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Same-Day Appointments Improve Care, Save Money

Same-Day Appointments Improve Care, Save Money

It began as a simple question from Wilmer Eye Institute Director Peter J. McDonnell, M.D.: “Wouldn’t it be great if any patient could call and get an appointment the same day?”

Eric Singman, M.D., Ph.D., the Milton and Muriel Shurr Division Chief of the General Eye Service clinic at Wilmer, has always been up for a challenge, so almost immediately, he began talking with staff members about what it would take. That was in 2014. Today, what started as an experiment has become a signature service that is offered across all of Wilmer’s clinics. Every patient who calls for an appointment has the option to been seen within 24 hours.

Wilmer now schedules 1,000 same-day appointments every month—some 14 percent of patients, notes Singman. “It’s pretty clear. People like being seen conveniently,” he adds.

Gina Locco is clinical operations manager. She runs the scheduling team and worked closely with Singman to make the idea of same-day appointments a reality. She helped figure out how to do it from a logistical standpoint and put procedures in place with the team of schedulers taking calls on the phone.

Working with just a single doctor at first—Singman himself—the team soon expanded the offering to the General Eye Service division. Within six months, the program was such a hit that all of Wilmer was offering same-day appointments, Locco says. “In April 2019, the clinic booked its 50,000th same-day appointment,” says Locco proudly. It is a milestone that seemed improbable, if not impossible, five years ago.

Same-day appointments are more than a high-profile service for Wilmer. Singman says they improve care by getting patients to see doctors faster. They are also a tremendous cost-saving measure. Eye concerns can be worrisome, and patients with nonurgent issues often turn to emergency rooms rather than wait for an appointment. “Try telling an anxious patient their eye problem isn’t urgent,” Singman says.

By keeping patients out of the ER, same-day appointments save money. To find out just how much, Singman devised a study to compare dollars to dollars and minutes to minutes. “We plumbed the data,” he says.

Turning to Epic, Johns Hopkins Medicine’s electronic medical record software, he worked with senior clinical IT analyst Kerry Smith; ophthalmologist Michael Boland, M.D., Ph.D., who is the IT director at Wilmer; and others to look back over the years and calculate the savings.

What the team discovered surprised even Singman. The average difference is $782 and almost six hours of wait time for eye patients who opt for same-day outpatient appointments over a visit to the ER.

“The ER costs at least three times as much and has three times the wait,” Singman says. “Patients— and their insurers—are going to like that data.”

A paper based on his finding won first prize in its category at the High Value Practice Academic Alliance and will be published in the journal JAMA Ophthalmology.

While pleased with these findings, Singman points out that the majority of patients who make same-day appointments are for nonurgent matters. In 2016, when Wilmer had more than 26,000 same-day appointments, a little more than 6,000 were urgent, he says. “Same-day appointments are for any reason,” says Locco. “Contacts, yearly eye exam, urgent or nonurgent. There are no limitations.”


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