NYC Health & Hospitals reduces clinic wait times with open access scheduling

When Dr. Ted Long joined NYC Health & Hospitals about 18 months ago to lead ambulatory-care services, he heard the same refrain from frustrated physicians: The method used to schedule primary-care visits doesn’t work.

On average new patients waited 52 days for an appointment, which is significantly higher than the national average in large U.S. cities of 24 days. Furthermore, 30% of appointments weren’t with the patient’s primary-care doctor. “The system was failing, we had to fix it,” Long said.

The new approach, which involved changing scripts at the appointment call center and adopting new scheduling templates, has been tested at NYC Health & Hospitals/Bellevue’s adult primary-care clinic since August 2018 and is showing positive results. Average wait times for new patients plummeted to 14 days and 87.1% of patients now see their assigned primary-care provider, up from 69.9%. “Now our patients can be seen when they want to be seen, ensuring they have the best possible experience receiving care from us,” Long said.

Based on that success, NYC Health & Hospitals is rolling out the changes at its roughly 70 clinics. The adult primary-care clinic at Bellevue was the pilot site because it’s one of the system’s largest patient-care clinics with 30,000 patients seen every year.

The effort has worked so well because leadership made sure to get buy-in from the physicians on changes, said Dr. Andrew Wallach, clinical chief for ambulatory care at NYC Health & Hospitals.

Frontline staff attended focus groups in which they were asked how the scheduling process could be improved. Their ideas were then used to determine solutions. Open access, a scheduling method that intentionally leaves appointment slots open on a physician’s calendar so patients can be seen sooner, came up in the focus groups.

Employees at the 24/7 call center in Manhattan now have schedules in front of them where about one-third of a physician’s clinical slots are left open for patients who want to be seen quickly. The call center employees were also trained on a new script that involves asking the patient if they’d be willing to wait a few more days to see their primary-care physician rather than another doctor who can see them sooner. Long said most patients will agree to wait to see their primary-care doctor.

Physicians like the change, since they want to follow up with their patients consistently. “The most important thing to us (in primary care) is to see our own patients,” Long said.

And for rare instances where the primary-care doctor still can’t see the patient within a week, call center employees ask patients if they’d like to see the advanced practitioner assigned to the doctor’s team instead, which still allows for care coordination, Wallach said.

Long said he is “100% convinced” the changes will lead to improved health outcomes. Because appointments aren’t scheduled so far out, patients are less likely to miss them. It may even lead to cost savings for the system since fewer patients will rely on the emergency department for routine care, Long added.

The improved efficiencies from the changes will also help the 11-hospital system prepare for an expected influx of patients as a result of NYC Care, a public option starting Aug. 1 that allows uninsured New Yorkers access to NYC Health & Hospitals services with prices on a sliding scale based on income.

“What we wanted to get right was primary care, with the goal being as we expand we’ll have the infrastructure to do it,” Wallach said.