Practices take a look at extending office hours

The growth of in-store clinics, which sell themselves on convenience, has some physicians thinking again about expanding their clinic hours to nights and weekends.

There are other reasons for practices to consider adjusting or expanding hours. Some see it as a way to alleviate unnecessary use of emergency departments, and others want to gain a competitive edge on attracting and keeping patients.

In any case, experts and physicians who have experience with expanding their clinic hours say extending office time is more than just putting a sign on the door saying you're open later.

First there's the matter of making sure every physician in the practice supports the idea. Then there's ensuring there are enough patients who would take advantage of the extended hours to justify the additional costs of staff, utilities, supplies and everything else needed to support a longer day.

Getting everyone on board with the idea is the first step in making the change, said Robert Kenagy, MD, chief medical officer for Wichita (Kan.) Clinics.

Dr. Kenagy, a family physician, said that before his 10-clinic network decided to convert its Newton County clinic to extended hours, he had a series of meetings with the physicians who practice there.

"We didn't want to start up and then three months later decide not to do it anymore," Dr. Kenagy said. "We wanted to be sure they were committed to this concept." As it turned out, they were.

So was the staff. About 75% of the staff volunteered to work weekend shifts, Dr. Kenagy said.

Because they saw how receptive patients were to the concept, the physicians are now in the process of adding evening weekday hours, according to Dr. Kenagy.

Other practices said scheduling was the biggest concern when making the switch but found physicians were pretty open to the idea. Some offer small bonuses or incentives for those willing to work nights and weekends.

Ed Hett, MD, president of Preferred Medical Associates, a Wichita medical group owned by the Via Christi Health System, said his group recently added convenience hours to two of its clinics that operate as occupational medicine facilities during regular hours.

The doctors who staff the clinic work day shifts at their primary care practices and volunteer on a first-come, first-served basis for the evening clinic.

"Amazingly, we've not had to twist anyone's arm to do it," he said.

Some say younger physicians are particularly enthusiastic about the idea of extending hours. Charlie Thomason, president of Atlanta-based Medical Management Associates, a practice management consulting firm, said that in practices he has helped convert to an extended-hours clinic, younger physicians are eager to volunteer because it gives them the opportunity to build their own, personal patient base.

As far as staffing, Dr. Kenagy advises that not every position needs to be filled every hour the practice is open.

Careful scheduling of support staff and limited use of the facilities help keep costs down, he said. In addition to a physician and nurse, the Newton County clinic has a receptionist to check patients in and out on weekends. But most of the billing waits until Mondays, he said.

And while there is a laboratory and a radiology department at the clinic, that portion of the building is closed on the weekends. Any patient needing those services is sent to the hospital, Dr. Kenagy said.

Thomason said another component in making the switch a success is getting the word out to patients.

"We've seen [extended-hour clinics] be quite successful, but we've seen others where there hasn't been sufficient patient demand in order to make it cost effective," he said.

Practices that have Web sites have a free and easy form of advertising, Thomason said, especially if they have a mechanism for e-mailing patients. "It can be a very effective and inexpensive way to publicize any service," he said.

Many say the conversion to extended hours hasn't been a losing venture, but it hasn't been an altogether lucrative one either. Dr. Hett said for physicians, individually, the extended hours mean more money for them, because they are paid by the hour at Preferred Medical Associates. But as a business, it's usually a wash, he said.

The access to care is what many hope will keep bringing patients back. Physicians aren't saying that they are extending hours just to compete with in-store clinics, which are a very small but growing percentage of the clinic population. But experts say doctors are going to have to watch these clinics to see what effect they will have on their practices -- including the need to extend hours.

Doctors offering longer hours also say they hope to keep patients with minor conditions out of the emergency department.

Angela Gardner, MD, secretary-treasurer for the American College of Emergency Physicians, said she estimates that taking nonurgent cases away from EDs will help hospital overcrowding by only 10%. But "we're filled to the breaking point now, so 10% is important," said Dr. Gardner, an emergency physician in Bedford, Texas.

She thinks the efforts are "a great response to America's need for more timely health care."