Abstract
We discuss capacity allocation for primary care practices at three different planning levels: the strategic, the tactical and the operational. The goal in each case is to maximize two important but often conflicting metrics: (1) timely access and (2) patient-physician continuity. Timely access focuses on the ability of a patient to get access to a physician as soon as possible. Patient-physician continuity refers to building a strong relationship between a patient and a specific physician by maximizing patient visits to that physician. Each primary care provider (PCP) has a panel of patients for whose long term holistic care the PCP is responsible. At the highest or strategic level, the design of physician panels, we demonstrate the impact of case-mix, or the type of patients in a physician’s panel, and show how panels can be redesigned effectively. Panel redesign, however, involves changing existing patient-physician relationships. A viable alternative is managing the inherent flexibility of PCPs to see patients of other physicians. At the tactical level, this requires allocating the flexible capacity to two types of appointments: 1) prescheduled appointments which are booked in advance and require continuity; and 2) same-day appointments. Using a 2-stage stochastic optimization model, we show that greedy algorithms find the optimal capacity allocation, and find that a partially flexible practice provides a good compromise between timely-access and continuity. Finally, at the operational level, the implementation of flexibility during a workday has to be made under partial demand information, as patient calls arrive over the course of a day. We discuss the impact of flexibility and suggest heuristics that practices can use in this dynamic case.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American College of Physicians (2006) The impending collapse of primary care and its implications for the state of the nation’s healthcare, Technical report. Available via: http://www.acponline.org/advocacy/events/state_of_healthcare/statehc06_1.pdf
Atlas S, Grant R, Ferris T, Chang Y, Barry M (2000) Patient–physician connectedness and quality of primary care. Ann Intern Med 150(5):325–226
Balasubramanian H, Banerjee R, Denton B, Naessens J, Wood D, Stahl J (2010) Improving clinical access and continuity using physician panel redesign. J Gen Intern Med 25(10):1109–1115
Balasubramanian H, Denton B, Lin M (2011) Managing physician panels in primary care. In: Yih Y (ed) Handbook of healthcare delivery systems, 10–1. CRC, West Palm Beach (Taylor and Francis)
Balasubramanian H, Muriel A, Wang L (2012) The impact of provider flexibility and capacity allocation on the performance of primary care practices. Flex Serv Manuf J 24(4):422–447
Bennett KJ, Baxley EG (2009) The effect of a carve-out advanced access scheduling system on no-show rates. Pract Manag Fam Med 41(1):51–56
Chou MC, Chua GA, Teo C (2010) On range and response: dimensions of process flexibility. Eur J Oper Res, Elsevier 207(2):711–724
Gill JM, Mainous A (1999) The role of provider continuity in preventing hospitalizations. Arch Fam Med 7:352–357
Gill JM, Mainous A, Nsereko M (2000) The effect of continuity of care on emergency department use. Arch Fam Med 9:333–338
Graves SC, Tomlin BT (2003) Process flexibility in supply chains. Manag Sci 49(7):907–919
Green LV, Savin S (2008) Reducing delays for medical appointments: a queueing approach. Oper Res 56(6):1526–1538
Green LV, Savin S, Murray M (2007) Providing timely access to care: what is the right patient panel size? Joint Comm J Qual Patient Saf 33:211–218
Gupta D, Wang L (2008) Revenue management for a primary-care clinic in the presence of patient choice. Oper Res 56(3):576–592
Gupta D, Potthoff S, Blowers D, Corlett J (2006) Performance metrics for advanced access. J Healthcare Manag 51(4):246–259
Hippchen J (2009) Flexibility in primary care. Masters thesis. (Advisors: Hari Balasubramanian and Ana Muriel). Accessible at: http://people.umass.edu/hbalasub/FlexibilityThesis.pdf
Hopp W, Tekin E, Van Oyten MP (2004) Benefits of skill chaining in serial production lines with cross-trained workers. Manag Sci 50(1):83–98
Jordan WC, Graves SC (1995) Principles and benefits of manufacturing process flexibility. Manag Sci 41(4):577–594
Kopach R, DeLaurentis P, Lawley M, Muthuraman K, Ozsen L, Rardin R, Wan H, Intrevado P, Qu X, Willis D (2007) Effects of clinical characteristics on successful open access scheduling. Health Care Manag Sci 10:111–124
Liu N, Ziya S, Kulkarni V (2010) Dynamic scheduling of outpatient appointments under patient no-shows and cancellations. Manuf Serv Oper Manag 12.2:347–365
Macinko J, Starfield B, Shi L (2003) The contribution of primary care systems to health outcomes within organization for economic cooperation and development (OECD) countries. Health Serv. Res. 38(3):831–865
Macinko J, Starfield B, Shi L (2007) Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv 37(1):111–126
Muriel A, Somasundaram A, Zhang Y (2006) Impact of partial manufacturing flexibility on production variability. Manuf Serv Oper Manag 8(2):192–205
Murray M, Berwick DM (2003) Advanced access: reducing waiting and delays in primary care. J Am Med Assoc 289(8):1035–1040
Naessens J, Stroebel R, Finnie D, Shah N, Wagie A, Litchy W, Killinger P, O’Byrne T, Wood D, Nesse R (2011) Effect of multiple chronic conditions among working-age adults. Am J Manag Care 17(2):118–122
Nutting P, Goodwin MA, Flocke S, Zyzanski S, Kurt C (2003) Continuity of primary care: to whom does it matter and when? Ann Fam Med 1:149–155
O’Hare CD, Corlett J (2004) The outcomes of open-access scheduling. Family practice management in Available via: http://journals.dev.aafp.org/XML\-journal-files/fpm/2004/0200/.svn/text\-base/fpm20040200p35.pdf.svn\-base. Accessed on Sept 2011
O’Malley AS, Cunningham PJ (2008) Patient experiences with coordination of care: the benefit of continuity and primary care physician as referral resource. J Gen Intern Med 24(2):170–177
Ozen A, Balasubramanian H (2012) The impact of case mix on timely access to appointments for a primary care group practice. Health Care Manag Sci: DOI 10.1007/s10729-012-9214-y. Accessed on sept 2011
Qu X, Rardin R, Williams JAS, Willis D (2007) Matching daily healthcare provider capacity to demand in advanced access scheduling systems. Eur J Oper Res 183(2):812–826
Robinson L, Chen R (2010) A comparison of traditional and open access policies for appointment scheduling. Manuf Serv Oper Manag 12.2:330–347
Rust G, Ye J, Baltrus P, Daniels E, Adesunloye B, Fryer GE (2008) Practical barriers to timely primary care access. Arch Int Med 268(15):1705–1710
Shi L, Starfield B, Macinko J (2005) Contribution of primary care to health systems and health. Milbank Quart 83(3):457–502
Simchi-Levi, D Wei Y (2012) Long chain in process flexibility. Oper Res 60(5):1125–1141
Solak S, Clarke J-P, Johnson E, Barnes E (2010) Optimization of R&D portfolios under endogenous uncertainty. Eur J Oper Res 207(1):420–433
Starfield B, Macinko J, Shi L (2007) Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv 37(1):111–126
Acknowledgements
This work was funded in part by the grant CMMI 1031550 from the National Science Foundation and grant R03 HS 018795 from the Agency of Healthcare Research and Quality (AHRQ). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of NSF or AHRQ.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Balasubramanian, H., Muriel, A., Ozen, A., Wang, L., Gao, X., Hippchen, J. (2013). Capacity Allocation and Flexibility in Primary Care. In: Denton, B. (eds) Handbook of Healthcare Operations Management. International Series in Operations Research & Management Science, vol 184. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5885-2_8
Download citation
DOI: https://doi.org/10.1007/978-1-4614-5885-2_8
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-5884-5
Online ISBN: 978-1-4614-5885-2
eBook Packages: Business and EconomicsBusiness and Management (R0)