1. www.postersession.com Improving specialty access with budget restrictions and limited staffing has been one of the major challenges while implementing a patient-centered approach to achieve organization benchmarks. We describe a patient-centered approach along with several methods to improve access in the multispecialty clinics. Methods We developed and implemented strategies to accomplish specialty care patient-centered cultural transformation with limited staff support. Along with the PACT philosophy, we implemented several methods to improve access while saving fee costs and avoiding unnecessary visits to our facility. These methods are HIPPA compliant and patients select these methods on a voluntary basis. The first method is Referral Templates that require specific criteria and tests for consultations. Once a consultation is requested, the nurse and/or specialist reviews the consult for appropriateness and schedules the consultation. The second method is a Secured Message that allows patients to communicate with their specialist providers through a secure e-mail. The third method is an Electronic Consult (e-consult) that allows primary care providers to consult specialists without the necessity of specialists to evaluate the patients face to face; e-consults are needed when more than a phone consult is required from the specialists. The fourth method is the Shared Medical Appointment where specialists can meet several patients in a block session of 2 hours and address group consults through medical education and open ended questions. Results Conclusions IMPROVING SPECIALTY ACCESS AND COST SAVINGS THROUGH PATIENT CENTERED CONSULTATIONS Gilmer J. Rodriguez, MD, MPH, MMM, CPE, FACP, FACPE Associate Chief of Staff, Acute Care and Specialty Clinics / Education Central Alabama Veterans Healthcare System Our multispecialty clinic access for new patients waiting more than 14 days for a desired appointment improved from 2.41% in January 2012 to 0.15% in February 2013. The rate of discontinued consults for 2012 improved our specialty clinic capacity by 22.87%. The rate of secure messaging for 2012 was 2.47%; e-consults and shared medical appointments were less than 2% in each of these categories. We went to the basics of team work among the current staff of providers, nurses and clerks, empowered the front line staff to make changes, monitored and provided real time data to staff and recognized staff for their achievements. Our specialty-centered philosophy is to provide comprehensive care in one single visit as much as possible. We identified a significant number of referrals in need of further work up and able to be managed by primary care providers; these consults were discontinued and patients went back to referral providers, improving access for new patients. Secure messaging rates were small due to the new implementation of the system bur rate were not different from other Services. Specialty providers may relate reasons for the small number of e-consults to the number of referrals and the ongoing process of education for appropriate capture of e-consults, a relative new process in the organization. Shared medical appointments did not show a significant impact on specialty access; this may be due to the preference of patients to have face to face consultations instead of a group session and a well established Veterans Health Education Program. The last method is the use of Store and Forward and Real Time Telemedicine consultations from specialists to clinics and is in the process of being implemented. The implementation of the previous methods described showed improvement of our current access; however, it did not explain the significant access improvement over a one-year period. It is our belief that the comprehensive care of patients the same day of the appointment with phone consultations and/or follow up to referral providers and patients, the referral screening, the team work of nurses and physicians and the cultural transformation of the specialty clinics explain the significant outcome achieved by the organization. It is expected that the implementation of secure messaging, e-consults, specialists shared medical appointments and telemedicine consults will further improve the access through the organization. Introduction Discussion Improving specialty access with budget restrictions and limited staffing has been one of the major challenges while implementing a patient-centered approach to achieve organization benchmarks. We describe a patient-centered approach along with several methods to improve access in the multispecialty clinics. Improving specialty access with budget restrictions and limited staffing has been one of the major challenges while implementing a patient-centered approach to achieve organization benchmarks. We describe a patient-centered approach along with several methods to improve access in the multispecialty clinics. Our multispecialty clinic access for new patients waiting more than 14 days for a desired appointment improved from 2.41% in January 2012 to 0.15% in February 2013. The rate of discontinued consults for 2012 improved our specialty clinic capacity by 22.87%. The rate of secure messaging for 2012 was 2.47%; e-consults and shared medical appointments were less than 2% in each of these categories. Our multispecialty clinic access for new patients waiting more than 14 days for a desired appointment improved from 2.41% in January 2012 to 0.15% in February 2013. The rate of discontinued consults for 2012 improved our specialty clinic capacity by 22.87%. The rate of secure messaging for 2012 was 2.47%; e-consults and shared medical appointments were less than 2% in each of these categories. Our multispecialty clinic access for new patients waiting more than 14 days for a desired appointment improved from 2.41% in January 2012 to 0.15% in February 2013. The rate of discontinued consults for 2012 improved our specialty clinic capacity by 22.87%. The rate of secure messaging for 2012 was 2.47%; e-consults and shared medical appointments were less than 2% in each of these categories. BACKLOG OF PATIENTS WAITING MORE THAN 14 DAYS FOR A DESIRED APPOINTMENT DATE 10/01/1101/15/1203/15/1206/01/1209/15/1212/01/1212/15/1201/01/1302/01/1302/15/1303/01/13 Clinic (303) Cardiology1710212015433112 (304) Dermatology314183310000 (312) Pulmonary/Chest1179653188328205 (313) Renal/Nephrol1463128990012 (315) Neurology55183519731 0 (401) General Surgery2410 912813159027 (404) Gynecology59349555002 (407) Ophthalmology39626132818 8533 (408) Optometry621747334249109895452232035 (411) Podiatry51419104235001 (414) Urology17592157513 8627 AC&S Total 867950497454226163151165775884 Uniques37,44639,48439,38239,61539,390 39,176 39,18539,222 39,211 Access Rate 2.32%2.41%1.26%1.15%0.57%0.42%0.39%0.42%0.20%0.15%0.21%