Referral-only appointment policy cuts wait times

COEUR D’ALENE, IDAHO – Switching to a referral-only policy in one pediatric dermatology clinic in a children’s hospital reduced the average wait for an initial appointment by 10%.

"A referral-only system may be an effective method for other pediatric dermatology clinics, as well as other pediatric subspecialties, to decrease patient wait time to see a subspecialist," Dr. Tiffany J. Herd concluded at the annual meeting of the Society for Pediatric Dermatology.

Nationally, pediatric dermatology is very close to the top of the list of pediatric subspecialties in terms of patient wait time. Strategies to reduce wait time for pediatric dermatology are urgently needed, noted Dr. Herd of Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

She presented a retrospective study analyzing the impact of implementing a referral-only policy for new outpatient pediatric dermatology appointments at the medical center. The study entailed reviewing the medical records of 6,316 pediatric dermatology clinic patients seen initially either during January-August of 2012–before the switch to a referral-only policy–or in January-August of 2013, after the policy was in place.

Self-referrals accounted for 24% of all initial appointments in 2012, but only 4% a year later. Mean patient wait time fell from 36.4 days in 2012 to 32.9 in 2013, a 9.6% decrease. The median wait time dropped from 34 to 24 days.

The 15 most common diagnoses were the same before and after the policy shift. The top three in both time periods were benign neoplasms of the skin, atopic dermatitis, and acne. Their proportion of total new clinic visits was the same in 2012 and 2013. Indeed, the proportion changed for only one of the top 15 diagnoses: warts, which accounted for 9.2% of initial appointments in 2012, but only 7.4% a year later, according to Dr. Herd.

Of note, however, the complexity of the cases seen in the pediatric dermatology clinic rose substantially following the shift to a referral-only policy. In 2012, 40% of initially referred patients were billed as Level 3 complexity, compared with 68% in 2013.

Patient demographics didn’t change, nor did the type of insurance coverage. These findings suggest that access to pediatric dermatology services remained equitable following implementation of the referral-only policy, she continued.

Primary care physicians are probably capable of handling many of the pediatric dermatologic conditions which they now commonly refer to the subspecialty clinic. An interesting topic for future study will be to see if targeted education of primary care clinicians and pediatric residents regarding the top 15 diagnoses seen in the referral-only pediatric dermatology clinic allows the nondermatologists to reduce their referral rate, Dr. Herd said.

She reported having no financial conflicts regarding this study, which was conducted with institutional funds.

bjancin@frontlinemedcom.com

COEUR D’ALENE, IDAHO – Switching to a referral-only policy in one pediatric dermatology clinic in a children’s hospital reduced the average wait for an initial appointment by 10%.

"A referral-only system may be an effective method for other pediatric dermatology clinics, as well as other pediatric subspecialties, to decrease patient wait time to see a subspecialist," Dr. Tiffany J. Herd concluded at the annual meeting of the Society for Pediatric Dermatology.

Nationally, pediatric dermatology is very close to the top of the list of pediatric subspecialties in terms of patient wait time. Strategies to reduce wait time for pediatric dermatology are urgently needed, noted Dr. Herd of Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

She presented a retrospective study analyzing the impact of implementing a referral-only policy for new outpatient pediatric dermatology appointments at the medical center. The study entailed reviewing the medical records of 6,316 pediatric dermatology clinic patients seen initially either during January-August of 2012–before the switch to a referral-only policy–or in January-August of 2013, after the policy was in place.

Self-referrals accounted for 24% of all initial appointments in 2012, but only 4% a year later. Mean patient wait time fell from 36.4 days in 2012 to 32.9 in 2013, a 9.6% decrease. The median wait time dropped from 34 to 24 days.

The 15 most common diagnoses were the same before and after the policy shift. The top three in both time periods were benign neoplasms of the skin, atopic dermatitis, and acne. Their proportion of total new clinic visits was the same in 2012 and 2013. Indeed, the proportion changed for only one of the top 15 diagnoses: warts, which accounted for 9.2% of initial appointments in 2012, but only 7.4% a year later, according to Dr. Herd.

Of note, however, the complexity of the cases seen in the pediatric dermatology clinic rose substantially following the shift to a referral-only policy. In 2012, 40% of initially referred patients were billed as Level 3 complexity, compared with 68% in 2013.

Patient demographics didn’t change, nor did the type of insurance coverage. These findings suggest that access to pediatric dermatology services remained equitable following implementation of the referral-only policy, she continued.

Primary care physicians are probably capable of handling many of the pediatric dermatologic conditions which they now commonly refer to the subspecialty clinic. An interesting topic for future study will be to see if targeted education of primary care clinicians and pediatric residents regarding the top 15 diagnoses seen in the referral-only pediatric dermatology clinic allows the nondermatologists to reduce their referral rate, Dr. Herd said.

She reported having no financial conflicts regarding this study, which was conducted with institutional funds.

bjancin@frontlinemedcom.com

COEUR D’ALENE, IDAHO – Switching to a referral-only policy in one pediatric dermatology clinic in a children’s hospital reduced the average wait for an initial appointment by 10%.

"A referral-only system may be an effective method for other pediatric dermatology clinics, as well as other pediatric subspecialties, to decrease patient wait time to see a subspecialist," Dr. Tiffany J. Herd concluded at the annual meeting of the Society for Pediatric Dermatology.

Nationally, pediatric dermatology is very close to the top of the list of pediatric subspecialties in terms of patient wait time. Strategies to reduce wait time for pediatric dermatology are urgently needed, noted Dr. Herd of Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

She presented a retrospective study analyzing the impact of implementing a referral-only policy for new outpatient pediatric dermatology appointments at the medical center. The study entailed reviewing the medical records of 6,316 pediatric dermatology clinic patients seen initially either during January-August of 2012–before the switch to a referral-only policy–or in January-August of 2013, after the policy was in place.

Self-referrals accounted for 24% of all initial appointments in 2012, but only 4% a year later. Mean patient wait time fell from 36.4 days in 2012 to 32.9 in 2013, a 9.6% decrease. The median wait time dropped from 34 to 24 days.

The 15 most common diagnoses were the same before and after the policy shift. The top three in both time periods were benign neoplasms of the skin, atopic dermatitis, and acne. Their proportion of total new clinic visits was the same in 2012 and 2013. Indeed, the proportion changed for only one of the top 15 diagnoses: warts, which accounted for 9.2% of initial appointments in 2012, but only 7.4% a year later, according to Dr. Herd.

Of note, however, the complexity of the cases seen in the pediatric dermatology clinic rose substantially following the shift to a referral-only policy. In 2012, 40% of initially referred patients were billed as Level 3 complexity, compared with 68% in 2013.

Patient demographics didn’t change, nor did the type of insurance coverage. These findings suggest that access to pediatric dermatology services remained equitable following implementation of the referral-only policy, she continued.

Primary care physicians are probably capable of handling many of the pediatric dermatologic conditions which they now commonly refer to the subspecialty clinic. An interesting topic for future study will be to see if targeted education of primary care clinicians and pediatric residents regarding the top 15 diagnoses seen in the referral-only pediatric dermatology clinic allows the nondermatologists to reduce their referral rate, Dr. Herd said.

She reported having no financial conflicts regarding this study, which was conducted with institutional funds.

bjancin@frontlinemedcom.com