From the 2018 HVPAA National Conference
Eric Singman (Wilmer General Eye Services @ Johns Hopkins Hospital), Kevin Frick (Carey Business School at Johns Hopkins), Gina Locco (Wilmer Eye Institute @ Johns Hopkins Hospital), Peter Mcdonnell (Wimer Eye Institute @ Johns Hopkins Hospital), Radhika Mehta (Emergency Medicine @ Johns Hopkins Hospital), Lynne Young (Wilmer Eye Institute @ Johns Hopkins Hospital)
Unnecessary visits to hospital Emergency Departments (ED) burdens health care delivery, causing delays in providing care for true emergencies, longer wait times for all patients and increased costs of care. Additionally, overcrowded ED’s lead to reduced patient satisfaction in the healthcare system and increased stress and burnout for ED personnel.
The Wilmer Eye Institute (WEI) at the Johns Hopkins Hospital (JHH) prioritizes patient-centric care in parallel with cost-containment. Toward that end, we created the Same-Day project. This project utilized the Wilmer Call Center, the team that responds to almost all patient requests for appointments, to ensure that patients are offered an appointment for that same day they call.
We summarize the impact of the Same Day project on key metrics such as patient satisfaction, estimated numbers of patients diverted from the ED, resident surgical volumes, estimated cost savings from those diversions and percentage of patients provided an outpatient ophthalmology appointment within two weeks of their request. We will also report wait times, patient volumes and satisfaction scores for ophthalmology patients visiting the JHH ED prior to and after the implementation of the project.
The Same Day Project was launched June 1, 2015. The number of same day patients visiting WEI outpatient clinics for the period up to and including November 30, 2017 (2.5 years) is 37,211, or 6.9% of the total number of outpatient visits to WEI (538,860) during this period.
The number of Same Day patients who indicated their medical circumstances would have taken them to the ED if not for being provided rapid access was 6,575 the first year that this data was collected (14 November 2016 – 30 December 2017). This represents 46.4% of the total number of Same Day outpatient visits to WEI (14,182) during this period.
The average visit cost for patients visiting WEI as an outpatient is approximately $316.85 while the average cost of an ophthalmology visit to the JHH ED is $3107.46. Presuming the 6,575 Same Day patients reported to the JHH ED, the charges would be have been $20,431,554; hence the realized savings were $18,348,265. The annualized cost of running the Call Center is $1.8M.
Throughout JHH, from July – October 2017, Wilmer has scheduled 34,962 new patients (the highest for any department) while being unable to offer an appointment within 2 weeks for only 25.7% (the lowest for any department). Despite this, patient satisfaction scores did not change with the implementation of the Same Day project.
The Same Day Project at WEI has proven itself to lower costs to patients while maximizing access of care. The savings realized by the project far outweighs the cost of running the Call Center which oversees and implements the project. In addition, the project is unlikely to be disruptive to day-to-day clinic operations since it increased clinic volumes by less than 7%.
Implications for the Patient
The Same Day project improves patient access to care, supporting better health outcomes. The project also relieves the ED so that patients with true emergencies might have better access through that venue, also supporting improved outcomes. Finally, the Same Day projects significantly lessens the cost of urgent care.