1. Improving Access to Subspecialty Care in an Academic Medical Center
Sam Weir, MD
Warren P. Newton, MD, MPH
University of North Carolina at Chapel Hill
STFM Annual Meeting
April 30, 2008

2. The Problem
Access to specialist care drives payer mix/revenue, relations with referring doctors and patient satisfaction
Many AHCs have significant problems with access
Not many easy answers…

3. Objectives
To describe an intervention to improve access to specialty care in an academic center
To describe the role played by the Department of Family Medicine

4. Setting University of North Carolina Health Care
UNCHCS provides comprehensive subspecialty care
65% of business comes from 6 area counties, but with large numbers of patients from all 100 counties
Long wait for appointments in most divisions, yet overall demand expected to double in 10 years given rapid growth in the region
A setting of rapid change in clinical infrastructure: scheduling, billing and clinical data system changes
Integrated clinical record system (hospital, ancillaries, outpatient)

5. Department of Family Medicine
Experience with practice redesign: open access, chronic disease, group visits (DM, Mothers, Well Children), e-medicine, as well as hospitalist/MCH

6. In the beginning…
Strategic planning retreat of senior leaders discussing plans for growth….
Reality check—how can we grow when we’re not able to see our current patients?
RFP for access improvement, implementation of new scheduling system
Outside consultants OR
Internal proposal developed by 3 MD faculty

7. Patient Access & Efficiency Initiative
Three year project with goals:
New patient evaluation in any clinic within 14 days.
Reduce visit cycle time by 30%
Implement enterprise wide scheduling system
Learning collaborative model with three waves of improvement teams; all 54 clinics involved.
Staff: Director, Redesign Change Managers, Data Coordinator, internal faculty (part time)
Budget: Total of 3.2 million dollars, with contributions from the practice plan and the hospital
Governance: Senior leader sponsors from both hospital and practice plan
Started data team in 4/05; third wave started 11/07

8. February 2008: 63% of UNC clinics had appointments for new pts in < 15 days

9. Lessons Making the Case for Advanced Access
Focus on new patients—improves revenue
Offload return demand creates opportunity
Service agreements between primary care and selected specialties improves understanding and collaboration
PAcE has pushed OR & hospital throughput to a crisis point
How will we organize quality?

10. Lessons Leading/Managing the Process
Helpful to have friends (and patients) in high places
Internal vs. External consultants
Strategy of waves (get some early success)
How to involve clinical leadership in subspecialties…

11. Lessons Role of Family Medicine
QI Expertise, proven track record – and relationships
Collaborating with other disciplines
Opportunity knocks – being able to answer having the capacity to ‘share’ faculty time for an institutional role
Spin offs/opportunities
Care protocols (‘service agreements’)
Uninsured care
Financial support/Good will
Downside
Distraction from departmental work

12. Next Steps
Incorporate new scheduling/tracking systems, address own services
Extend to OR & ED throughput, linking ambulatory and inpatient care and community reorganization
Key issue is sustainability, both in other departments and across the institution.