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Measures medical practices can take to improve patient access

MGMA Stat - September 6, 2018

In medical practices, patient access goes hand in hand with patient satisfaction and can encompass a variety of metrics. 

A recent MGMA Stat poll asked healthcare leaders about their level of satisfaction with their organization’s patient access process. Of the 823 applicable responses, 20% reported a “high” level of satisfaction, 51% “moderate”, 23% “low” and the remaining 6% were “unsure.” 

Initially, patient access can be assessed by determining the length of time it takes to make an appointment with a provider, which can be done by time to third and days to schedule.  

Time to third (TTT) is a prospective daily measure of when the third next available appointment is for each provider. The third next available appointment is chosen rather than the next available appointment to reduce variations in provider availability that may be caused by last-minute cancellations or schedule changes. These variations make it seem as though the provider has more openings than he or she really does. Consistently looking for the third next available appointment makes the measure comparable to other providers and can better demonstrate trends. TTT is a common metric and is reported in the MGMA DataDive Practice Operations.

The downside of TTT is that figuring out the time to the third next available appointment for past appointments is very difficult and unreliable given changes in providers’ schedules. Also, practices can measure TTT for new and established patients, but that’s the extent of how detailed the measure can be.

Days to schedule (DTS) is calculated by comparing the date the appointment was created to the date the patient arrives for the appointment. One advantage of DTS is that most practice management systems store the date each appointment was created, which makes it easy to track information. Another advantage of DTS is that it has a variety of data points.  For example, DTS data can be used to answer questions such as how long the average Medicare patient waits for a new patient appointment. 

A disadvantage of DTS is that practices may want to filter some appointments. For example, annual wellness visits, six-month follow-up visits and other patient appointments intentionally scheduled far in advance can skew the DTS calculation if those appointments are not filtered. Regardless of whether your practice uses TTT or DTS or a combination, you should measure trends over time to find out if it is becoming more difficult for new patients to see your providers.

In addition, focus on other measures such as no-shows, cancellations and utilization when considering patient access. A no-show or a last-minute cancellation not only wastes the providers’ time, it makes patients who could have been seen in that appointment slot wait longer. Scheduling templates that are too picky or too complex can also increase patient wait times.  For example, an orthopedic surgeon may have a template scheduled to see a new, workers compensation, knee replacement patient.  Patients who have a different insurance, a different joint, or who are not new cannot fill that slot, and the slot may go unused while patients wait to be seen.

Even if there is an available provider, practices must also consider how long patients have to wait in the lobby and exam room, and how easy it is to make an appointment when determining provider access. Some practices are successfully using online scheduling, online registration, telemedicine and other technologies to make providers more accessible and increase patient satisfaction. What will you measure, and what will you change, to improve patient access in your practice?

Additional resources: Learn more about MGMA Stat

Nate Moore, CPA, MBA, FACMPE
Moore Solutions, Inc.

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