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August 2008 Issue

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Neurology Opens Patient Access to Help Meet UC Physicians Re-engineering Project Goals

Published August 2008

Improving patient access to specialties and services is one of the major goals of the UC Physicians (UCP) Re-engineering Project.

Thanks to some steps taken over the past year, the neurology department is making significant progress toward reaching that goal.

“We needed to make some changes in our clinical practice, University Neurology, Inc.,” says Brett Kissela, MD, the department’s vice chair for education and clinical services.

“We needed to improve our access because we believe we have a very high-quality clinical service, but demand is very high and people were frustrated with wait times.”

The department, chaired by Joseph Broderick, MD, put together a clinical task force chaired by Michael Privitera, MD, to examine ways to improve the clinical practice. Numerous people from the neurology department participated.

With prospective patients facing waits of three to six months from the initial contact to the time of the appointment, the task force knew that access was a paramount issue. The solutions, Kissela says, were as simple as making more efficient use of time and as ambitious as starting a new program to ensure same-week access for some patients.

One simple fix was making sure that physicians worked full four-hour blocks to fill up the clinical schedule.

“We’re paying for the overhead for a half-day whether people are there are not, so let’s have people work for four hours,” Kissela says. “This seems like a simple thing, but ensuring that it comes to pass leads to greater efficiency, and it does improve access.”

The new program, whose profile is being raised after being quietly advertised by word of mouth, is an urgent clinic that will hold a minimum of four slots open each week. Responsibilities are shared equally by all faculty members, Kissela says.

“So if someone is referred to neurology from the emergency room who needs a good neurological evaluation this week, they would be a perfect candidate for the urgent clinic,” Kissela says. “We’re starting to advertise this more widely—we know that we can deliver on it now.”

Part of the process is changing mindsets both inside and outside the department, Kissela says.

“In the past, scheduling has been made a barrier, saying, ‘Well, we’re going to have to prioritize— it’s going to be a six-month wait for most patients but we need to get the sicker patients in sooner, so send us your records and then we’ll decide.’

“But patients or physician offices, when they call, want to be given an appointment. Now we have the capacity,” Kissela says. “I know for a fact that there’s a misconception among other practices in our medical center that we’re still six months out in scheduling, and that’s just not true,” he says.

“If someone wants a new patient visit, they can be seen this week—we’ll make it happen.”

With improved scheduling, Kissela says, patient visits are up. Collections are up, too, after successful negotiations with managed care providers.

“The position we took is that we’re a very high-quality practice in great demand, and we think that the people within the various managed care plans would like to have access to our practice,” Kissela says. “Obviously, the private insurers agreed, so that has improved our bottom line.”

The UCP Re-engineering Project is an ambitious effort to merge the clinical practice corporations that comprise the UC College of Medicine’s faculty practice into a single nonprofit tax-exempt corporation. Through shared and centralized services, the goal is to improve patient care and overall operations.

Thomas Boat, MD, executive associate dean of the College of Medicine and CEO of UCP, is guiding the process.

“I think that has been a stabilizing move that people are very excited about,” Kissela says of the appointment of Boat, who previously served as director of the Cincinnati Children’s Research Foundation and chair of the UC pediatrics department.
“To meet him is to respect him.”

As for Boat, he’s understandably pleased with the progress made by the neurology clinical practice. “The department of neurology provides an outstanding model for clinical programs of the College of Medicine,” Boat says.

“They have created a new system of care that both responds to the needs of patients and the community and allows physicians and other health professionals to work more efficiently. Everybody wins in such a system.”

With a head start on working toward some of the goals of the Reengineering Project and some experience with similar projects at other institutions, Kissela knows the challenges that lie ahead but believes the effort will pay off.

“I think that if we can work through the logistical challenges that a re-organization of this size will bring, then we should all be able to reap the benefits,” he says.

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