Every year, it seems hospital and healthcare leaders try new strategies to expand patient care and access across their markets. This year, a popular choice is to expand after-hour care.
“This isn’t just a tweak around the edges,” MetroHealth President and CEO Christine Alexander-Rager, MD, told Becker’s. “Over the past year, we took a hard look at our entire footprint and made some strategic decisions to align our resources with where demand is highest. We can’t expect people to alter their lives to fit into our schedule. We need to alter our schedule to fit into their lives.”
After-hours care is quickly becoming a popular choice among systems and patients. Extended hours allow patients to fit appointments into their schedule more easily and receive care faster. On the provider side, after-hours care can help relieve call volume to offices and provide better work-life balance to providers.
“Providers work really hard in primary care, and they’re constantly trying to figure out how to squeeze patients in,” Craig Cheifetz, MD, president of Inova Primary Care, told Becker’s. “By expanding to after hours and weekends, we’re indirectly improving quality of work life for our physicians and [advanced practice providers] as well. [With after-hours care], we now have all of these added appointments and weekends to accommodate that [desire].”
The way systems are providing after-hour care can differ. Here are just four examples of after-hour programs.
Inova Health System
The Falls Church, Va.-based system is planning to launch an after-hour virtual clinic in early July where providers respond to patient calls all night.
“We recognize that there are national entities — the Amazons of the world — that are setting up virtual care offerings and advertising them constantly,” Dr. Cheifetz said. “I almost worry at times about entities that want to deliver transactional care without necessarily having the complete picture. We know our patients. Given the market, we feel we can [provide comprehensive care] better and deliver primary care 24/7, 365.”
The after-hours virtual clinic will operate with a walk-in concept, where patients can call the central number or use MyChart to schedule into the after-hours clinic. They will be triaged by a nurse and then meet with a nurse practitioner or physician assistant over video call to discuss their needs. The clinic will also have a physician backup if a higher level of care is needed.
The clinic will be open 24/7, including holidays. At least 50% of appointments will be scheduled in advance, with the rest open to day-of demand. The system is working to staff the clinic with existing team members, who will be able to work from home while manning the after-hours clinic.
Dr. Cheifetz said he anticipates a number of advantages for Inova. On the operations side, the after-hours clinic will be able to take 20 to 40 calls a night, which will help triage patients to the right level of care. This could help cut unnecessary ED visits. But the night-time hours can also help decompress offices during the day because patients can schedule their follow-ups or handle their low-acuity needs that night, rather than waiting until offices open in the morning.
Alongside the after-hours clinic, Inova is rolling out an advanced primary care program — a Medicare product that reviews patient charts. During downtimes, after-hour clinic staff can do additional work related to patient care, follow-up, chart review and inbox management.
MetroHealth
The Cleveland-based system has expanded hours across many of their clinics in Northeast Ohio. Appointments for routine and same-day care are now available from 7 a.m. to 7 p.m. for pediatric and adult primary care. The system will also open a new 24/7 drive-thru pharmacy in June at its outpatient health center, operating on the system’s main campus.
In order to expand hours, the system closed a handful of its smaller offices last fall, and redeployed those providers to larger sites.
The early results from this strategic choice have been encouraging, Dr. Alexander-Rager said. Patient comments say they appreciate having more options, and the system has seen a steady growth in appointment utilization during extended hours.
“But beyond the numbers, this has been a great reminder that healthcare operations can’t be static,” she said. “What worked five or 10 years ago doesn’t always fit today’s realities. By stepping back and reexamining how we’re organized, we’re creating a more patient‑centered experience.”
Montefiore Einstein
The New York City-based system began offering Saturday diagnostic appointments in its ophthalmology department five years ago. The practice sees about 220,000 patient visits and 5,000 surgical procedures a year, making it one of the largest ophthalmology practices in the state, Ann Allowe, unified administrator for the department of ophthalmology and visual sciences at Montefiore Einstein, told Becker’s.
Three diagnostic tests are offered on the weekend, including optical coherence tomographies, Humphrey visual field and pachymetry. These tests are the most commonly performed in ophthalmology and are used by a range of specialists, Ms. Allowe said. The Saturday openings are staffed by a manager, receptionist, certified ophthalmology technicians and one physician. Existing staff members rotate Saturdays to ensure coverage.
Opening testing on Saturdays had a few benefits: patients were able to obtain follow-up appointments quicker, wait time in the practice for testing was cut and patients were happy to have the flexible option, she said.
NYU Langone
The New York City-based system has expanded services and operation hours across several clinical areas, including primary care, gastroenterology, physical therapy and radiology. The extended hours are staffed by existing staff on a rotational basis; however, additional staff often volunteer to adjust their schedules to cover those shifts, Andrew Rubin, senior vice president for clinical affairs and ambulatory care at NYU Langone, told Becker’s.
Demand has been so high that all of the after-hour appointments are filled as they become available. Mr. Rubin said his team regularly reviews volume and is adding more appointments.
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