Managing year-end patient volume amid flu outbreaks

The annual flood of patients seeking routine medical care before their insurance deductibles reset for the new year has grown into a tsunami, largely because of influenza A(H1N1).

Many patients are asking for a vaccine that is becoming available more slowly than expected. Those sickened by respiratory pathogens are looking for care. And practice staff may be out ill.

But those who run medical practices say several strategies can help manage the volume more effectively.

"We have had to change our protocols," said Eileen Szanyi, director of operations at Finger Lakes Medical Associates in Geneva, N.Y. The multispecialty group has a staff of 120 and 22 physicians.

For example, Szanyi added a hotline with recorded information on the availability of both seasonal and H1N1 vaccine. Updated regularly, it has reduced the number of calls staff needs to answer.

According to the Centers for Disease Control and Prevention, the number of people with influenza decreased slightly in the first week of November, although activity was still widespread in 46 states. As of Nov. 17, more than 47 million doses of H1N1 vaccine had been allocated, meaning they were ready to order.

Szanyi's office also has been referring ill callers to a triage nurse before scheduling any appointments. Some callers are told to stay home and given instructions on the symptoms that should trigger them to come in.

Parents seeking routine medical care for their children are being asked to delay these appointments until respiratory illness season is over in spring.

But "if the parent needs [the appointment] before the insurance runs out or the insurance changes, if the child needs it for day care or for school, we're going to put them in," said Szanyi.

Saying "no" to patients could mean they switch to another practice, but Szanyi says this is not a significant concern. "We try to explain to people that we're having a national health crisis," she said. "And I don't think any one else is doing it any better than we are."

Other options for dealing with the increased patient load include opening up schedules for more same-day appointments.

At Laguna Beach Community Clinic in California, patients now have to wait four to six weeks for routine care. The clinic used to schedule four routine appointments an hour, but that is now down to three. This makes it easier to squeeze in walk-ins, which has increased from 400 a month to 650.

Staff also have been asked to adjust their work hours. Part-timers are having to work more hours. Temporary staff have been called in. Doctors are coming in on days off.

"We're all working a little bit harder to get through the season," said Thomas C. Bent, MD, the clinic's medical director and chief operating officer. He is also president of the California Academy of Family Physicians, although he was speaking personally.

Experts suggest creating annual strategies, include sending out notices in the fall reminding patients of the impending busy season.

Practices should recommend that patients make appointments for routine or elective procedures before their deductibles are reset at the beginning of the year and before they run out of time to use money in flexible spending accounts.

"The most important thing is to acknowledge that it is coming and to anticipate what it is going to mean for your practice," said Tannus Quatre, principal and consultant with Vantage Clinical Solutions in Bend, Ore.

Policies should be in place to encourage staff to take time off if they are sick to reduce spread to other workers and patients. It's also a good idea that these policies state that vacation time must be staggered.

"We ask that not everybody take a vacation during the worst time of the year," Dr. Bent said. "Most people are cooperative."