Hospitals

Toby Cosgrove: How Cleveland Clinic felt the urgency for same-day appointments

The CEO of Cleveland Clinic talked about the one case that led to the decision to ask every patient who called in whether they want to see a doctor that same day.

From left to righ Toby Cosgrove, CEO, Cleveland Clinic, Steven Corwin, CEO, NewYork-Presbyterian, Jena Hausman, CEO, Children's Hospital Colorado

From left to right Toby Cosgrove, CEO, Cleveland Clinic, Steven Corwin, CEO, NewYork-Presbyterian, Jena Hausman, CEO, Children’s Hospital Colorado

Last year Cleveland Clinic had 1.3 million same-day appointments, Toby Cosgrove, CEO of the nonprofit academic medical center, told a roomful of entrepreneurs and investors in San Francisco on Monday.

Cosgrove added that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. In 2016,  98% of the people who asked to be seen the same day was successful in doing so.

“We think you ought to be able to see people anytime you want to see people,” he declared.

Cosgrove was speaking at the StartUp Health Festival, which has become part of the J.P.Morgan Healthcare Conference scene in the last few years. He and his copanelists — Steven Corwin, CEO of NewYork-Presbyterian and Jena Hausmann, CEO of Children’s Hospital Colorado — were speaking at a session about access to care.

For the Cleveland Clinic, the urgency for same-day appointments was made apparent through, “quite frankly” a single case, Cosgrove recalled.

A patient wanted to make an appointment with the urology department but was given an appointment two weeks later.

“It turns out he was in acute urinary retention,” Cosgrove said. “Our lesson from that was you have to ask the patient whether they want to be seen [that day] or not. Our objective is to make access universally available to our patients.”

For Children’s Hospital Colorado, the issue of access has a decidedly geographic flavor. Its CEO pointed out the fact that it is the only children’s hospital in a seven-state region.

“There are 34 free-standing children’s hospitals left,”Hausmann said. “One of the things that we have discovered in Colorado is we are serving kids from all 50 states, we are serving kids from 27 countries and increasingly we are becoming the destination for some of the most complicated, medically-complex children.”

For a busy urban academic health system like NewYork-Presbyterian, technology helped to ease access and waits in the emergency department, Corwin said.

He pointed out that the integrated health system found emergency department visits increasing 7-10 percent per year even after the passage of the Affordable Care Act when it should have gone down. The time to see a provider was also inching up. And that led the hospital to offer kiosk care in the ER for patients who are not visibly in need of immediate, acute care.

“I think we’ve done over a thousand such visit,” he said. “It lowers the total amount of time in the emergency room from about two hours to about 30 min. We can cover two or three emergency rooms simultaneously….”

In other words, the emergency setting too can be an exmaple of how access issues can require some experimental thinking.

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