Doctors try open-access system to improve care, morale

By Shari Rudavsky, The Indianapolis Star
http://www.usatoday.com

When Loy Assell or members of her family want to see their doctor, they can get in within hours. If they need to cancel an appointment at the last minute, they can easily reschedule.

The physician, Dr. Cynthia Kizer of Olio Road Family Care, and her colleagues keep about half their daily appointments open for last-minute patients, a system known as advanced open access.

Though it may seem unorthodox, it is one of the models for a nationwide experiment to transform and improve family practice for both patients and practitioners.

“It was horrible. They wanted you to schedule two months out, and you just don’t know,” said Assell, 40, of Fishers, Ind. “This works better because a week out you know what your schedule will be like.”

As fewer medical students enter the field and more professionals in it seek early retirement, 36 practices around the country — including Olio Road in Fishers — are experimenting with ways to deliver and improve care. These approaches include:

• Same-day access to the physician.

• No phone trees when calls are made to the office.

• E-mail consultations and electronic records.

• Group visits.

Mother-to-be Rebecca Shelton, 20, who made a number of calls looking for an obstetrician-gynecologist before she was referred to Kizer, is sold on the new model. She called the Olio Road practice at the end of the week and had an appointment for the following Monday, the first day that worked for her.

“It’s definitely a lot easier to get in,” said Shelton. “With most OBs or family doctors, you can usually count on at least one appointment getting rescheduled because someone’s in labor.”

Possibly the only people happier with the changes than the patients are the doctors.

In his previous practice, Dr. Patrick Rankin, one of Kizer’s partners at Olio Road, was booked six weeks out. He saw 40 patients a day. Here, he sees fewer patients and spends more time with each one, something he said he finds far preferable.

“In a traditional practice, so much energy is spent trying to keep people out of the practice. In open access, all of the energy is spent getting people into the office,” said Rankin.

To Kizer this practice, her first job out of residency, looks much different from the ones she saw during training.

“We wanted to have a whole new model of care where patients didn’t feel like they got lost,” she said. “We just think this is the right thing to do.”

The American Academy of Family Physicians agrees.

About 15 months ago the academy started an initiative, TransforMED, to test a new model of patient-centered care. More than 500 practices around the country applied for the project, which will end next summer.

“What we’re learning is what works and what doesn’t work in different environments, and how to do the implementation,” said Dr. Terry McGeeney, TransforMED’s president and CEO.

Not only does TransforMED want to find whether patients and providers are more satisfied, the initiative also seeks to learn whether a practice that makes these changes still can succeed financially.

“Family medicine is a very high-volume, low-margin business, so the details of running it like a business are very important,” McGeeney said. “What we’re finding is with creating a lot of efficiencies in the practice, doctors are getting more satisfied with their work environment.”

Some of the practice’s initiatives have not proved as successful as others. Electronic visits haven’t been too popular, Rankin said.

“We’re beginning to find that patients would rather see their doctor when they can get in to see their doctor,” he said.

It is hoped such trial and error will result in a better model, McGeeney says.

“Primary care in this country really is in trouble for a lot of reasons, and some things need to be improved at a global level, but some of it needs to change at the practice level,” he said. “They’re out there doing God’s work to try to really figure out how to reinvent primary care.”
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