Is failure embedded in our current system?
Improving patient access to the ambulatory enterprise is on the minds of every health system, hos- pital, and group practice executive.
Whether it’s accommodating patients
with primary care or specialty physicians,
focusing on the “keep-age” of internal
referrals or growing external referrals,
patient access is vital to the success
of any healthcare organization. There
may, however, be internal and external
barriers embedded in the very core of our
business that prevent us from moving
forward effectively. We need to address
six barriers against our goal to expand
access to meet patients’ needs.
Physician Compensation Plan. Let’s start with perhaps
the most surprising barrier: Most healthcare organizations incentivize physicians via work-relative value units
(RVUs). The system has its merits—the scale, which is a
consistent national measure, is payer-blind. As a result,
it avoids the often-painful results of historical models
that focused on collections.
Albeit payer-agnostic, the units are not access-ignorant,
as Table 1 demonstrates. Using most any standard combination of the appointment duration of new versus
established patients, the physician who sees established
patients in lieu of new patients comes out ahead each
and every time. Physicians are rational beings: the work
RVU productivity model incentivizes avoiding new patients
as the work RVU credit (and, therefore, compensation)
increases the more established patients they see.