Researchers have identified top performers on key financial and clinical metrics across the athenahealth network — and are uncovering the innovations that drive their success. Here's a snapshot of one tactic on the road to lower cost, higher value care.

The problem

Annapolis Internal Medicine, a primary care practice that serves more than 20,000 patients every year, set same-day access for every patient as a top priority. The practice had been holding open 30 appointments each day for urgent care — but data revealed that those appointments were all filled by 9 a.m. Patients who called any later were out of luck.

"We realized that patients who could not be scheduled must be going to retail clinics," says practice manager Yvette Perry, who understood the potential toll on patient loyalty — and revenue. "Saying, 'We can't help you today. We can help you tomorrow,' means you probably will never see them. You've probably lost that business. Maybe you lose the relationship."

The solution

Annapolis determined that adding another nurse practitioner wouldn't cover the gap. "There was just too high of a demand," she says. So the practice opened a walk-in clinic of its own, downstairs from the main clinic, for established patients only.

The Annapolis Internal Medicine Walk-In Clinic is staffed by four nurse practitioners — one of them a diabetes educator — and is open extended hours on weekdays and most of Saturday. Because the clinic is open only to current patients, full medical records are already on-site. Now, 60 to 80 patients show up for urgent care each day, about a quarter of the group's overall daily patient volume.

The outcome

Separate same-day care lightens the load on the main clinic staff, who no longer need to manage concurrent workflows for scheduled and walk-in patients or catch up on registration information for urgent visits. Phone traffic is also reduced as the front desk no longer needs to take calls for same-day appointments.

Kevin Groszkowski, M.D., a physician partner, says the clinic allows him to be present for all of his patients.

Even when he's seeing patients in the main office, nurse practitioners in the downstairs walk-in clinic can consult with him in real time.

"The patient actually sees the nurse practitioner and the physician working together to make sure they are receiving the best care possible," he says.

"The walk-in clinic is an extension of our main office," says Perry, "an area where our patients can come in, not have to make an appointment — just have us accessible when they are not feeling well. And they love it."

Gale Pryor is a senior staff writer for athenaInsight.