Where Have All My Patients Gone?

By Dr. Sue Kressly

If your practice is like mine, you may have noticed unfilled slots in your patient schedule over the past few weeks. While your staff may be celebrating that they finally have a moment to breathe, if you are like me, you are thinking “Lost Revenue!!!” So where have all the patients gone and what can you do about it?

Pediatrics is “predictably unpredictable.” What does that mean? It means that much of what we see is acute infectious illnesses and often those are at the mercy of what happens to be circulating in the community. We have all experienced the unexpected timing of flu outbreaks. Does anyone remember H1N1 in October? We ended up seeing patients until late at night, but it sure was great for the bottom line!

Our office has been unusually quiet since school left out in mid-June. This is due in part because (1) there isn’t much illness in our community at the moment, and (2) some of our patients are choosing the convenience of Retail Based Clinics (RBCs) and community Urgent Cares, even when our office is open.

So what is a pediatric practice to do? This may not be our fault, but it is our problem and I encourage you to work to solve it. To me, the solution comes down to attention to the following:

  1. Focusing on well care and recalling preventive visits
  2. Focusing on chronic disease management (like ADHD and asthma) and recalling for follow-up visits
  3. Having “scheduling agility”
  4. Creating a strategy for response to the urgent care/RBC visit leakage

Well care IS the cornerstone of pediatrics. Make sure you are using every opportunity to fill your schedule with well visits. Run recalls several times a month, reach out to patients who are home for the summer and should be more available to make and keep an appointment. Keep a “cancellation move-up queue” with good contact numbers so you can text someone if your day is slow or you have a last minute cancellation. If the week is looking slow on Monday, use your staff to contact families and start overbooking Wednesday-Friday with more well visits. Turn a sick visit into a well. Is a sibling along for the ride who is overdue? Fill them in now. Cancellations? Your staff shouldn’t have to wait for someone to tell them to start calling and filling those slots. Empower them to own this problem and solve it!

Families don’t like their kids with chronic disease to miss school. They’re already likely to be absent more frequently than their healthy peers. Run recalls and get the ADHD, asthma, anxiety, and obesity rechecks scheduled over the summer. Use care plans to identify and recall those patients.

Don’t get locked into the way you usually schedule. Be quick to react and adjust. I create template zones based on the last three years of actual sick visit useage, and then fill in the rest with well visits. However, this never works 100% of the time, so I monitor and tweak it constantly. Same day sick visits will always need to be seen and providers need to have an agreement in advance that if this is a really busy day, someone may have to be the “late person” or everyone may have to agree to add 2-3 more patients over lunch. The morning huddle can really help determine how to be flexible as the day moves on, without constant interruptions from your staff. Empower your team members to “do the right thing.”

Some patients will choose the convenience of an Urgent Care for a variety of reasons. Every practice should have their own strategic response to this trend. It might include same day walk-in sick visits, open access scheduling, developing your own urgent care, or embedded Telehealth into your medical home. Get creative. Make it easy to say “yes” to patients when they want care. They have more options than ever, and you want them to look to you first. What is your strategy to create value for your medical home and make sure your appointments are filled?


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