Why Patient Wait Times Exist: A Rebuttal

This article is in response to [The Waiting Game — Why Providers May Fail to Reduce Wait Times](http://www.nejm.org/doi/full/10.1056/NEJMp1704478#t=article" target="_blank)

We found that longer waits for specialist appointments at Geisinger Health System generally led to higher costs from the perspective of Geisinger Health Plan (our insurance arm) and higher revenues for the provider side of the business (albeit with higher operating cost due to no-show inefficiencies and patient dissatisfaction).

Dr. Lee and Ryu posit in [The New England Journal of Medicine](http://www.nejm.org/doi/full/10.1056/NEJMp1704478" target="_blank) that long patient wait times for appointments exist because providers have a financial incentive to keep waits long. We disagree, while the real causes of patient wait time represent a microcosm of what's wrong with healthcare.

Where the argument falls short

1) Argument does not hold up for providers that don't belong to health systems and/or have Emergency Departments.

The data provided by the doctors should be applauded. Transparent data benefits the industry as whole and is sadly the exception, not the rule.

The doctors speak to the experience of Geisinger Health System. They show how the decrease in revenue caused by long wait times is offset by an increase in revenue from Emergency Departments (ED). However, for providers that are not part of health systems and/or don't have Emergency Departments (ED), the longer wait times decrease provider revenue, which is not offset by a corresponding increase in ED revenue. Roughly 75% of providers do not belong to a health system, so this is not a small group of providers [(source)](http://healthaffairs.org/blog/2016/05/09/the-tangled-hospital-physician-relationship/" target="_blank).

2) Assigns incentive structure of overall health system to individual providers

In large health systems, individual providers are paid based on productivity. Productivity is defined as what % of their day is filled with patients. Since the doctors' research (and ours) show that the individual provider's productivity is lower with longer waits, the individual provider is incentivized to shorten wait time.

3) Analysis Ignores VIPs

Furthermore, long wait times are not decided upon by providers, but schedulers. Ask a provider what their wait time is, she/he will immediately turn their scheduler for the answer. Wait times are catalogued and can be adjusted by schedulers, not providers or executives.

Admins/schedulers are the controller of the office. They make the schedule, talk to the patients, and deal with providers. Healthcare vendors often speak in hushed tones about the gatekeepers.

Thus, it is important to investigate the incentive structure for schedulers/admins, when analyzing why patient wait times exist. Admins have no financial incentive to get patients earlier appointments, but may want to avoid getting yelled at by providers. They do not have a strong incentive to shorten wait times. In fact, with the tools they have it creates more work!

Drs. Lee and Ryu do discuss that there are tools like secure messaging, QueueDr, and telehealth visits that can help shorten wait time. Why those tools are not used by every group reveals the true reasons why patient wait times haven't been solved, they are indicative of larger flaws in healthcare operations and technology.

Why Patient Wait Time Hasn't Been Solved

Like many issues doctors face, bad technology is to blame. Technology that lacks empathy, fights interoperability, and ignores data outcomes.

There is a key moment illustrating this in the doctors' article.

Most [providers] deny that they like having long waiting lists, but when their lists shorten they worry that competitors are taking their business.

Based on our research, 90% of practices do not keep a wait list. It's why QueueDr does not require using one. It's not that they shouldn't have one, it's that they don't have one. Many providers even believe they have one or their staff tells them they have one. Wait lists aren't used by schedulers for one of two reasons:

a) Schedulers don't know where the wait list is in their Practice Management System (PM) or the PM doesn't have one (Translation: the PM system doesn't display the product and it's functionalities at the right time of the workflow)

b) The wait list creates extra work for them with no payoff (Translation: the wait list functionality doesn't work seamlessly enough)

Because most practices do not have wait lists (pull from your Practice Management System to see how many patients are really in there), no patients get a call when there is an earlier appointment. This makes it very difficult for existing technology to solve patient wait times. But the technology does exist!

Why Smaller Problems Don't Get Solved in Healthcare

Patient wait times are a "small" problem to many healthcare systems. They would like to solve them because they want their patients to have the best care and service, but they will still always have patients. Plus, they have a million other things to do! There are a thousand of "small" problems in healthcare. If they were solved, the impact would be incredible, why haven't they?

Tools haven't changed because most healthcare systems rely on 1 vendor (usually their EHR Vendor) to build all their tools. Because of the difficulty for outside vendors to integrate into their PM/EHR and the desire to not manage multiple vendors, health systems are at the mercy of a single vendor.

Instead of choosing from the hundreds of companies who are competing to produce the best solutions to combat wait times, health systems (and most providers) are waiting on 1 vendor to do it. Predictably, the tool is either never built, built poorly, or is late. Problems that are not legally required to be solved are solved last.

Want wait times to be solved? Demand that all EHR and PM systems have APIs for developers that allow connection within hours.

Patrick Randolph
CEO and Founder of [QueueDr](https://queuedr.com" target="_blank)

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QueueDr - Helping healthcare groups take back time through automation since 2013.