Patient Waiting Time Targets
As of today, California is the first state requiring HMOs to make sure their members can see their doctor within reasonable time frames. The regulations, approved in 2010, specify the usual wait times for appointments.
For instance, patients must be seen within 48 hours for an urgent-care appointment that doesn’t require prior authorization. Non-urgent primary-care appointments must be scheduled within 10 days of the patient request. Specialist appointments should occur no later than 15 days from the request, and patients needing mental health appointments with someone other than a physician should be seen within 10 business days. Non-urgent appointments for ancillary services for diagnosis or treatment of an injury or illness should occur within 15 business days of the request, according to the rules.
The news is obviously great for patients but how are the HMO’s going to make sure it happens. Simulation can help the organizations understand the resources required to ensure these targets are met, without compromising patient care. SIMUL8 software was used to model similar waiting time targets in the UK, and the model is already being adapted for the Canadian and Australian systems and targets.