Offering extended hours is one way that physicians can position themselves for the changes coming in healthcare, said Kenneth Hertz, principal at MGMA Consulting Group. The decision, however, should not be taken lightly and should be evaluated both from a patient and business standpoint.
“The reason a practice would offer extended hours is to help meet the needs of their patient population or expand access to their practice for their patient population,” said Hertz.
Expanding access to care is the cornerstone of the patient-centered medical home (PCMH). According to the American Academy of Family Physician (AAFP)'s 2010 Practice Profile I Survey, practices are providing greater access in a few different ways:
- 48.8 percent of active AAFP members offered extended office hours (early morning and/or evening appointments) in 2010;
- 31.6 percent offered weekend appointments; and
- 73.2 percent offered open-access (same-day) scheduling.
Jeffrey J. Cain, MD (pictured at right), a family physician in Denver, and president-elect of the AAFP, is just weeks away from beginning the process of offering extended hours in the form of evening hours to his patients. The practice, which is a Level 3 PCMH, currently offers open-access scheduling. Cain said they have taken a "carved-out" model approach where a percentage of the office is open for same-day appointments. He views it as a good business decision for his practice, patients and the community. The practice determined that there was enough of a patient demand through a survey it conducted.
“The next step is to be open on Saturdays,” said Cain. “It is a stretch to physicians – a new way of people working, but everyone is expected to participate.” Staggering shifts is how the practice aims to cover its new hours between 5-7:30 p.m., he added. Cain said in offering extended hours the practice aims to “increase patient satisfaction, decrease inappropriate ER utilization, provide higher quality of care at a lower cost, and improve continuity of care.”
Conrad Flick, MD (pictured at left), of Family Medical Associates, a medium-sized practice in Raleigh, N.C., has extended hours in both the morning and evening. Flick said patients schedule appointments for the extended hours sporadically, mainly in the early morning. Extended service increases overhead – "most times not covering it when opened longer, but we all hope to grow into it,” added Flick.
“Yes, patients demand it, but not that many take advantage of it for various reasons,” he noted.
If analyzed strictly from a financial perspective, it may be difficult to justify extended hours, Flick explained. “If you look at the books, extended hours without additional revenue is almost always a losing venture – at best a break even,” he said. “This comes down to what we are supposed to be doing – taking care of patients,” Flick observed. However, he said practices are businesses. “We need to generate a revenue stream,” and have to know how many patients we need to see in a certain time to cover overhead, he added. Flick finds it difficult for physicians to be open for extended hours under the current model of payment. Physicians should be paid to “manage the population better,” he maintained.
Hertz said practices need to consider how to offer greater access, but the decision should be made with their eyes “wide open.” Practices need a vision for what they want to accomplish, a strategic game plan and a budget, he said.
With that in mind, Hertz offered practices seven considerations related to the offering of extended hours:
1. Understand the marketplace. Who else is doing this and are they successful?
2. Understand your patient population. Determine whether there is a need, either through a patient survey or by evaluating emergency records.
3. Staff availability. How many doctors are in the practice? How can you move hours around? Can you do it with existing staff or do you need additional help?
4. Additional cost to your office. Are you in a building that is open on the weekends or after 5 p.m.? If not, will the building operator charge you for this time?
5. Breaking even. How many patients at the minimum do you need to break even?
6. Trial run. How long am I going to try doing this? Two weeks? Or can I afford to commit to six months?7. Marketing. How will you market your extended hours and let people know you are available? What is the cost?