Air Force Medical Service improving access to care

“We’ve always focused on and provided high-quality and safe care,” Lt. Col. Donald Lofton, Air Force Surgeon General Medical Support Division access to care director, said. “Now access is getting a lot of attention.” 

Patients have always been highly satisfied with their clinic or hospital care, but getting to the right clinician in a timely manner has sometimes been a challenge.

“We’ve heard people say, ‘Once I’m in the door, I love it,’” Lofton said. “But we need to be getting the right patient to the right place faster.” 

A 2014 Secretary of Defense Military Health System review reported that the AFMS was doing well regarding access to care, but uniformed and civilian leaders know it could be better.

“Our leadership basically told us: ‘Patients who were calling in were being told to call back too often. We need to fix that,” Lofton said. 

The AFMS, working with the other service’s medical branches at the Defense Health Headquarters, laid the foundation to move forward on improved patient access to care. Here are the top 10 things the AFMS is doing to improve access: 

1. Simplified Appointments. Instead of appointment clerks using 10 different appointment categories for patients, there are now only two. In the past, if someone called in with a cold, and all the acute category slots had been filled, the patient wouldn’t necessarily be seen in the clinic that day. Meanwhile, other slots potentially went unfilled. The system has changed from a symptom-based schedule to a time-based schedule.

“Our goal is to see patients when they need to be seen, rather than forcing them into our previous symptom-based appointing construct,” Lofton said. “You’re now either in a 24-hour slot for things you need to be seen for in the next 24 hours, or a future slot for things you want to be seen for at some time beyond the next 24 hours.”

2. More Same-Day Appointments. The AFMS is pushing to have more same-day appointments on the schedule each day, providing more patients the opportunity to be seen within 24 hours of calling for an appointment.

3. No Call Back Policy. To prevent appointment clerks from telling people calling for an appointment to call back the next day, the AFMS has created a new policy where, if no slots are open, the appointment clerk can directly contact a nurse in the clinic. If they are unable to reach a nurse, the clerks send an electronic note to a nurse, who will call the patient back within two hours. The AFMS is also working towards greater enrollment in MiCare, where patients can use a secure server to make appointments, request refills or ask a nurse questions, saving time and money.

4. Direct Access Physical Therapy. To save active-duty Airmen from going through their doctor to see a physical therapist, they may now book an appointment directly with a physical therapist for certain issues.

5. Embedded Pharmacy Clinics. A new pilot program places pharmacists in primary care clinics to better support patients with poly-pharmacy issues.

6. Clinical Support Staff Protocols. Clinical nurses and technicians are being utilized to treat a variety of common symptoms, such as sore throats. This maximizes the high level of training and competency these staff members have and helps get the patients to the right level of care for their issues and needs.

7. Nurse Advice Line. The AFMS is leveraging the Defense Health Agency’s Nurse Advice Line, a toll-free service where people can speak to a nurse who provides self-care advice, determines if the patient needs to see a doctor or needs to go to an emergency room. The nurse can also activate emergency services and will remain on the line until the assistance is rendered. The nation-wide service can be reached by dialing 1-800-TRICARE and pressing 1.

8. Improving DART. The AFMS continues to refine and improve the Direct Access Reporting Tool, or DART, a system that enables clinic administrators to better manage schedules and patient access. It refreshes data every two to 30 minutes, so it allows for timely, tactical decision making to better meet patient demand for appointments.

9. TRICARE Online. The AFMS has worked with the other Services and the DHA to improve TRICARE Online, making it easier for patients to book appointments online. This system allows patients to book primary care appointments 24 hours a day, seven days a week, from the convenience of their home or office.

10. TOL has also expanded its Blue Button service, which allows a patient to review and track their medical history. Patients can check on their allergy tests, follow their immunizations and track their cholesterol, among other things. Visit http://www.tricareonline.com for more information.

While some improvements have been incremental, Lofton sees them all working together to increase access to care.

“I see it getting better,” Lofton said. “We made a promise to our Air Force family; we’ll take care of you.” 

It’s a promise Lofton and the AFMS team intend to keep.

“Good things are coming but nothing happens overnight,” Lofton said. “We continue to make strides because we want to ensure timely access to the high quality and safe care that we provide in the AFMS.”