Yesterday, I had a primary care appointment. It was a routine physical, scheduled four months ago — this was the first available appointment. When I arrived, I waited an extra 45 minutes to see my doctor. Who can relate, and what got us here?
I came across this article from 1985 published in The Washington Post highlighting long patient wait times. My interest was piqued, so I took a look. It would make sense that without digital technology, healthcare operations would be slower, but this article highlights something different. One doctor said, “I might see a child with a 105.5 fever and spend an hour and a half with a nurse sponging him to bring the fever down.” The extent of patient-provider interaction in this era was esteemed. Thirty-seven years later, the healthcare industry still suffers from long wait times, but not because doctors are spending too much time with patients. Over time, the quality of the patient-provider interaction deteriorated, and so did patient sentiment.
According to research from Cooper University Health Care, 46% of patients feel that providers lack compassion, and 56% of clinicians feel that they don’t have time to be compassionate. The average patient appointment wait time is up 8% since 2017 and 24% since 2004, with the latest data showing that it takes around 26 days for a new patient to get an appointment with a provider in 2022. Then, once that patient walks through the door, it’s another 19 minutes. America’s primary care crisis has reached a boiling point and is in dire need of an intervention to improve healthcare quality, access, and the patient experience.
The US Patient Experience Needs A Total Reconstruction Now
In 2022, a typical patient must wait 20.6 days for a primary care visit. Although this is down from a 29.3-day wait time in 2017, this change could be indicative of the shifting landscape of primary care as alternative care sites gain traction and telehealth booms. It is important to note the significant disparities by location. The average wait times to see a family medicine physician range from a high of 44 days in Portland, Oregon, to a low of eight days in Washington, DC. Bostonians can expect to wait 40 days due in part to professional commitments and out-of-towner demand.
In a nation where four out of 10 adults suffer with two or more chronic diseases, delays in care can have fatal consequences. Retail health clinics are stepping in to pick up the pieces, offering same-day appointments and solutions to improving poor scheduling systems and call center woes. There are more than 3,000 functional retail clinics in the country as of 2020. Big retail companies like Amazon, CVS, Walgreens, and Walmart are scaling rapidly with big moves in primary care. Walgreens is making a sizeable impact by opening a new VillageMD clinic “every three days.”
To compete, providers must wrestle with staffing shortages, outdated technology, and inefficient workflows. The Association of American Medical Colleges estimates that the US could see a shortage of between 37,800 and 124,000 physicians by 2034, including in both primary and specialty care. At the same time, the number of new physicians entering the field has been limited by a cap on funding for training that Congress enacted in 1997. Addressing scheduling and wait times is critical to improving patient experience and health outcomes. Ignoring this problem can result in:
- Retail health monopoly on primary care. Retail companies are able to apply their existing technology stack and acquisition-acquired clinician assets to streamline workflows and provide next-level patient experiences. One low-hanging fruit that they will transform is patient appointment and provider scheduling. The big retail firms know that 30% of patients have left a doctor appointment because of a long wait time. Leveraging AI, retail health will offer personalized scheduling experiences that are user-friendly, convenient, and that reduce the traditional wait time for an appointment. For example, CVS MinuteClinic enabled same-day scheduling via Google Search. To manage patient throughput, CVS uses Schedule360 healthcare scheduling software to oversee provider shifts across 1,100 locations.
- Diminished patient outcomes. Far from novel, the longer it takes to see patients, the higher the risk of morbidity, mortality, and potentially avoidable hospital visits. In extreme cases, Patrick Allen, director of the Oregon Health Authority, told a state legislative committee last month that people in need of intensive care often have to wait for admission because hospitals lack staff, which can lead to worse consequences. “They would have had a good outcome, but in at least a few cases, people died waiting for that higher level of care,” Allen told the Interim Senate Committee on Health Care during an informational hearing.
- Patient experience and satisfaction reduction. When patients arrive at a doctor’s office and have to wait in the waiting room, anxiety, stress, and frustration build. Maybe they are taking time out of their workday or have kids to care for at home. Whatever the circumstances, when patients are left in the dark about their wait times, patient satisfaction plummets. The National Library of Medicine found that, across 51 studies on organ transplant, surgery, or cancer management, most patients and caregivers reported anxiety, depression, and poor quality of life, which deteriorated with increasing wait time. Packed waiting rooms are also a petri dish of activity. These areas increase the risk of infectious disease spread, especially to susceptible and vulnerable patients.
Four Solutions To Help Set Patient Expectations And Improve Patient Experience
At Forrester, we talk to hundreds of healthcare organizations, vendors, and subject matter experts each week. Patient experience is an increasingly common theme, especially in technology solutions addressing streamlining scheduling and nudging patients. Yet despite the innovation and emergence of startups in this space, healthcare organizations still rely on outdated methods to schedule appointments and notify patients — think fax machines, phone calls, and even snail mail. To improve patient satisfaction, healthcare organizations should:
- Streamline the scheduling experience. Embed a scheduling system on your website or mobile app. This allows patients to schedule appointments easily without having to call your office and wait on hold or get transferred to a call center and have to repeat information. Scheduling systems should leverage AI to suggest appointments based on location, insurance coverage, and estimated wait-list times. According to our Forrester Analytics Consumer Technographics® survey data, 61% of online adults say they want to book/change their healthcare appointments with a website or app.
- Remind patients of crucial tasks and upcoming appointments. Missed appointments (no-shows) are costly and operationally inefficient for health systems. In the US, the annual cost for no-shows is estimated at $150 billion. Using precision nudging to nudge patients with reminders can help avert no-shows, reduce the administrative burden, and lower costs. One vendor found that a “5-3-1” -day reminder ratio works well to remind patients of upcoming appointments.
- Provide real-time messaging to patients to set expectations on wait times. As mentioned above, wait times can cause anxiety, especially with no communication. Text alerts with estimated wait times can help set expectations and ease stress. Implementing a mobile queue tool is also a great way to drive down wait times. Users can join a virtual line that updates their position in real time so that they can go grab a coffee instead of sitting in the waiting room. Providing the patient an option to share their status with a caregiver is an added bonus. This functionality was a game-changer during the pandemic.
- Develop a strategy that prioritizes critical patients. Some practices keep appointment slots open for same-day appointments. Others have a queue system that tags conditions based on level of severity to determine who will come off the wait list first. Both methods ensure the best use of time and better patient outcomes, especially in critical situations.
The final piece of the puzzle is feedback. Real-time feedback collected via text or email will help healthcare organizations uncover points of friction in their patient journeys, remove bottlenecks, and delight patients. If wait times are a problem, these surveys will identify critical control points to focus on. Eager to start on your patient experience transformation journey? Schedule a call with us — we would love to strategize and help you take your first step!