Stalking the elusive wait time

How long do patients really have to wait to get an appointment with the doctor?

It’s not as easy to measure as you’d think, especially since health care organizations use wait-time yardsticks that are often narrowly defined and can vary widely.

The U.S. Department of Veterans Affairs recently came under fire for allegedly misrepresenting how long it took for veterans with mental health issues to see a provider. Using its own internal measures, the VA had reported that 95 percent of new patients requesting mental health services were seen within two weeks for a comprehensive evaluation. But when the Office of the Inspector General investigated the numbers more closely, it found that fewer than half of veterans were seen within that time frame and the average wait for the rest was 50 days.

Why the discrepancy? Some of it seems to lie in how the data was collected and how scheduling was handled, Stars and Stripes explained:

For new patients, scheduling clerks frequently stated they used the next available appointment slot as the desired appointment date for new patients, thereby showing deceptively short wait times. For established patients, medical providers scheduled return appointments based on known availability, rather than the patient’s clinical need.

The VA is working to improve its scheduling processes and come up with better – and more accurate – measures for reporting wait times.

This isn’t an issue confined to the VA system. From the family doctor’s office to the medical imaging center, health care is grappling with getting a handle on access. How many days, or weeks, does it take for someone to see their doctor? How long is the wait to see a specialist?

Some of it seems to depend on where you live and the care you need. A survey last year of eye patients, for instance, found that the vast majority were able to schedule an appointment within two weeks of calling an eye care professional. Seventy percent were able to book their exam within a week or less.

When Merritt Hawkins conducted a survey of 1,160 medical practices in more than a dozen metropolitan markets three years ago, it uncovered a wide range of responses. Someone in Miami might wait anywhere from four days to 200 days to see a cardiologist for a heart checkup, while the wait for someone in Atlanta ranged from one day to nine days. People in Boston and Philadelphia sometimes waited a year to see a dermatologist for a routine skin exam. Among all the cities that were surveyed, the combined average wait time to see a family doctor for a routine physical was just under three weeks.

Wait times seemed to be influenced by many factors: physician supply, patient demographics, patient demand, insurance trends and even the U.S. economy. Indeed, a shortage of mental health professionals is probably at least one of the reasons behind the long waits for veterans needing mental health care from the VA.

It’s clearly hard, however, to pin down exactly how long patients must wait for an appointment, and there seems to be no agreed-upon yardstick for how this should be measured.

Sometimes it can get downright confusing and perhaps a little deceptive. Many emergency rooms, stung by complaints of patients and families spending hours in the waiting room, have taken steps to fast-track the care they provide, even going so far as to issue promises – backed up by billboard advertising – of half-hour waits or less.

You’d better read the fine print, however, because the 30-minute wait time might not apply to you if your situation isn’t considered an emergency. And you’d better check to see how the promised wait times are calculated. When the Miami Herald explored some of the marketing claims, it found that some ERs measured wait times as a four-hour average recalculated every 30 minutes, others measured it in one-hour increments and some urgent care centers measured it in 30-minute increments.

And although ER spokespeople told the Herald that they take their wait time service pledge seriously, they also admitted it’s an approximation that may vary for individual patients.

An even bigger question is how wait times should be benchmarked. How long, exactly, should patients have to wait between the time they make an appointment and when they actually receive care? What’s acceptable and when might a delay become unsafe?

“Is cancer treatment urgent?” wonders Kathy Day, a nurse and patient safety advocate in Maine who last year faced an agonizing wait between being diagnosed with endometrial cancer and seeing a surgeon. It took her nine days to decide on the specialist she wanted to see. It took another four days to get an appointment. Although her personal doctor told her she should have surgery “within a few months,” Day acknowledges the waiting is difficult and worries that it might affect her prognosis.

She writes on her blog:

On November 1, I was given an appointment on November 30. Tomorrow it is 28 days (4 weeks or 1 month) since I learned of my cancer. November 30 will be 41 days. Then I don’t know how long after that my surgery will be scheduled. That “couple of months” recommendation is frittering away. I honestly never dreamed I would have to wait a full month to see an expert GYN/oncologist for surgery.

How do you measure the wait time in this situation? Does the clock start ticking only when the appointment is made? What about the time patients might need to choose the doctor and then make the phone call? What about additional waits between the time the patient sees the doctor and when he or she undergoes a test, has surgery or receives lab results that help confirm a diagnosis or determine a course of care?

The process isn’t swift, and there are reasons why it can’t always be swift. How health care organizations measure their wait times is often far from straightforward, however, and there can be a wide gap between what providers think their wait times are and the amount of waiting that patients actually experience.

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