Only 16% of total patient time spent concerns face-to-face medical care

Only 16% of total patient time spent concerns face-to-face medical care
Overview

Reducing waiting time will have the highest impact on reducing total patient time burden and opportunity costs for society.

US researchers[1] measured both patient time burden (in minutes) and patient time costs (in dollars) for ambulatory medical care across the United States of America covering the period 2003-2010. When measuring patient time and costs pertaining thereto, travel time, waiting time at the physician’s cabinet and the time when actually receiving face-to-face medical care are particularly relevant.

The results of the study show that the mean total time of the patient for medical visits amounts to 121 minutes.[2] Of the total time 37 minutes related to travel time. On average the patient is spending 64 minutes waiting at the physician’s cabinet or performing tasks not relating to receiving face-to-face medical care (e.g., paying, filling out medical questionnaires, etc.). Only 20 minutes of the total patient time relates to face-to-face medical care with the physician, which is about 16%.

The mean total opportunity cost – calculated based on self-reported wages, which is an acceptable metric in labour economic theory – per medical visit amounted to $43USD. Put differently, it costs society $43USD per medical visit in respect of non-productive worker time, on top of the actual healthcare spending. To put this in perspective, the mean out-of-pocket expenses in respect of patients was only $32USD and is clearly lower than the opportunity cost. The opportunity costs for society are estimated at $52 billion USD per year across the entire US population.

But let’s look on the bright side. There’s room for improvement – a lot of room.

One way to decrease the total patient time is by cutting travel time. Adequate urban planning and smart mobility contribute to decreasing travel time. This is a clear task for public policy. But cutting travel time all together by applying telemedicine, where possible and appropriate (e.g., for follow-up consultations, prescriptions for birth control, etc.), is a clear win as well. In Belgium to date this is still not legally allowed, and the Belgian General Medical Council still strongly opposes to telemedicine unfortunately.

Another way to decrease the total patient time is by cutting the waiting time at the physician’s cabinet and optimizing tasks which do not relate to receiving direct care. Decreasing this part of total patient time will have the highest positive impact on total patient time.

Appropriate scheduling can offer great advantages in this regard. Question remains: what kind of scheduling is appropriate? Will online calendars solve this issue? Not very likely. Although the typical online calendar platforms provide for some patient convenience and thus contributing to a slightly higher patient satisfaction, online calendars do not cut waiting time.

Quite on the contrary actually. Why? Because online calendars typically provide in a flat calendar with standardized blocks of 15 to 20 minutes. So it suffices for two appointments taking 30 minutes each to disrupt the entire schedule of the physician and to increase the waiting time for the other patients.

When referring to appropriate scheduling, you’d have to take three aspects into account – next to the obvious online 24/7 availability for the patient.

First of all, the scheduling software platform should be able to make appointment blocks dynamically adaptive depending on the patient, the physician and the treatment. This means that the software should be able to differentiate between patients who are to-the-point and who can easily explain the symptoms they have and patients who cannot, between physicians who take a lot of time with their patients and those who don’t and between treatments that take a lot of time and those that don’t.

Secondly, the scheduling software platform should allow, in itself or through seamless integrations, for performing tasks which do not relate to the face-to-face medical care in a convenient and time-efficient manner. Registering the presence of the patient at the physician’s cabinet, payments, filling out medical questionnaires, reporting symptoms and smart intake to prepare for the consultation.

Thirdly, whenever the physician is ahead or behind on his schedule, an appropriate scheduling software platform should be capable of automated and interactive communication to enable the patient to show up earlier, where possible, or later. Also, dynamic and (semi-)automated rescheduling should be possible as well in order to cope with gaps in the schedule of the physician due to e.g. no-shows or urgent unforeseen interventions of the physician.

Of course, such scheduling software platform will only be adopted by physicians and other healthcare providers insofar it saves time and proves to be very convenient for them as well.

 

[1] M. BERTHOLET, A. V. CHARI, J. ENGBERG, A. MEHROTRA, K.N. RAY, “Opportunity costs of ambulatory medical care in the United States”, AJMC 2015, Vol. 21/8, 567-574.

[2] This is in line with the results of earlier research. See D. CARR, Y. IBUKA, L. B. RUSSELL, “How much time do patients spend on outpatient visits?”, The Patient 2008, Vol. 1/3, 211-222.

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