Improving Access to Care in Neurology
Michael Kalfin, DHA, MPH
Frances Jensen, MD
Raymond Price, MD
In 2022, the neurology department at Penn Medicine hired more clinicians to meet increasing demand for neurology care. However, waitlists remained long, which can lead patients to seek care elsewhere. An investigation leveraging custom analytics revealed that many clinic slots were going unused due to no-shows, late cancellations, and scheduling obstacles. Optimal use of clinic slots depends on an orchestrated interaction between the Penn Medicine Access Center, patient self-scheduling in the electronic health record, appointment reminders, and waitlist functions.
We piloted a series of interventions with Penn Medicine neurology leadership, providers, and staff to improve patient access and increase revenue.
In terms of access-centered interventions, we tested the effect of:
- Reallocation of follow-up care to advanced practice providers,
- Load balancing to enable open slots with subspecialists to be filled by new patients seeking general neurology care,
- A "Fast Pass" automatic waitlist program offering patients next-day appointments to account for late cancellations,
- And Switchboard visit reminders encouraging patients to cancel early if their schedule or needs had changed.
For revenue-centered interventions, we piloted the following:
- Targeted emails to help providers avoid delinquent chart closures – which can result in unbilled work or lower chance of payment,
- And a self-service tool designed to enable clinicians to see their billing activity and receive feedback on productivity.
After piloting the access interventions, the neurology department achieved 16.7 percent year-over-year growth in visit volume – an increase of more than 15 percentage points.
With revenue-centered interventions, the targeted emails flagging open encounters led to 100 percent compliance with chart closures. Clinicians with access to the productivity tool also identified several systematic billing errors and were able to correct them.
Other than visit reminders, which are still in pilot mode, all these interventions have been implemented in the neurology practices at the Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Penn Presbyterian Medical Center.
To understand why slots were unfilled and attempt to fill them, we created a daily report of open slots and sent it to team members responsible for reaching out to patients whose needs matched the openings. We found that this helped to fill slots, which suggested that part of the problem was inefficiency or friction with the existing process.
We also learned that special permission was sometimes required for a clinician to see a particular problem. Automatic processes were in place at the Access Center to ensure these rules were followed, but they were also preventing matches between patients and available slots.
Because of insights we gleaned using the concierge method, we could identify interventions that would improve efficiency – the Fast Pass program for scheduling open slots – and solve the mismatch problem, which we did by advocating for policy changes around which providers saw which patients.