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The QLess Blog

Patient visit redesign: QLess dynamic wait management allows HMOs to comply with new regulations mandating shorter patient access delays

Jan 24 By Alex Bäcker | Categories: Healthcare

New rules were announced last week aimed at limiting the long wait times for patients in health maintenance organizations to see a doctor.

QLess allows health organizations to comply rapidly and inexpensively by moving to active or dynamic scheduling. Dynamic scheduling improves patient access to doctors, reducing wait times, in three ways:

  1. QLess SMS and voice appointment reminders reduce no-shows by 15 to 40%, eliminating unproductive gaps in a doctor's schedule.
  2. Today, appointments are scheduled based on average appointment durations. If a consultation is shorter than expected, they cannot ask the next patients to come earlier. QLess allows that via automated interactive SMS and voice notifications, making each appointment exactly as long as it actually is.
  3. By not promising appointments and scheduling actively in real time, QLess can more schedule in a way that's better than FIFO (first in first out), such as allowing patients marked as urgent to be seen sooner.

QLess is revolutionizing appointments as we know them.

--Alex

Reprinted from the San Jose Mercury News:

HMO patients will soon have shorter wait times to see a doctor

By Sandy Kleffman
Contra Costa Times

Posted: 01/19/2010 05:15:11 PM PST

California regulators will announce new rules today aimed at limiting the long wait times for patients in health maintenance organizations to see a doctor.

In most cases, HMO doctors will be required to see a patient for a primary care appointment within 10 business days.

Specialists will be required to see patients within 15 business days.

Those with urgent problems requiring prompt attention should be seen within 48 hours.

The regulations, to be announced in Los Angeles, will make California the first state in the nation to provide such consumer protections.

Advocates hailed the move.

"This will help patients get the care they need when they need it," said Anthony Wright, executive director of Health Access California. "It will help improve health outcomes, since care delayed is often care denied."

Long delays to see have a doctor have been a frequent complaint of HMO patients. A 2009 study in Los Angeles found that new HMO patients wait on average 59 days to see a family practice physician.

The rules will apply to the 21 million residents who are in HMO plans, but not to other patients.

The regulations spring from a 2002 law that required the state to ensure timely access to HMO care.

For seven years, the California Department of Managed Health Care has worked with consumer advocates, HMO representatives and others to draft the rules.

HMOs will be required to submit plans for meeting the standards, then implement the plans within one year.

Critics have argued that the organizations may have to hire more doctors, which could drive up health care costs, and that doctors may be forced to rush patients through more quickly, which could compromise care.

However, many HMOs, which were heavily involved in the negotiations, are cautiously supporting the rules.

"We think these regulations, with enough flexibility, can make it clear to everybody what the standards are," said Patrick Johnston, president and CEO of the California Association of Health Plans.

He said that doctors should still be given leeway to see patients with the most critical problems first. Regulators should look at general compliance with the time limits, he said, rather than occasional violations.

Kaiser Permanente leaders noted that they already offer members same-day urgent care appointments, 24-hour phone advice, and Internet-based tools that enable patients to e-mail their doctors.

"We worked with the Department of Managed Health Care during the development of the new access regulations. "... We will continue to work with regulators on implementation of the regulations, ensuring that we meet the 2011 compliance requirement," Kaiser officials said in a written statement.

Consumers who think their HMO has violated wait times can complain to the state Department of Managed Health Care at 888-466-2219 or www.healthhelp.ca.gov.

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