By Brooke LeVasseur
Healthcare systems are faced with challenges in patient access and availability of care. As a result, innovative healthcare solutions are invaluable for reducing patient wait times. Telehealth solutions, such as eConsults, increase efficiency of care by improving access to specialists while also optimizing time and place of care.
The shortage of specialist physicians in the United States continues to receive a great deal of attention. However, a lesser-known compounding factor is the increase in referral rates to specialists. In a 2012 study, the National Ambulatory Medical Care Surveys found that between 1999 and 2009, the probability of receiving a specialist referral during an ambulatory patient visit nearly doubled, from 4.8% to 9.3%. While this study is now several years old, we can surmise that this trend has continued due to the persistence of several factors contributing to the overall disparity between specialist referrals and the number of available specialist physicians.
Taken together, the clear impact of these problems is substantially increased wait times among patients referred to specialists. In 15 major metro areas, a recent Merritt Hawkins study—covering the medical specialties of cardiology, dermatology, orthopedic surgery, and OB-GYN—found appointment wait times increased 25% from 2014 to 2017. Wait times averaged 24.1 days across the study, with some extreme cases waiting 165 days for an appointment.
Source: Hospital Council
Long wait times impact patient outcomes and healthcare operations
On top of the emotional impact of having to wait for care, diseases can progress as patients sit in appointment queues for weeks or even months on end. As NEJM describes, “long waits before appointments, particularly specialist appointments, often contribute to the development of avoidable complications,” creating more difficulties both for patients and their physicians.
Long wait times also increase the prevalence of no-shows, indicating that patients are either frustrated enough to not follow through on scheduled appointments or forget about them altogether. Sometimes, specialists move appointments around at the last minute, leaving patients in limbo for even longer.
Additionally, long wait times frequently lead to inefficient care delivery. Firstly, extended waits often deter patients from seeking initial care. This shifts the healthcare industry away from proactive to reactive care, which is less effective and more costly for all parties involved. Secondly, the inability to access care when they need it leads to patients seeking care within inappropriate settings. These patients are more likely to be admitted to EDs, as the 30-day rate of ED and inpatient usage was 8.7 times higher for patients awaiting a specialist appointment. A study by Truven Health Analytics noted that 71% of emergency room visits are avoidable. Each of these issues alone makes a strong case for reducing patient wait times; combined, they suggest shorter waits are a crucial goal that must be prioritized.
In light of these concerning figures and effects, healthcare organizations are turning their focus toward reducing wait times and improving patient outcomes. Below, we will focus on how telehealth platforms, specifically eConsults, combat multiple factors driving specialist appointment wait times, streamlining the physician referral process and resulting in happier and healthier patients.
Accessing specialty care from within primary care
Increasingly, healthcare providers are entering into value-based payment arrangements. Telehealth solutions, such as eConsults, can support the drive toward efficient care delivery by increasing access to specialists while optimizing time and place of care.
eConsults are an electronic form of peer-to-peer collaboration, providing primary care physicians (PCP) with a platform to consult with specialists on specific patient cases. eConsults take place through a secure, HIPAA-compliant messaging platform, and specialist guidance is received within 24 hours, drastically reducing the time between referral and treatment. eConsults can replace over 70% of routine referrals with immediate, specialist-guided treatment from the PCP, without the additional wait and cost. Keeping lower-acuity patients out of the specialist referral queue means higher-acuity patients have faster access to face-to-face visits, expediting care and improving outcomes for all.
One provider (and frequent user of AristaMD eConsults) at a federally qualified healthcare center describes the challenges of securing specialty care for the patients at her clinic: “Especially with MediCal patients, it usually takes at least four or five months for a patient to complete a referral. Very often, patients end up waiting three to five months, then receive notification their appointment has changed, the specialist has moved, or even that the specialist is no longer taking that patient’s insurance. Some of these patients are then in limbo for more than six to nine months. This is where the benefit of AristaMD’s eConsult platform comes in. AristaMD specialists provide guidance on patient care plans—for example, diagnostic or medication recommendations—within 24 hours.”
Several studies have already noted decreases in wait times once eConsults were introduced in large health systems. The San Francisco Department of Public Health saw dramatic improvements following the introduction of their eConsult program: Median wait times for a non-urgent appointment with a rheumatology specialist were drastically reduced, from 126 days to 29 days. Additionally, patients visiting specialists needed fewer follow-up appointments because eConsults allowed for more extensive pre-visit workup. Similar successes have been observed in Los Angeles and the NYC Health + Hospitals System, with the latter finding that median wait times for high-urgency specialist visits decreased from 30 days to 16 days as a result of eConsult implementation.
eConsults are ideal for addressing the growing problem of patient wait times. They empower PCPs to deliver specialist-guided care to lower-acuity patients in a timely manner while freeing up specialist visits for the more complex patients who need them most.
Brooke LeVasseur is CEO of AristaMD.