Q&A
Explanation of changes to appointment times and impact on patient care
0:28:00
ยท
8 min
Dr. Mitch Katz explains the recent changes to appointment times at NYC Health + Hospitals, particularly the reduction of new patient appointments from 40 to 20 minutes. He discusses the reasoning behind this change and its potential impact on patient care.
- New patient appointments reduced from 40 to 20 minutes to address long waiting lists
- Doctors are expected to see 8 patients in a 3.5-hour session, allowing time for charting and other tasks
- Katz emphasizes that the change is not about money, but about improving access to care
- He explains that doctors can still provide quality care by prioritizing the most pressing issues and scheduling follow-up appointments as needed
Mercedes Narcisse
0:28:00
How will how will the reduced appointment times, because we will hear a lot about the time from 20 minutes, 40 minutes to 20 minutes if I'm correct, Right?
0:28:13
Impact the quality how that gonna impact the quality of care, particularly for patients with complex medical needs?
Mitch Katz
0:28:22
Right.
0:28:22
Well, thank you.
0:28:23
So, again, nothing sometimes it seems in health care, nothing is exactly straightforward.
0:28:29
So I wanna just make sure we're we're all talking about the same thing.
Gale Brewer
0:28:33
Mhmm.
Mitch Katz
0:28:34
A follow-up appointment has always been 20 minutes, and the vast majority of our appointments are follow-up appointments.
0:28:41
New patient appointments have typically been 40 minutes.
0:28:44
Mhmm.
0:28:45
The the change that we asked was that if people were taking new appointments and not everybody is taking new appointments, because some people have already filled up their panel.
0:28:56
But if you have not yet filled up your panel, we have reduced the 40 minute appointments to a 20 minute appointment.
0:29:03
But that does not mean and, you know, I I I saw patients as recently as Wednesday under the same rules as everybody else.
0:29:11
That doesn't mean that you have to spend 20 minutes with the new patient, because we're asking people to do 8 visits in a session.
0:29:23
A session is 3 and a half hours.
0:29:26
8:20 minutes is 2 hours and 20 minutes.
0:29:30
So you have 3 and a half hours to do 2 hours and 20 minutes of appointments.
0:29:38
That's important because you have to chart.
0:29:40
Right?
0:29:40
You have to fill out forms.
0:29:41
Right?
0:29:42
So we would never we would never use up the whole 3 and a half hours.
0:29:47
Right?
0:29:47
You have to give people time to catch up.
0:29:51
But asking people to see 8 in an afternoon, is certainly well within the community standard.
0:30:00
Many people in other federally qualified health centers are seeing 10 to 12.
0:30:06
When I looked up the overall US data, it's 11 in a session.
0:30:11
Asking people to see 8, is not unreasonable for the standard.
0:30:17
But, again, I I wanna go a level deeper and say, we didn't do this for money.
0:30:25
We didn't do this to make people's lives harder.
0:30:28
We did this because there were 20,000 people waiting for a new primary care appointment, because as chairwoman Shulman talked about, primary care is probably the most effective and least expensive way to provide health care to people.
0:30:46
So we have a long list of people waiting for appointments, And we recognize that people if you once were going to spend 40 and now people have less time, we realize you're not gonna be able to do everything in that visit, and that's okay.
0:31:05
We want people to address whatever is most pressing to that person and have that person come back again, and that's certainly what I do if I don't have enough time.
0:31:16
I would also tell you, and I think every primary care doctor would agree with this, I don't always know in my session who is going to need more time.
0:31:27
In my Wednesday session, it was a follow-up person with a very complicated social situation who needed the 40 minutes, and my new patient was very straightforward.
0:31:37
The point is it's really not, in my view, about a 40 minute or a 20 minute.
0:31:42
It's about 8 patients in a session.
0:31:46
That's 20 minutes 8 hour 8 it's 2 hours and 20 minutes.
0:31:51
It's a 3 and a half hour session.
0:31:54
We ask that people do their best, recognizing that nobody can address every issue.
0:32:00
That's this has been studied, that that if you total up all the recommendations that we primary care doctors are supposed to do for every patient, we would never sleep.
0:32:11
Right?
0:32:12
We would because it's just not possible.
0:32:14
So you do those things that are most important to your patient.
0:32:20
Final point about this is and we think it's this is a good airing and good for people to understand, and I and I believe support, there are not enough primary care doctors to hire.
0:32:34
Right?
0:32:35
I I if any of you know primary care doctors, our salaries for primary care doctors are absolutely competitive with the market, we will hire them.
0:32:44
There is an absolute shortage in New York City and most of the country of primary care doctors.
0:32:51
So the solution has to be to identify things that are currently being done by primary care doctors that could be done as well by somebody else in the team so that the primary care doctor can function.
0:33:08
So what we have done and it it's been a little bit uneven because any new thing takes a little bit of time.
0:33:15
We have asked for other staff to do prior authorizations for medications, something I know I personally detest doing.
0:33:24
I have spent 25 minutes on the phone with an insurance company in order to get them to agree to pay for a medication.
0:33:33
And there's nothing in the rules that says it needs to be a doctor.
0:33:36
Interestingly, nothing in the rules that says it has to be a nurse.
0:33:40
It it absolutely can be somebody so long as the doctor or the nurse has explained what is the medication and what is the indication.
0:33:48
The problem is you spend 25 minutes on the phone, because for one thing they don't answer for the first 15, and then you go through 3 different voice mail systems till you get to the person, and then their question is, what's your name?
0:34:03
What's your address?
0:34:04
What's your license number?
0:34:05
What's the patient's name?
0:34:06
What's their insurance number?
0:34:08
What's their date of birth?
0:34:09
What's the medication, and what's the indication?
0:34:12
So our vision is let's not have our primary care doctors do that.
0:34:16
Let's have an administrator or a a physician assistant do that.
0:34:22
Another example is same with MRIs and CT scans.
0:34:26
Right?
0:34:26
The physician can determine the order.
0:34:31
The prior authorizations are about communicating the information.
0:34:35
And, frankly, the real reason they created the prior authorizations is to discourage doctors from ordering the tests and ordering the medicines, because, generally, we know what indications they'll approve and what indications they won't.
0:34:49
If I had a patient who at this moment needed who I wanted to treat for obesity, I would know that the medicines used for diabetes won't be approved.
0:35:00
I won't do the prior authorization.
0:35:02
It won't be approved.
0:35:03
On the other hand, if the person has diabetes, I know it will be approved, but it's still 25 minutes of my time.
0:35:11
So another example that we're working on, and many of you may have had the same experience, in the private world, if you go to a primary care doctor for the first time, you'll be asked to fill out your information likely online, what medicines you're taking, what your prior diagnosis are.
0:35:30
Right?
0:35:31
That's something that we haven't yet achieved.
0:35:34
So we, as primary care doctors, I'm asking you, please tell me what your medicines are, and I'm typing them in as you're talking.
0:35:42
Right?
0:35:43
It would be much easier for us to do a a first visit if all of that information was already populated.
0:35:49
Ideally, in my view, by the patient, that might mean that we would assign somebody to help someone who is not as high-tech in the waiting room to do it while they're waiting for their appointment.
0:36:01
It could also be done by a nurse with the patient, things like allergies, smoking history, alcohol use.
0:36:08
There is a large number of things where we are currently expecting doctors to do it.
0:36:15
As long as there are enough doctors, that can be okay.
0:36:18
But if there are not enough primary care doctors, rather than leave people on the waiting list, we would like to try to get them in for a visit.