Intermountain Orthopaedics, Boise, Idaho

Background

Intermountain Orthopaedics is one of Idaho's fastest growing musculoskeletal groups. The group is comprised of 14 fellowship trained physicians in Pediatric Orthopedics, Foot and Ankle, Rheumatology, Spine, Joint Replacement, and Hand and Microvascular. They have three locations in the Boise area and operate a surgery and imaging center.

The Challenge

Intermountain Orthopaedics sought to improve processes throughout all of the specialty areas. Primary care physicians were dissatisfied with long delays for a new patient consultation appointment, and some new patients were seeking care elsewhere. Physicians were working long days finishing documentation and patient calls after seeing patients, and production was low relative to total number of hours at work. Patients were unhappy with delays for services; waits to get an appointment, and waits in the office when physicians ran behind schedule. Staff and physicians were frustrated with cumbersome work processes and a stressful pace.

Our Solution

We implemented practice improvement solutions to increase patient and referral physician access and improve office flow efficiencies. To improve access, we measured demand and capacity, analyzed patient flow data, introduced new scheduling guidelines and visit increments, opened the templates, and worked down appointment backlogs. To streamline the patient visit and run on a timelier basis, we facilitated weekly meetings in which physicians, staff and managers reviewed each process (check-in, rooming, ordering other services, exiting the patient) to eliminate waste, clarify care team roles and appropriately empower the staff to complete their work more easily. We designed new medical-records form (for rheumatology) to reduced intake time, allow physicians to complete documentation at the time of visit, and appropriately code for their level of service. We provided weekly reports to measure the process change and tracked the care team's progress toward improvement goals. To respond on a timelier basis to patient requests and complete their work throughout the day, the team also created standard work for ,telephone triage, prescription refills, lab tracking and results-reporting processes.

We trained an in-house facilitator, who continued to expand the program in other subspecialty departments, including spine, joint replacement and hand specialists. The clinic continued to receive weekly web-based reports to monitor and sustain their improvement results

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The Results

Happier Patients	Measure	Rheumatology	Clinic Summary All Specialties
Better Access	3rd Next Available Consult Appointment	Reduced From 40 Days to 23 Days 43% Improvement	Reduced From 16 Days to 8 Days 100% Improvement
More Efficient Visit	Cycle Time for Consult	Reduced From 62 to 46 Minutes 26% Improvement	Reduced From 54 to 41 Minutes 24% Improvement
Ease of Scheduling Appointment	Patient Satisfaction Survey Question Regarding Scheduling/Access	Increased From 3.9 to 4.5 16% Improvement	Increased From 4.3 to 4.6 8% Improvement
Quicker Results- reporting Response	Average Days to Report Lab Results to Patients	Reduced From 1-2 weeks, to 90% reported within 72 hours	N/A

Happier Physicians	Measure	Rheumatology	Clinic Summary All Specialties
Increased Physician Satisfaction	Physician Satisfaction Survey Satisfaction Level Pre vs. Post Implementation*	Increased From 2.4 to 3.9 64% Improvement	Increased From 2.9 to 3.8 35% Improvement

Happier Staff	Measure	Rheumatology	Clinic Summary All Specialties
Increased Staff Satisfaction	Staff Satisfaction Survey Satisfaction Level Pre vs. Post Implementation	Increased From 2.7 to 4.0 46% Improvement	Increased From 3.4 to 4.0 18% Improvement

Improved Bottom line	Measure	Rheumatology	Clinic Summary All Specialties
Increased Productivity	Increase in Relative Value Units (RVU) Pre vs. Post Implementation	20% Improvement	7% Improvement

Coding improved, contributing to the 20% increase in production for the rheumatologists

*Survey questions for which 70% of physicians noted greater than 25% Improvement:

• Patients' access for a consult and follow-up visit
• Patients' wait time in office
• Physician level of efficiency
• Flow of work throughout the day
• The amount of time allocated for each appointment type
• Physician ability to leave work "on time" at end of each day
• Physician sense of completion at the end of each day