Elizabeth Woodcock, MBA, FACMPE, CPC, is a speaker, trainer, and author who is dedicated to helping physician practices achieve and sustain patient satisfaction, practice efficiency, and profitability. An expert at practice operations and revenue cycle management, she is nationally recognized for her outstanding presentations and writings aimed at improving the business of medicine. Her education and expertise, combined with her humor and an engaging delivery, make her popular with physicians and administrators alike. Below is an excerpt of our interview with Elizabeth.
Nikki: So my first question for you, Elizabeth, is how did you become interested in patient access?
Elizabeth: Well, that’s a great question. As you mentioned the book Mastering Patient Flow, which was first published in actually the late 1990s. I really felt like that the topic of scheduling was something that was underreported in practice management. In my opinion, the schedule is the be all, end all for practice operations, patient flow, and the patient experience. So it seemed only natural to think about how do patients actually get on our schedule.
Nikki: There is so much going on in healthcare these days. Where does patient access fall in the list of priorities for practices?
Elizabeth: If you ask most physicians and practice executives, they would say very important. But they are really not as attuned to it, given the fact that there all these regulatory issues. And yet if you step back, I think everyone would agree that patient access is the ultimate priority because you are never even going to worry about any HIPAA regulation or ACA, if you don’t see the patient. I do believe that if we were really having a heart-to-heart or soul-to-soul conversation with any physician executive, they would say it is absolutely #1.
Nikki: What are some of the top challenges practices face regarding patient access?
Elizabeth: Well, I think it really runs the gamut from very strategic to very tactical. From a strategy perspective, I will use an example of a surgery practice - how do I get patients on to the schedule that really fit my training? It is the idea of serving our patients and community best. That is a more strategic issue. A tactical issue is literally that appointment template and making sure that once patients get onto the template, they are arriving and not no-showing, cancelling, or being bumped at the last minute by the physician himself or herself.
Nikki: It is important for practices to also take into account patient preferences and provider preferences. That is really hard to balance sometimes. How are they addressing these types of challenges?
Elizabeth: Well, I would have to tell you not very well. We haven’t really thought about it as an operational issue. And to your point, we’ve got this big issue about matching provider’s best experiences and training with patients in terms of their demand. We train our schedulers for maybe a day, possibly an hour. We really have a great opportunity to improve that because it is either in our schedulers’ head or it is on a bunch of sticky notes of doctor preferences.
Nikki: One of the big trends we’re seeing in the market is centralizing scheduling. What are some of the stumbling blocks for practices as they centralize their scheduling operations?
Elizabeth: It’s the lack of strategic thinking about the topic of patient access. Again, it’s been ‘well, the scheduler can handle it.’ The schedule is an awesome person but quite often one of the least trained and lowed paid employees at a practice. So if we think of this as let’s just put all those people together in a room and cross our fingers - it is going to be a disaster. It is the strategy of we have all these sticky notes and schedulers - how do we actually put this all together so we have the best patient experience possible?
Nikki: No-shows continue to be a big problem. What are some innovative ways you have seen practices improve no-show rates?
Elizabeth: There is certainly a lot. Some of it starts with us. My first strategy to manage no-shows is to prevent them from happening altogether, and that’s by actually not celebrating when a patient fails to show up. Interestingly enough, there have been studies that prove that patients actually think they are doing us a favor by not coming in. To stay in tune with the patient experience on all levels is a good prevention strategy. We have great tactics like texting patients now, instead of just calling. A wonderful and probably the best way to prevent no-shows is to look at our scheduling horizon, which is how far out we schedule patients. The longer it takes to get in to see a doctor, the higher the no-show rate is for that patient. We have to manage that very wisely.
Nikki: What are practices doing to reduce the number of scheduling errors?
Elizabeth: Going back to the sticky notes. It is a disaster waiting to happen. Integrating the sticky notes from an automation perspective is certainly how we can reduce errors. We have got to figure out how to create algorithms that are automated in our system, just like we would a decision tree that is automated as part of clinical decision support. That’s embedded in any electronic health record. Again, we have not replicated that same logic and those same tools and resources on the management side. It is due time for that.