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    The delicate balance between staffing your practice amid a tight labor market and the increasing demand for care from patients was disrupted countless times since the start of the COVID-19 pandemic, and it remains a major focus of healthcare administrators heading into 2023.
    Prioritizing patient access and scheduling is top of mind for medical group leaders heading into 2023 as the industry grapples with staffing shortages and schedule optimization
    A Dec. 13, 2022, MGMA Stat poll asked medical group leaders what their top patient experience priority for 2023 will be. The majority (64%) responded access/scheduling, followed by:

    • Bill pay/estimates (18%)
    • Communication (15%)
    • Other (3%), which largely centered on:
      • All the above areas
      • Improving word-of-mouth and patient recommendations
      • Chronic care management
      • Growing service lines to grow the patient population.

    The poll had 428 applicable responses.

    Provider staffing, patient scheduling and communication to improve access

    To better understand how to meet patient demands for a consumer-centric experience in healthcare, MGMA and Relatient produced the 2022 Patient Engagement Report — a research effort to:

    • Understand the approaches and tools used in patient scheduling;
    • Identify the top challenges in scheduling;
    • Assess common strategies in patient communication methods;
    • Understand challenges in administrative staffing; and
    • Identify the top external threats to scheduling and communications.

    In a recent webinar presentation on the findings, Relatient’s David Dyke, chief product officer, and Emily Tyson, MBA, chief operating officer, provided an overview of how organizations are rethinking patient engagement, “whether it’s to address shifts in value or to address operating performance and patient satisfaction,” as Dyke noted.

    • For the full report on the MGMA-Relatient study, read our article in the upcoming January issue of MGMA Connection magazine, exclusive to MGMA members.

    The access landscape

    Patient access’ “new normal” has rapidly evolved since the height of the pandemic, with impacts from inflationary economics and “massive volatility” in labor markets and ongoing shifts in patient expectations for their healthcare experience, Dyke said.

    “Patients still continue to report trouble finding the right type of provider; trouble making an appointment, whether that’s technically or operationally; to having significant wait times associated with appointments,” Dyke said, noting that many of these factors are not new but are being felt more intensely because of the speed at which they are changing post-COVID-19.

    “On the provider side, it’s increasingly a competitive landscape, [with] new players entering the market … low-acuity environments setting up and taking care away from primary care networks,” Dyke added. “These [shifts] are happening faster, but they’ve really been happening for a long time across healthcare.”


    As Tyson noted, the study found that almost half (47%) of respondents indicated that patient scheduling was the patient experience function most important to their success, ahead of:

    • Digital patient registration and intake (15%)
    • Patient payments (15%)
    • Appointment reminders/messaging (12%)
    • Health maintenance campaigns (4%)
    • Online chatbots/artificial intelligence (1%)
    • Something else (7%).

    Within that area of patient scheduling, areas such as call center experience, online scheduling and patient self-service were the most important to respondents, Tyson noted. But another way to consider this increasingly important area is the quality of scheduling as it impacts overall patient experience.

    “This might seem like an obvious perspective — you want to deliver a high-quality experience … [but] what is the definition of quality?” Tyson said, noting that the concept of quality could include appointment availability, scheduling without a phone call, the length of time needed to schedule, and the wait time until the scheduled appointment.

    Medical group and health system leaders also must balance the expectations of patients around scheduling with their providers, who could be frustrated if the scheduling workflows send them the wrong patients, not enough patients, patients scheduled for an inappropriate amount of time for their care needs, or just individual preferences (e.g., doing specific procedures on certain weekdays).

    The study revealed provider preferences (31%) and patient preferences (21%) accounted for more than half of the biggest factors impacting scheduling complexity, outpacing staff turnover (15%), managing waitlists and unfilled appointment slots (11%), patient-to-provider matching (9%), referral management (9%), and something else (4%).

    How it gets done

    As the factors impacting patient satisfaction have evolved and intensified, provider groups increasingly have more than one channel for patient scheduling, but the front desk or receptionist (84%) remains the most common channel for scheduling to occur, per the study, followed by:

    • Call center (58%)
    • Online, request to book (48%)
    • Online, self-booking (30%)
    • Text/SMS (11%)
    • Other (8%)
    • Chatbot (5%).

    “There have been real strides in the industry to try to enable patients to do this themselves, outside of usual business hours [with] an easy process to get the appointment confirmation and know that I am booked,” Tyson said, “but it’s still only 30%.”

    Appointment-related communications

    Dyke noted that the study found that more than half of respondents reported a no-show rate above 6%, and the methods used by provider groups to remind patients about appointments varied widely:

    • About three out of four respondents noted using text messages to confirm and/or remind patients of appointments.
    • A little more than half of respondents use email to confirm appointments (51%) or remind patients about appointments (55%).
    • About half of respondents still rely on a manual, human phone call to confirm appointments (52%) or remind patients about appointments (48%), while a higher percentage uses automated calls for confirmations (63%) and reminders (52%).

    “The human phone call is still a very manual, expensive modality as opposed to automated calls with dynamic scripts, or emails or texts that can be automated,” Dyke said. The benefits of some of the automated and digital channels are found in combining cancellation and rescheduling functions into the patient alerts and reminders: Nearly two in three provider groups that have patient alert/reminder systems also allow patients to cancel or reschedule care from the appointment reminder communication.

    However, Dyke noted there remains misalignment in that nearly three out of four (73%) patient appointment cancellations or rescheduling occur during a human call rather than a prompt from an automated call, text, email or other modality. This typically is due to a lack of online schedule management to patients, patients being unaware of self-service scheduling, patients finding the system to not be easy to use, or systems being set up to trigger manual outreach to the patient following a rescheduling or cancellation request.

    “Nearly a quarter of us are offering online schedule management, but the patients are finding that it’s too complicated,” Dyke said. In many situations, “the barriers to entry are a little high.”

    Looking ahead

    The MGMA-Relatient study saw a fairly even distribution around the top priorities among provider organizations to improve scheduling:

    1. Offering/improving online, self-service patient scheduling (22%)
    2. Improving the ability to fill appointment slots (21%)
    3. Reducing no-show and cancellation rates (20%)
    4. Reducing manual workflows with managing rules/preferences (17%)
    5. Decreasing call center or front-desk wait times (16%)
    6. Something else (5%).

    Do you have any best practices or success stories to share on this topic? Please let us know by emailing us at


    We depend on a strong feedback loop with you to provide great resources, education and advocacy for medical group leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message.

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