Army medical staff struggling to improve access
March 1, 2009
HEIDELBERG, Germany — Sorry you’re sick but no, no appointments today. Next week? Not gonna happen.
Or, you don’t even get that far. You call Central Appointments, but you’re put on hold for a long time, and after trying some deep breathing and muttered curse words, you hang up.
Army medical officials feel your pain, or at least are aware of it.
"Patients are not happy with us," said Brig. Gen. Keith Gallagher, commander of the Europe Regional Medical Command.
The Army is trying to provide better access to medical care, but officials recognize it has a ways to go.
For instance, it used to take 12 weeks to get results for a routine mammogram at Landstuhl Regional Medical Center — after two appointments with a primary care doctor, one for the procedure and another with the primary care doctor to get the results. Patients are now allowed to go straight for the procedure, and the whole process takes six weeks.
The Army’s guidelines for appointments are to schedule patients within 24 hours for acute care, a week for routine care and 28 days for specialty or wellness appointments.
"To meet the guidelines, when the resources aren’t available, it’s sort of tough," Gallagher said. "So access becomes a little challenging."
Access to care, specifically difficulties getting that access, is on the minds of Army medical officials throughout ERMC — and in the United States.
"I was dismayed to learn that, at a recent [Association of the U.S. Army] conference, most of a very large audience of Family Readiness Group leaders … had a number of specific complaints," Lt. Gen. Eric Schoomaker, Army surgeon general, wrote on his blog several months ago.
The most common complaints were:
Inability to get through on the phone to make an appointment.Being told there were no appointments available and to call back, and this happened repeatedly.Clinics’ refusal to give them a referral to the network, despite there being no appointments available.The attitude of the staff on the phone or at the front desk.Gallagher said ERMC patients report problems with appointment convenience and wait times, "But the phone system is probably the No. 1 complaint. The biggest complaint I get is, ‘I hung up.’
"If I get 100 calls and 20 of them drop, we have a problem."
The complaints come mostly from family members. For secondary populations, such as military civilians and Department of Defense teachers and many retirees, who used to be able to get appointments, nowadays, "Access is truly on a space-available basis," Gallagher said.
According to ERMC, 92 percent of patients reported satisfaction with their medical visit. But getting to that point can be tough, and the primary reason echoes problems throughout the Army: repeated deployments have stretched the medical corps. Doctor deployments, the rigors of pre- and post-deployment assessments when soldiers leave for and return from downrange and the dwindling number of Army reservist doctors are just some of the factors having an impact on getting care in garrison, Gallagher said.
ERMC, for instance, gets about three months’ notice before a doctor is deployed. "Sometimes we get a backstop, sometimes we don’t," Gallagher said. Although the reserves used to be an available pool, Gallagher said, "We have exhausted that avenue."
ERMC also must shift providers from clinic to clinic to accommodate labor-intensive periods like post-deployment — and that’s not always efficient.
"We spend a lot of time and effort moving people around," said a senior medical officer who declined to be named because he was not authorized to discuss the matter.
Civilian doctors can and do contract with the Army, but that’s a long, arduous process. "We have to justify it — put together metrics, PowerPoint slides … and if you get the funding, it still takes forever," the officer said.
Still, Gallagher said he’s hiring more providers.
There are other problems, too. The computerized medical record system — slow and cumbersome, hated by the majority of doctors — eats up time. There are not enough examination rooms, Gallagher said.
As for the phone problems, a new appointment management system and call system is being phased in.
"We’re doing customer service training," said Steve Davis, an ERMC spokesman. "Patients deserve to be heard and to have their needs met. We’re emphasizing that."
Gallagher and his staff have put together a list of initiatives to try to address access, in part by squeezing in more appointments through a variety of efficiencies.
"If I can add two more patients for every provider for each week, that’s significant," he said.
Among the initiatives are:
Changing clinics’ training times from Thursdays to Friday afternoons, when a majority of missed appointments occur. Also, clinic staff are giving up four training holidays a year they once took with the rest of USAREUR.Expanding appointment scheduling from a month out to 45 days.Adding to liaison programs to assist people referred to German doctors."When I can’t meet the access standards," Gallagher said, "I want to send you downtown."