The revenue cycle begins when a patient walks through the door, but what if that door is seemingly locked? Patient access is one of the most important areas of healthcare, but too often under prioritized. Long wait times and limited patient accessibility may lead to poor health outcomes; jeopardize the organization’s reputation and financial well-being. In an era shifting to lower-cost ambulatory services, institutions must adapt to the growing systems’ needs with a focus on improving a patient’s ability to access care.

Despite Texas Children’s success in clinical care and research, tremendous demand for world-renowned programs contributed to significant access challenges – long appointment wait times, restrictive scheduling practices, unfilled appointment slots, complicated referral processes, unexceptional patient experience and underutilization of technology. Both administration executives and clinical leadership recognized the situation and prompted an organization-wide initiative to transform specialty access without adding clinical resources. Directed by a collaboration of revenue cycle, ambulatory operations and physician leadership, a dedicated task force challenged Texas Children’s to think differently and adopt a culture of change. By embracing standardization, maintaining patient focus, communicating frequently and leveraging technology, the organization was able to improve access for specialty care areas.

Embrace technology to increase patient engagement and improve the scheduling experience.

Patient portal. Texas Children’s put patients at the forefront of their care with online instant access to medical records, laboratory and test results and open communication with providers. New technology was implemented to make portal sign up and activation much easier for families. Now, registration staff at clinic welcome desks generate a text message to the families containing a link to activate the portal account instantly. In addition, a system-wide employee competition encouraged staff to promote patient activation of the portal technology. Patient activation quickly increased from 60% to 71%from FY 17 to FY 18.

Online scheduling. New technology was also deployed to create two online scheduling platforms for convenient, self-serve scheduling. Online scheduling through the patient portal was implemented to allow patients to schedule return appointments with their existing providers. In addition, a separate platform was established to offer online scheduling for patients scheduling with a new doctor or a new specialty. Marketing efforts were also launched to claim search engine links to ensure patients were appropriately directed to the new online scheduling options. These new technologies resulted in patient satisfaction scores around “ease of scheduling” improving from 57% to 73% having a very good experience. Between the two scheduling platforms, more than 8,000 appointments were scheduled online within the first 11 months of deployment, representing over 900 staff scheduling hours redistributed while improving patient experience.

Electronic waitlist. Texas Children’s also implemented an electronic waitlist within the patient portal to transform appointment cancelations into access opportunities. A newly canceled appointment is offered up via text alerts to families listed on the electronic waitlist. The offer can easily be accepted by simply clicking on a link within the text message, thus automatically canceling the patient’s original appointment and resulting in scheduling the newly offered appointment.

For patients who accept new appointment offers through the electronic waitlist, they are now seen an average of 50 days earlier than their originally scheduled appointment.

Strengthen partnerships with referring providers. Previously, with over 40 referral submission routes, Texas Children’s not only made it difficult for patients to access care, but also providers attempting to refer patients for specialty care. Operational efficiencies were introduced to consolidate to one standardized and simplistic electronic referral form. This update reduced completion time from 2 minutes to 30 seconds. Additionally, automatic responses notify referring providers of a scheduled appointment within 24 hours of the submission. Efforts to ensure automatic visit summaries from the Texas Children’s electronic medical record were sent automatically to referring providers increased 60% to 100% after clinic visits.

Increase capacity and improve utilization. Restrictive scheduling practices combined with variations in clinic sessions and appointment templates resulted in 20% of appointment slots going unfilled in FY17. A focused effort moved the organization to a 4-hour clinic session, ensuring maximized provider availability and use of clinical space. Additionally, the implementation of “72-hour flipping” released unfilled appointments reserved for unique appointment types 72 hours prior to appointment time to a broader population of patients needing services. From these efforts, more than 53,000 appointments were added annually; of which 44% were new patient appointment openings.

Outcomes

Texas Children’s door is now open for patients, with 83% of specialties able to offer the third next available new patient appointment within 14 business days, an increase from 66% in FY17. Completed appointments have increased by 16.5% over from FY 17 to FY 19. In addition to the financial solidity, greater patient satisfaction was achieved.

Lessons Learned

A key for improving access at Texas Children’s was recognition by the hospital’s CEO, Mark A. Wallace, that improvement was necessary. His support prompted a culture of change and physician partnership at the forefront of the task force supported clinical restructuring to ensure the vision translated into organization-wide accomplishments. The adaptability of the Information Services Department facilitated the technological advances needed, while ensuring patient privacy and safety. The Marketing partnership for focused elements of the access initiative provided communication channels for both internal and external audiences.

Texas Children’s was able to make significant improvements within just 12 months. By standardizing processes and improving efficiency with modern technology, the way the organization approaches patient access was completely revolutionized. The access journey is an ongoing initiative with additional areas of focus that will be implemented soon to ensure “patients receive the right care, at the right place at the right time.”