Primary and specialty care physicians make it a practice to provide coverage
after office hours and on weekends. In fact, it is a requirement for all
network providers to maintain this coverage. However, are your patients aware
of this service, or are they simply going to the emergency room/department (ER)
for care?
Recent findings
According to the 2014 Accessibility of Services Report, the number of
members who call their physicians after office hours over the last four years
has steadily decreased. In addition, members enrolled in Keystone Health Plan
East HMO identified a decreased response rate (i.e., return call within 30
minutes) from physicians when they call after hours. Members enrolled in
Personal Choice® PPO did not identify any significant change
from previous years.
Another recent study of a targeted member population showed that members
were utilizing the ER for urgent medical care, including otitis media, upper
respiratory infection, and acute pharyngitis. Thirty four percent of these ER
visits occurred on the weekend, when most primary care practices are closed.
Although some providers have voicemail or answering services that answer calls
after hours, this may not prevent an ER visit if:
- the patient does not call;
- there is a delay in physician response;
- the member/caregiver does not understand the difference between an
emergency and urgent medical care need.
Visits to the ER can interrupt continuity of care and may affect quality of
care as well — especially if the patient?s physician is unaware of the ER
visit and needed follow-up care is absent.
Educate your patients
Independence encourages all physicians to discuss after-hours and weekend
coverage, as well as the availability of urgent care centers and retail health
clinics with their patients. Physicians can communicate this message by:
- placing a notification in the office that explains how to contact you when
the office is closed;
- providing a listing of the nearest urgent care centers and retail health
clinics;
- discussing coverage individually with patients.
Remind patients to contact their primary physician or specialist after a
visit to the ER, urgent care center, or retail health clinic for assessment of
appropriate follow-up care. This is especially important for pediatric
patients, elderly patients, and those patients with chronic conditions. Explain
that calling will allow the physician office to coordinate services with the
facility for the best patient outcome.
All patients want to receive the best possible care, so if they understand
the rationale behind the request, they may be more apt to communicate more
openly with your office to coordinate care after hours and after visits to the
ER, urgent care center, or retail health clinic.