Third Next Available Appointment - TNA

Third Next Available Appointment – TNA

I heard this term being used in the healthcare circles when I moved from an HMO to a clinical group and wasn't sure what it meant and why does it matter, so I went about exploring the significance of this term and how it matters.

My first interpretation was a literal definition of this term, or sentence. I ended up with the third available appointment slot. This came out to be a pretty accurate definition but still did not make sense as to why do we need to skip the first two appointments. may be to keep slot open for last minute or urgent  appointments, but that would result in two slots being kept vacant for every appointment and that did not make much sense.

So after digging through a few links from google I was able to have a better understanding of the concept, its application and importance in the healthcare setting. The definition basically stays the same:

"TNA is the number of days from the current day to the third available appointment for a physician." 

Essentially, the first two available appointments are skipped, and the reason for this will become apparent shortly as we go further into the concept of TNA. This measure represents how quickly a patient can be scheduled for an appointment with a particular doctor, and this measure gives a good idea of how loaded is the doctors schedule. Simply put, it is a nice way of comparing available appointments (supply) versus appointment requested (demand).

The TNA should be measured at the same time and day at regular intervals (ideally weekly), to see the trend and compare it with other doctors within the practice. Another thing to take care of is to measure TNA by appointment types, for example new patient appointments, annual wellness visits, follow-up visits, etc. should be kept separate. Also, while counting the days, if third next available is available the same day of measurement then TNA is zero, if it is available the next day then it is 1 and so on. Holidays and weekends are generally not counted, but provider's days off are counted. Some practices do include the weekends and holidays to get a true measurement of how soon a patient is expected to be seen from time of appointment request. This is a patient focused approach as against the provider focused when these days are excluded.

High TNA numbers indicate an overloaded schedule and patients healthcare suffer due to delayed availability, and continuity of care is affected too. Target goals for primary care physicians are ideally set at zero and for specialists it is set at 2.

TNA reduction can be achieved by adopting certain measures but these vary from practice to practice:

·                     Have patients call in for next appointment instead of pre-scheduling.

·                     Extend re-visit intervals.

·                     Review current schedule and cancel/remove unnecessary appointments.

·                     Transfer patients to other physicians or APPs within the group.

·                     Use technology to offset face to face interactions/visits: this may include emails, live chats, patient portals, secure messaging, etc.

·                     Utilize patient care teams more effectively for services where interaction with the physician is not deemed necessary. These services may include refills, referrals, labs interpretations and results, preventive care and patient education, etc.

In conclusion, keeping TNA as close to goal as possible gives the physician a healthy work-life balance, the patients get timely healthcare services, and the panel size of physicians can be expanded by delegating certain services to technology and patient care team. Remember, not to use TNA as a tool for patient scheduling.