Provider Supply and Patient Demand
Before deciding whether to add another physician or advanced practice provider, determine how good or bad your patient access is and determine how productive all the providers in the group are.
After reading this article you will be able to:
- Assess patient access and provider supply
- Determine if provider productivity is limiting patient access
- Determine if it is time to add another provider
In order to decide whether you need to add another physician or advanced practice provider, you to determine how good or bad patient access is and determine how productive all providers in the group are. It might be that access can be improved by becoming more productive, rather than by adding another provider.
To assess supply and demand, create a benchmarking chart.
Make the X-axis the number of days to the next available new patient appointment -- an access measurement that can serve as a proxy for patient demand. Make the Y-axis work relative value units (wRVUs) per half-day clinic -- a productivity measurement that represents provider supply. Chart the measurements of each physician in the practice relative to national benchmarks for wRVUs, available from organizations like the Medical Group Management Association, while choosing a generally accepted standard for access for specialists in the community (e.g., 10 calendar days).
While there are other ways to determine the need for added providers, this assessment is a useful method to understand demand and supply in a medical practice. Access, in this scenario, is a measure of patient demand, while the wRVUs are an assessment of provider supply.
There is a successful balance of demand and supply — favorable access and productivity — if most physicians are in the upper left quadrant.
If some physicians are in the unfavorable category for both access and productivity — in the lower right quadrant – there may be a problem to address. Find ways to make those particular providers more efficient. Maybe they need additional staff, smoother work habits, a little motivation, or to find a group practice that is better suited to their work style.
If the physicians are highly productive but patients still have to wait a long time to be seen — that is, they are positioned in the upper right quadrant — it may be time to recruit.
If a physician has favorable access yet poor productivity — in the lower left quadrant — let's hope it's a new doctor. If not, find out why he or she is unproductive and not in demand. If they are new providers, the clock is ticking. They shouldn't stay in this quadrant much more than 24 months. If they do, there's opportunity for improvement.
Balance supply and demand. Before a provider is hired, make sure there are enough patients to support another physician and that all is being done to assure each provider is as productive as possible.
Pearl: More Hours, Maybe
Weekend and evening hours - from 5:00 p.m. to 7:00 p.m. or later — are what most physicians consider "after" hours, but this is not the only option to increase hours. Early morning hours offer an appealing option to those of you who are early risers. You'll find that many patients love the idea of getting in to be seen before they go to work or, for pediatric patients' parents or guardians, before school. Although it's not technically "after" hours, seeing patients from 12 noon to 1:00 p.m. allows you to use a block of time that is historically "down" time for practices. Plus, it offers an appealing option to those patients who want to be seen over their lunch hour and return to work. Seeing patients after hours won't add to your fixed operating costs — your landlord won't charge you extra rent; if anything, you'll be getting more out of your office lease or mortgage.
Flexibility is critical for the first year or two after a new physician starts. Physicians who join a practice can certainly indicate their preferences, but their preferences shouldn't become a barrier to productivity and patient access. Empower the scheduler to make decisions if the new doctor's supply of appointments is not meeting patient demand. The scheduler should be able to schedule a new patient, for example, in an hour blocked for post-op slots if it's clear that the slots will otherwise go unfilled. And physicians should praise the scheduler's insight — not punish them for not following directions. Meet with the new physician once a month to touch base about his or her schedule. What's working and what's not? Proactive management of the schedule optimizes patient access – and practice profitability.
Pearl: On Track
Track how many new patients are seen per quarter; it's important to have a good mix of new and existing patients in the schedule. Although every physician's practice is unique, the minimum percentage of new patients to sustain a busy procedure or surgical practice is 25-30%. Many practices lose new patients for internal scheduling reasons — there aren't enough appointments open in a reasonable time frame, or worse, there are openings that go unfilled but they were reserved exclusively for established patients. Don't let time go to waste just because the appointment type doesn't match the patients' needs.
Pearl: Be Ready
A patient should be in the exam room ready when the provider walks in at 8:00 a.m. (or the designated start time for clinic). This may mean running "two" schedules — one for providers and one for patients. The key is to get provider time aligned with a patient's schedule, so they're ready when the clinician is ready. In most practices, there is usually a 15-minute variance. For efficiency keep it running in concert.