Date: 12/01/2016

The patient traveled from the Cayman Islands to see a Johns Hopkins specialist. At 8:48 a.m. on the appointed day for his visit, he received a phone call informing him that his appointment was canceled.

He was quite upset. And understandably so.

Of course emergencies arise, and a provider must cancel clinic. But late cancelations can compromise patient care, sharply reduce patient satisfaction and decrease revenue when patients choose to go elsewhere, as some indeed do. For those reasons, getting the provider-initiated cancelation rate — also known as the bump rate — to under 3 percent in all departments is a high-priority goal for FY2017.

For FY2016 the goal was to drop the overall institutional rate to below 3 percent. “We achieved this institutional goal, but not all departments got below that mark,” says John Flynn, vice president of the Office of Johns Hopkins Physicians. In the last fiscal year, a number of departments saw their bump rates drop dramatically. Dermatology got its rate down to 0.8 percent, for instance.

Flynn points to the Division of Cardiology and the departments of Plastic and Reconstructive Surgery, Medicine, and Orthopaedic Surgery as other success stories. (See the sidebar “The Keys to Cardiology’s Success.”)

These factors drove the downward trend:

• Re-education about using the correct cancelation reason codes was introduced at all levels. (See the sidebar “What Is and Is Not a Bump?”)
• Many departments have mandated that cancelations within 30 days be approved by the department director.
• Several departments, including Dermatology, give their patients the option of being seen during their scheduled appointment by another physician who is covering for his or her colleague during the emergency absence.
• Monthly access-focused meetings review cancelation data.

Other Key Ambulatory Goals for FY2017

The key ambulatory goals for FY2017 fall into one of four categories: operational excellence, quality and safety, patient service excellence, and physician support.

Operational Excellence

Reducing the provider-initiated cancelation rate is one of the goals pertaining to operational excellence. The other one is closing encounters within 14 days, to facilitate continuity of care for patients. “If a patient presents to the ED, no documentation of recently received medical care could be detrimental to that patient’s health,” says Michelle Campbell, administrator for ambulatory operations for satellite locations.

The hospitals’ vice presidents of medical affairs are now accountable for the closed-encounter metric.

“Our physician leaders have made it a priority to expeditiously close encounters, and that has had a significant impact already,” says Campbell.

Quality and Safety

Another priority for FY2017 concerns timely follow-up with test results, which is measured by the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) patient satisfaction survey.

Campbell points out that when lab tests are communicated via MyChart without a note, some patients may not perceive this as follow-up.

“It’s important to remember that the highest-quality clinical care from the patient’s perspective may be different than what the physician defines as the highest-quality clinical care,” says Campbell. “Providers are encouraged to include a note in MyChart when they release test information.”

Blood pressure control for patients with hypertension is the other goal in this category. For patients 18 to 59 and for those 60 or over who have diabetes, the target is that at least 74 percent have a reading less than 140/90mm Hg. For older patients without diabetes, the target is that 74 percent will have a reading less than 150/90mm Hg.

“If we can make improvements in hypertension rates, it will also improve other aspects of the patient’s health,” says Jenny Bailey, vice president of quality and transformation for Johns Hopkins Community Physicians.

Physician Support

There are two physician support goals: 98 percent of transcriptions are to be available within 48 hours and the Ambulatory Management Program (AMP) is offered. By incorporating Lean methodology and focusing on effective leadership and problem solving, AMP provides clinical leaders with the knowledge and skills required to enhance ambulatory care delivery. Click here for information on the Ambulatory Management Program.

“Our job in the Office of Johns Hopkins Physicians is to give our clinicians and clinical faculty members tools to help them do their jobs,” says Flynn.