Book Next Doc Visit on the Spot

Paying physicians to schedule follow-ups while patients are still in the office boosts care continuity and health system income

Based on the research of Diwakar Gupta

If you’ve ever tried to schedule a follow-up visit with a doctor, you know what can happen: Sit on hold, and then learn that the earliest available slot is three months out.

New research from the McCombs School of Business at The University of Texas at Austin might help to ease your pain.

Understanding their patients’ frustrations, some doctors encourage them to book follow-up appointments while still at the doctor’s office, says Diwakar Gupta, professor of information, risk, and operations management and Daniel B. Stuart Centennial Professor in the Application of Computers to Business & Management. It’s a process he calls prioritized follow-up appointments.

But there’s a dark side as well, he found. Doctors may not schedule them as much as a health system prefers, because they’re afraid of late cancellations and no-shows. When patients book a follow-up several weeks in advance, there’s a greater chance that they may cancel late or not show up — because of schedule changes, or because they may not need the appointment.

The solution, Gupta found, is to tweak pay incentives. By rewarding doctors for prioritized follow-ups, healthcare systems can make them easier to get — and improve the systems’ own bottom lines.

“They’re able to ensure continuity of care, as opposed to letting the patient call two or three weeks later,” Gupta says. “If patients try to book an appointment with the same doctor, and they can’t, they might go to a different clinic or health system.”

Clash of Incentives

With Yichuan Ding of McGill University in Montreal and Shenghai Zhou of Central South University, Changsha, China, Gupta analyzed a year’s worth of appointment data at 37 clinics. They found prioritized follow-ups boosted continuity of care.

For every extra 10% in the ratio of prioritized follow-ups to regular ones, patients were at least 10.7 percentage points more likely to see the same doctor.

That’s good for healthcare systems, when insurers pay them or penalize them based on continuity of care.

Doctors, however, have conflicting financial incentives. They’re paid for services, which means they lose money if they schedule a follow-up too far ahead of time, and the patient turns out not to need it.

“The doctor acts independently to maximize their own revenue, while the healthcare system tries to maximize overall revenue, which includes incentives for greater continuity of care,” Gupta says.

Measuring Follow-Up Visits

To align incentives, the researchers proposed paying doctors extra for scheduling prioritized follow-ups.

They adapted an idea from a very different field: contracts for salespeople, where it’s common to base bonuses on performance benchmarks such as sales quotas.

For doctors, Gupta proposed adding a performance payment based on how many prioritized follow-ups they book.

Gupta modeled four ways to structure the payments. He found two kinds of optimal contracts:

• It’s more effective to focus on prioritized follow-ups than on overall follow-ups.
• Instead of setting a minimum number of prioritized follow-ups, systems should gauge their percentage in a doctor’s schedule.

Such contracts serve dual purposes, he found. By maximizing follow-ups and improving continuity of care, systems earn more from insurers. Systems also end up with the highest net profits after paying out performance bonuses to doctors.

“If you want to achieve high continuity of care, look at ratio-based contracts and only give incentives for prioritized follow-ups,” Gupta says.

He adds that such appointments should be easy for systems to track. Says Gupta, “You can see which ones are booked on the same day the patient came to see the doctor.”

“Early Reservation for Follow-up Appointments: Enhancing Patient Care Continuity” is published in Manufacturing & Service Operations Management.

Story by Steve Brooks