The Impact of Patient Access and Scheduling on Providers Under a Productivity Compensation Model

Summary: Patient access and scheduling practices influence healthcare providers’ performance and compensation under a productivity-based compensation model. In many clinical settings, provider compensation is tied to productivity metrics, which can create scheduling challenges. Optimizing scheduling can help practices balance patient access, provider capacity, and productivity expectations. Effective scheduling and access strategies may improve operational outcomes, enhance the patient experience, and align financial incentives with broader organizational goals.

Provider compensation within a productivity-based compensation model is often viewed through the lens of basic measurements of clinical effort and output: current procedural terminology (CPT) codes, work relative value units (wRVUs), professional collections, payment modifiers, panel size, patient volume, and more. One of the less-discussed but equally important drivers of patient volume, and by extension wRVU production, is patient access and scheduling. The irony is that under a productivity model, providers face pressure to produce more but are often limited by a system that is unable to deliver the requisite patient volume. A provider can be unfairly labeled as underperforming when the true issue is a poorly designed patient schedule.

Defining Patient Access

Patient access refers to the ability of patients to obtain timely, convenient, and appropriate care within a clinical practice. Such access is determined by providers, staff, established practice hours, availability of ancillary testing, and access to subspecialists. In many respects, patient access is the gatekeeper of provider compensation. In a typical productivity model, a provider’s earning potential is directly tied to patient throughput. However, throughput is only possible when patients can actually get onto the schedule and show up to their appointment. It’s important to recognize that no clinical practice will operate at 100% optimization.

Barriers That Disrupt Patient Access

Despite best efforts to optimize scheduling and throughput, several factors can still prevent patients from getting timely access to care. Key barriers to access that reduce provider productivity include:

• Patient preference
• Patient cancellations and no-shows
• Language barriers
• Provider cancellations
• Provider availability for new or existing patient appointments
• Provider preference
• Scheduling software or technology limitations
• Clinic hours
• Clinic staffing
• Weather
• System outages

Data-Driven Metrics for Monitoring Patient Access

Effective oversight of patient access requires consistent, data-driven monitoring. Key performance indicators (KPIs) designed to monitor patient access, such as the following, can provide this visibility:

• Kept appointments per week by each provider vs. target appointments
• Scheduled appointment hours per week by each provider
• Clinical service hours worked per week by each provider
• Third-next-available new-patient appointment
• No-show appointments
• Appointments cancelled within 24 hours

Developing a patient access practice committee to monitor these KPIs is critical. The committee should include a lead physician, administrator, front office manager, clinical manager, ancillary manager, call center manager, IT or electronic medical record superuser, and scheduling coordinator/specialist. This core group should have a daily huddle to review the prior day’s schedule results, today’s scheduled patient appointments vs. capacity, and the next day’s schedule capacity. That committee can then redirect resources as necessary to maximize the schedule.

Designing Effective Provider Scheduling Templates 

A provider’s scheduling template should have enough slots to achieve their targeted scheduled patients per day and not their expected patients seen per day. Such templates need to find a balance of patient volume with complexity in order to both maximize efficiency and meet patient demands. Best practices include:

• Scheduling expected patients and average cancellation/no-show patients so that net patients actually seen is the targeted number
  • For example, if 30 patients per day are expected and an average of five patients cancel or do not show up for their appointment, then the target number of patients to schedule is 35 patients per day.
• Standardizing appointment types
• Developing appropriate visit lengths based on acuity or reason for the visit
• Creating urgent/same-day holds
• Limiting schedule-blocking permission to managers only
• Offering a waitlist to patients for appointments that free up within 24-48 hours, with separate urgent and routine appointment waitlists

Managing Cancellations and No-Shows To Protect Productivity

Patient cancellations and no-shows are inevitable but can still be managed and the impact mitigated. Best practices include:

• Implementing a practice policy regarding patient cancellations and no-shows and communicating the policy during scheduling and appointment confirmation
• Confirming the appointment at seven days, three days, and two days
• Rescheduling patients if the appointment is not confirmed, authorization is not obtained, or insurance is not verified two days prior
• Filling unconfirmed appointments with patients from the waitlist

Balancing Time Off With Scheduling Needs

Providers are entitled to time away from the practice. Among other benefits, reasonable time off helps avoid burnout. Instituting a provider time-off policy ensures that the impact on patient access is limited. Best practices include:

• Requiring at least 60 days’ advance notice for more than three days off
• Requiring at least 90 days’ advance notice for continuing medical education
• Exempting emergencies from advance notice provisions
• Requiring written requests for time off to be formally approved
• Resolving scheduling conflicts by fairness and rotation
• Ensuring minimum provider coverage
• Limiting concurrent time off for providers in the same practice
• Rotating provider coverage during high-demand periods (e.g., holidays, summer)

Strengthening Operations Through Proactive Access Management

Because so many variables influence patient access and scheduling, creating a reliable operating system requires proactive management, adherence to practice policies, and investment in resources, such as staff, a call center, and software. The rewards for these efforts are higher clinical performance and higher patient and provider satisfaction. Organizations that treat patient access and scheduling as strategic levers, rather than clerical tasks, are better positioned to strengthen provider productivity and overall operational success.

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