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THE DEFINITIVE GUIDE TO PATIENT WAITLISTS

Health systems view the waitlist as the key to solving patient wait time.We examine how waitlists work, their success rate, waitlist management software, and patient access alternatives. Here is your guide to everything you've wanted to know about patient waitlists.

Why Health Systems Turn to the Waitlist

Patient wait times are up 30% since 2014. The average new patient now waits 24 days for an appointment.

Patients want to get in sooner? Put them on a waitlist. If patients do not get in soon enough, they will not show up at all. Poor patient access is the number one reason patients no-show, something we cover in the The Definitive Guide to Patient No-Shows. This guide will showcase ways other health systems fix their patient access problems - from manual workarounds to autonomous technology solutions.

Who is this guide for?

QueueDr created this guide for those working at health systems focused on operations, patient experience, patient access, and call centers to shed some light on the pro's and con's of the different types of waitlists.

UNDERSTANDING THE PATIENT ACCESS PROBLEM

We cannot go into waitlists without talking about patient access. An athenahealth study looked at 4.2 million appointments and showed that patients cancellation rates increase the further out a patient is booked. If you book three new patients out one month, you will never see one of them.
There are not enough physicians for the number of patients out there. As a result, patient satisfaction has dipped and the number of physician extenders has skyrocketed.

This problem will get worse. By 2030, the percentage of American over 65 will grow by 55%, which makes the projected shortage especially troubling. As patients get older, they need two to three times as many services, mostly in specialty care, which is where the shortages are particularly severe, further exacerbating the patient wait time. Thus, health systems started doing the only natural thing...adding patients to a waitlist.

COMMON WAITLIST WORKFLOWS

For health systems, there are two types of patient workflows. First, there is practice offered waitlists. Second, there is patient requested waitlists.

Practice-Offered Waitlists

Schedulers ask patients if they want to be put on a waitlist. Normally, this occurs when a patient openly expresses anger with their wait time. Many patients are excluded from this type of waitlist, specifically the polite ones!

Patient-Requested Waitlists

Many access centers require patients to expressly ask to be added to the waitlist. Many patients do not know this policy and thus don't ask. In addition, shy patients are less likely to be added.

Patients Call-In

Most healthcare systems do neither of these waitlist workflows. Instead, schedulers frequently tell patients to call back in the morning and see if a slot has opened. Patients wait longer and now have to do additional work to accommodate that!

WAITLIST MANAGEMENT SOFTWARE + WORKFLOWS

Waitlist workflows vary drastically from organization to organization. We dive deeper into waitlist management software 101 here. We won't cover that, but definitely check it out.

DOES THE WAITLIST WORK?

There are a key reasons health systems are not successful in solving patient access when utilizing the waitlist.

  1. Waitlists only only include a small fraction of the patients who would want an earlier appointment. Fewer patients means a lower likelihood of filling a cancelled appointment, something we dive into in this white paper on cancelled appointments.

  2. Waitlists add more work for overworked schedulers. The fluidity required of medical scheduling software is not conducive to manual work/human component.

Customer Case Study Number 1

We recently conducted a Status Report for a 40 provider practice before they went live with QueueDr. This practice had a very disciplined processes for managing the waitlist. When we looked at 9,454 visits, we found they had one patient on the waitlist. The customer was shocked. They had educated their staff on the waitlist and had been told it was in use.

Customer Case Study Number 2

A customer of ours ran a test. They used QueueDr and told it to only text patients on the waitlist for one month. Then, the next month they used QueueDr, but allowed the product to text patients booked more than one week in the future who were clinically eligible.

The Results

Patient access improved in both cases but the difference is staggering. We found reaching all clinically eligible patients resulted in a 43x improvement in patient access over using a waitlist and resulted in 7x more appointments filled

Waitlist Only:  161 patients contacted for earlier appointments. 41 appointments filled.

Clinically Eligible Patients:  6,882 patients contacted for earlier appointments. 300 appointments filled.

THE WAITLIST DOESN'T WORK, WHAT SHOULD WE DO?

Here are some ideas you can implement today to help you improve patient access without burdening your staff (or patients). We cover these more in depth in The Definitive Guide to Patient Access.

Autonomous Patient Access Solutions


It's not secret that we love automation and think it's the future. We wrote a whole guide on why true automation is the future for health systems. These solutions allow you to offer earlier appointments to clinically eligible patients. Depending on the solution you will find these operate with very little to no human components (ie your staff does nothing).

Upside to Autonomous Patient Access Solutions

No waitlist needed and no change to staff workflow. More patients see improved patient access, while providers experience higher utilization.

Downside to Autonomous Patient Access Solutions

The IT procurement processes can be time consuming. Many health systems have also had poor experiences with healthcare technology before and are hesitant to implement a new solution. That's why its vital for health systems to do their homework!

Open access Scheduling

Leave 20-30% of the schedule open every day for patients who call in. Once the day fills up, either book people out or have people call in the next day.

Upside of Open Access Scheduling

Open access scheduling allows sick patients to be seen earlier. It has the potential to decrease patient no-shows since patients are not waiting less

Downside of Open Access Scheduling

Studies of open access find that it is quite taxing on the staff. We’ve found that health systems using open access, oversimplify their appointment types. Schedulers then write the true appointment type in the notes. Health systems then lose the ability to track appointment type usage. Fundamentally this decreases patient access for anyone who schedules ahead, and rewards/prioritizes same day appointments. This also puts more revenue at risk, same day calls need doesn’t match open appointments, otherwise you will have large fluctuations in your revenue at risk.

Telehealth

Telemedicine has seen a surge in popularity because it makes patient access easier and can result in shorter appointments.

Upside of Telemedicine

Downside of Telemedicine

it’s expensive and requires incredible coordination between staff and technology. We have not seen any group do this at scale. In the same article, Kaiser Permanente noted that that only 66% of the video visits were connected and it represented a small fraction of their overall appointments.

Hire More Providers

The theory is simple, if you have a waitlist, hire more providers to see those patients!

Upside

You shorten the wait!

Downside

Hiring more providers isn’t always an option and doesn’t account for patient preference. There is a decades old shortage of physicians and nurses and in many geographic areas it can be tough to attract talent. Furthermore, hiring more providers means adding more real estate which can be costly and require more management, leading to a slippery slope.

CONCLUSION

Patient access is only getting more important. Waitlists, regardless of type, will provide small improvements in patient access but come at a cost to your staff productivity and patient convenience. Running reports on cancellations and no-shows will help you fully understand your patient access needs and evaluate if a manual solution or an automated solution is a better fit for your health system.
Enjoy That Reading?
Check out The Definitive Guide to No-Shows.
Want to automate your waitlist away?
Schedule time with QueueDr.