Patients With Acute Needs Can't Wait. Neither Can You.

In this first of a two-part look of the role of acute visits in primary care, we’ll discuss why offering this access is so important and will help determine the future of primary care. In the next blog, we'll discuss what practice administrators and clinicians can do to effectively prepare for same day patients.

Here’s a question for you. What business would survive yielding up its most valuable and profitable product to a competitor? Not sure if your answer is different than mine, but I’m going to go with “none” or at least none I’ve ever heard about. Of course, there may be an exception, but I’m pretty sure primary care medicine isn’t it.

Getting back into the conversation

Before considering the benefits inherent in increased acute care access, let’s take a look at what’s generating part of the problem:

A short while back, I came across an online message from Aetna Health Insurance targeted primarily to its policy holders but also to the public in general. The information focused on the benefits, including convenience and out-of-pocket cost savings, of accessing retail walk-in clinics or urgent care centers instead of emergency rooms for non-life or limb-threatening conditions.

Based on average claim costs, Aetna made a strong financial case for using the clinics and centers through a straight comparison of the same non-emergent treatments. What was clear as I read the information was that primary care practices weren’t even in the urgent care equation, despite the fact that most of the conditions shown could be appropriately resolved on the primary care level.  Not being part of the conversation is an omission we should be addressing for a number of reasons that benefit patients and practitioners alike.

The most valuable visit of the day

In our practice, acute presentations were the most profitable segment of the day, providing the highest level of reimbursement per minute. In most cases they were also the quickest and among the most satisfying.  What we found was that the episodic care – specifically two acute visits a day – paved the way for employing a full-time MA or LPN which in turn, enabled us to see several more patients.

I want to emphasize that two same day visits more per day was all that was necessary to pay for one additional full-time employee. This extra staff member, trained with true exam room skills, not only helped provide our patients with the timely access they needed, but also helped restore my own work-life balance to a healthier and far more satisfactory level. With this addition, I could see 5-6 more patients per day while working fewer hours. Intentionally working to capture all the same day visits within a panel can transform this aspect of a comprehensivist’s practice from a loss leader to a profit center. 

While the majority of unscheduled visits are still reimbursed on a FFS basis, the continuing movement toward newer value-based payment models should continue to position acute treatment as a significant factor in improving the continuum of care and the bottom line.

The visit that helps strengthen the provider-patient relationship and significantly raises population health

Historical and contemporary medical literature are replete with articles, monographs and chapters on the role of the therapeutic relationship as the foundation for trust and open communication. And there’s a strong connection between this special relationship and treating acute care patients.

What we found was that the well-documented benefits of a strong provider-patient relationship as a major determinant in patient and staff satisfaction and compliance were enhanced even more by our commitment to bringing urgents in as quickly as possible. These encounters offer an excellent opportunity to grow the trust and overall level of engagement that, in turn, positively impact other visits for the same patient, including both preventive care and chronic condition management. Simply put, treating a sore throat on a Saturday morning is a significant part of a continuing relationship that can add substantially to the patient’s long term health.

In fact, my own experience leads me to believe that the most effective management of chronic diseases takes place when reliable access, including same-day access by the same provider, is consistent across the continuum.  On a very personal level, that same experience has convinced me that timely access can save the lives of patients who won’t go to the ER because they want to be seen by their own familiar and trusted doctor.

Access is key but it's a sore throat, not a Starbucks moment

Timely access is at the absolute center of effectively meeting acute needs in the primary care setting. By “timely access” I mean access when the patient needs it provided by someone he or she knows and trusts. Sustaining that level of access requires a considerable amount of focus, and you may have to sacrifice catching up on your patient’s recent life story since unlimited time with one individual precludes access for another.

But looking at it from the patient’s perspective, even a short visit with a familiar provider is a highly desirable and valued experience. It’s also an experience we have to view as a necessity rather than a luxury. If people can’t get timely care from their regular provider they will go somewhere else for it, with the understanding that health may not be possible if it’s not on time. And in the process they will sacrifice money, trust, comfort and even a degree of competency for convenience, access and reassurance. 

Now that we have a sense of how vital it is to provide access to patients with urgent care needs, the second part of this blog will discuss the mechanics for making it happen. To be continued...