Monday, June 7, 2010

Come one, come all

We’re still riding the crest of the backlog blitz’s success. Or maybe, the trough, given the curve on our 3rd NAA chart:

This shows an average of all our urologists’ 3rd NAA. Many patients are being scheduled within 10 days of referral. I wonder if it will last? Summer holidays temporary drop our capacity. Backlog may creep up again.

A factor outside our control is demand from outside our traditional service area. While patients can be referred from anywhere in Saskatchewan, most of our referrals are from the “north” of the province. Early on in our Advanced Access project, however, publicity around our quest for improved access garnered us attention from referring physicians in the south. Seeking prompt urologic consultation for their patients lead some of them to refer patients to Saskatoon rather than somewhat urologically under-serviced Regina.

As our new, shorter wait times become widely known (perhaps someone should keep his blogging mouth shut!), this will likely recur. Each patient will have an individual tipping point (based on pain and suffering, or perception of disease seriousness) that will convince them to travel the extra miles to see us. As our access improves, more patients will be referred to us. Our efforts will be “rewarded” with more work!

The outstanding success stories of Advanced Access are achieved in closed systems, known as capitation. Physicians or, more often, large practice groups are assigned a set number of patients for whom they have responsibility for providing care. They receive set funding and so have strong motivation to develop systems that are efficient, while still satisfying patient needs. If these physicians successfully implement Advanced Access (and more broadly, Clinical Practice Redesign), they may be rewarded with financial bonuses and less hectic practices.

But, if their practices are open to any and all new patients, any time freed up by effective practice management will be quickly filled. So, why would they make the effort in the first place?

As our docs are essentially private contractors being paid fee-for-service, there’s no geographic boundary on which patients can be referred to us. If we did negotiate an “alternate payment plan” (a term used to allay physician’s distaste of “salary”) with the government, it would include clear boundaries for how many patients and for what health regions we were to service. That would be a big motivation for us to pursue further CPR efforts, because, although we wouldn’t be paid more, our practice could be less busy and we could have more time off.

But, what would happen in areas of Saskatchewan that were under-serviced? There would be a lot of pressure on local healthcare administrators, and on the government, to deal with the problem at the regional level, rather than relying on our group to pick up the slack. That might get pretty uncomfortable for them.

I wonder if the government realizes what a sweet deal they are getting with fee-for-service physicians?

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