traditional hours as strong motivators to use these alternate services. With so many practices around the U.S. now constrained from providing preventive and routine care because of the COVID-19 pandemic, there will likely be a pent-up demand for primary care visits in the months following the lifting of stay-at-home orders. Now that telehealth visits have been integrated into so many practices, it seems like an appropriate time to revisit expanding operating hours on a permanent basis by extending into evening and weekend times utilizing telehealth visits. Doing so will not only broaden access, it will also reestablish and sustain the strong patient-doctor relationship at the heart of primary care.
The COVID-19 pandemic has also amplified the need to modernize our thinking about the use of patient portals, self-scheduling platforms and open access hours to continue to drive broader access and patient engagement. Most practices are adept at educating patients about their health condition, teaching them to manage the symptoms related to a chronic condition and to identify warning signs that might indicate their situation is deteriorating. If well-informed and engaged patients can connect with their doctor in a convenient, self-directed manner, this will likely reduce the odds that they will seek care elsewhere.
Our fee-for-service (FFS) reimbursement model further confounds the problems of patient access as it incents physicians to see high volumes of patients which understandably diminishes their ability to focus on service quality and outcomes. The current crisis has highlighted the vulnerability of ambulatory practices built solely on a FFS or productivity model. The financial uncertainty caused by these reduced patient volumes presents an opportunity for providers to consider alternate payment arrangements that reward patient outcomes, experience of care and access.
FH Healthcare Indicators and FH Medical Price Index, March 2018 accessed via:
https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/
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