Financial incentives keep doctors from reducing patient wait times

Waiting room
Financial incentives stand in the way of physicians cutting wait times for patient appointments.

Waiting for weeks or even months for an appointment can add to patients' anxiety and worsen medical issues, but financial incentives may keep doctors from taking action to reduce patient waiting times, say two chief medical officers.

Financial reasons may help explain why most healthcare providers have failed to reduce wait times, particularly for specialty care, write Jaewon Ryu, M.D., of Geisinger Health System, and Thomas H. Lee, M.D., of Press Ganey, in The New England Journal of Medicine.

“The painful reality is that the fee-for-service system rewards long waits and overbooking to squeeze in sicker patients. Practices maintain a higher-acuity mix, while health systems benefit from care spilling over into more costly settings,” the two doctors say.


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At Geisenger Health System, longer waits for specialist appointments generally led to higher costs from the perspective of the system’s insurance arm, but higher revenues for the provider side. That's because patients who couldn’t get in to see a doctor had a higher rate of using the emergency department or had inpatient hospital stays. The downside is higher operating costs because of no-show patients and patient dissatisfaction, they say.

The longer patients wait for appointments, the greater the chance they won’t show up. That can cause practices to double-book, which in turn lead to angry patients who have to wait an hour or more to see the doctor and dispirited clinicians and staff trying to juggle the volume of patients, the doctors say.

Solutions, however, can be expensive. As Geisinger has tried to provide more timely appointments, the system has had to invest in its call center and scheduling systems and processes. However, systems are trying to reduce wait times, fueled by market competition, such as the Cleveland Clinic, which started offering same-day appointments in 2011. Another reason is the move to value-based payment models that reward providers for driving care to more efficient settings, such as preventing expensive hospitalizations.

RELATED: Doctor shortage fallout: Survey finds new patients wait longer for appointments

While those factors may provide incentive to cut wait times, there’s actually been a steady increase in the amount of time it takes for new patients to get doctor appointments, a reflection of the physician shortage, according to a new survey. The average time to schedule a new patient appointment has increased by 30% since 2014 in 15 major metropolitan areas and now stands at 24 days, a Merritt Hawkins survey found.

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