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New Program Eliminates Delays in Seeing Doctors

By Mark Scott

Buffalo, NY – One of the more frustrating parts of life is having to wait to schedule an appointment with your doctor, and then having to wait even more in the waiting room when you arrive. But a new program being used by a number of physician practices, including some on the Buffalo area, is starting to change that.

There's something different about a handful of doctors offices in our area. The patients are able to see their doctor on the same day they call for an appointment. And they don't have to wait as long once they arrive.

The concept behind this new way of doing things is IDCOP -- "idealized design of clinical office practices." It's the brainchild of the Institute for Healthcare Improvement in Boston.

Independent Health here in Buffalo learned of IDCOP and, says Chief Medical Officer Michael Cropp, began exploring how it could be implemented locally. He said IDCOP is designed to match the needs of patients with the capacity of the system. Cropp said it begins with doing today's work today.

"If you focus on quality, then the other dimensions of health care performance will improve," Cropp said. "So, focusing on quality first will result in better access to care and more satisfied patients. Ultimately, doing things right the first time is less expensive."

One of the first physicians in the Buffalo area to sign up for IDCOP was Dr. John Notaro, an internist with the Buffalo Medical Group in Orchard Park. Though there are four themes associated with IDCOP, Notaro said the one that has resonated the most with patients is "open access."

"How do we operate our system and how to we manage our capacity so that patients can get into the system when they think they need to get into the system," Notaro explained. "It's a very patient-centered point of view."

The typical doctor begins each day with 80 percent of his schedule already filled in. The remaining 20 percent can quickly fill in, forcing other patients to wait a few days for an appointment. Under IDCOP, the doctor begins the day with as little as 20 percent of his schedule booked.

But according to Independent Health's Michael Cropp, the law of probability works. On any given day, the phone starts ringing and the calendar fills out. Still, Cropp admits not all physicians are receptive to the idea.

"There's a tradition in medicine that the longer the waiting time is for that next appointment, the better physician you are. That's a difficult mentality to break out of," Cropp said. "Then, there's the economics of looking at a schedule at the beginning of the day that's open, knowing that your income is dependent on that schedule being full."

"It's a leap of faith to start with an open schedule and expect that it will fill up naturally," Cropp continued. "Physicians who have made that leap of faith have found that predictability to the demand of their practice is very clear. I don't believe that any of the physicians who have been using this system have had to go home early because their schedule wasn't full."

Internists and family practitioners aren't the only ones buying into IDCOP. So are specialists like Western New York Urology Associates. Dr. Christopher Skomra says an analysis of their offices found they weren't as open as they thought they were. So, they, too, made a change to open access. As specialists, more of their day is scheduled in advance than a primary care doctor. But the waiting time to see a doctor, says Skomra, has been reduced from seven to ten days to three to five days. Skomra also says the practice has made a commitment to new technology in its efforts to enhance patient satisfaction.

"We're using a centralized computer system that allows us to access information at any of our locations at any time of the day," Skomra said. "It allows us to import data such as lab and pathology reports from wherever they're done into our system automatically without (having to deal with paper)."

Supporters of IDCOP say "open access" does not mean the practice turns into a drop-in clinic. Appointments are still necessary. Perhaps the biggest benefit, says Dr. John Notaro of the Buffalo Medical Group, is that patients become more engaged in their own care. Illnesses or other health problems are caught earlier. And he says patients are less likely to seek expensive emergency room care.

"Looking at some of our own data, we think that utilization of the emergency room seems to be less for the doctors (using open access)," Notaro said. "This is due to the emergency room serving as an overflow valve. It's been a place where a patient could go when they couldn't get in to see their doctor. That, of course, is unsatisfactory to the patient. They prefer to see someone who they know and prefer not to go through the rigors of an emergency room experience."

Besides fewer emergency room visits, Independent Health's Michael Cropp says patients of doctors using IDCOP have fewer referrals to specialists and significantly less use of presciption drugs. And that, says Cropp, leads to reduced costs, which supporters say will eventually result in more physicians buying into the "idealized design" concept.