Physicians should consider finances, staffing when expanding office hours

William Manard, MD, FAAFPAs primary care practices consider transforming to the Patient Centered Medical Home framework, one of the key concepts is increasing practice availability to patients. Adding nontraditional hours is worth exploring to meet patient needs and increase profitability.

There are multiple ways to provide greater availability to patients, including increasing office hours, shifting to less traditional hours when patients may be more available, and changing scheduling models to create ready availability of appointments. 

A practice interested in making this transformation must carefully consider implications of making these changes, including financial issues, patient satisfaction and understanding, and provider/staff willingness.

Per the National Committee for Quality Assurance, one of the most widely used bodies for medical home recognition, nontraditional practice hours include basically anything outside of “normal” business hours, including seeing patients during what would normally be considered a lunch hour. 

Because many patients and family members work “normal” business hours, having appointments available outside of these times may help improve patient satisfaction.  However, adding these appointment hours requires understanding and acceptance of this need by providers.  Additionally, it requires willingness of support staff to be available during these times.  These barriers, though, are not insurmountable.

A first step: Lunch hours

A consideration as an initial step, likely without increasing staffing costs or stress on providers, would be to offer lunch time hours.  One way to make this a less stressful change would be to offer only same-day scheduled appointments during these times, as these are usually associated with less provider time and can be frequently managed in a more timely manner.  To facilitate these hours, staggering lunch breaks for providers and staff members by 30 minutes either direction is frequently all that is required, resulting in no increase in costs and minimal additional stress for the staff.  Many practices have found this to be a satisfactory first step toward meeting patient needs.

Evenings and weekends

To further increase availability to patients at their times of need, adding early morning, evening, or weekend hours can be very helpful.  Morning and evening hours can usually be added with minimal staff cost, as overall schedules can be altered to match practice hours without adding overall staff hours.  For example, a medical assistant could work from 7:00 am to 3:30 pm, while another works 10:30 am to 7:00 pm.  If practice staffing supports it, another could work more traditional hours, thus providing extra coverage during the busiest portion of the day. 

This staffing would generally provide adequate coverage for two providers working similar hours, while not adding significantly to practice overhead.

Staff resistance

However, staff members and providers who may have worked regular business hours for years may be unwilling to make these changes. Slow introduction of changes (perhaps one day a week at first) can help make acceptance a little easier. Additionally, making expectations clear during the hiring process for new staff allows these changes to be part of the practice foundation. As many providers are already working extended hours (frequently to complete administrative tasks), acceptance may be more challenging here.  However, as most providers are interested in patient satisfaction, using this as a motivator can be helpful in introducing these changes.

Open access

Availability can also be increased via changes in how a practice manages its schedule.  The basic concept of “open access” is basically doing today’s work today. Appointments are not scheduled in advance, patients can be accommodated when they call, and providers do not have appointments scheduled beyond previously agreed templates (no “double booking”).  When strictly applied, this concept does not allow patients to schedule follow-up visits at the time of their current appointment, which offers the potential for patients becoming lost from needed ongoing care.

Advanced access

The hybrid concept of “advanced access” has been successful. In this model, practices set aside some portion of appointments for advanced scheduling, but keep the majority of appointments available for same- or next-day scheduling. This results in the ability to meet different patient needs.

As practices transform, patient satisfaction, staff and provider needs, and financial implications must be considered and balanced to make care delivery as seamless as possible. 

William Manard, MD, FAAFP, is assistant professor and director of clinical services for the Family and Community Medicine and SLU Medical Home, St. Louis University School of Medicine. Send your questions about practice finances to medec@advanstar.com.

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