New patient appointments an ongoing struggle for practices amid COVID-19

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders how their organizations’ new patient volumes were affected amid the COVID-19 crisis. More than half (55%) reported new patient volume decreased, while 25% noted it stayed the same, and 20% said new patient volume increased. 

The poll was conducted July 7, 2020, with 839 applicable responses. 

Among those practices that had a drop in new patient volume, most saw modest decreases: 

• 57% of respondents noted decreases of 1% to 25% 
• 35% reported decreases of 26% to 50% 
• 6% indicated decreases of 51% to 75%
• 2% noted decreases of 76% to 100%. 

For practices that managed to increase new patient volume, most reported similarly modest gains: 

• 72% increased new patient volume by 1% to 20% 
• 18% grew volume 21% to 40% 
• 4% noted volume gains of 41% to 60%
• 4% grew volume by 61% to 80% 
• Only 2% of practices reported volume increases 81% or higher. 

Understanding the importance of continuously adding patients and growing physician panel size is critical to the long-term health of an organization. This is partially due to an inevitable amount of ongoing patient attrition that naturally occurs. 

Panel size is a valuable key performance indicator (KPI) practices should be tracking, which includes measuring new patient volumes. Panel size is the number of unique patients for whom a provider or care team is responsible within a specific time frame, usually the past 18 months. The care team (e.g., physician, medical assistant and health educator/nurse) is often responsible for preventative care, disease management and acute care for all the patients on its panel. Patients who have seen more than one provider are assigned to the provider they have seen most often.

Managing your new patient volumes, panel size and scope of practice allows the care team and the practice to balance supply and demand, optimizing access to care. To start, calculate average number of visits per week and the number of visits per week that can be supported based on current “supply” (i.e., number of providers, number of slots available). The goal is to achieve an equilibrium between the two results to close the gap between when the demand is initiated and when the service is delivered. 

Tracking third next available appointment is a KPI that should be used to benchmark with current industry standards. This metric measures the delay a patient experiences for a scheduled appointment. Third next available appointment is the average length of time between the day the patient makes an appointment request with a physician/provider and the third available appointment for a new patient physical, routine exam or return visit exam. Creating and tracking appointment availability and access for patients is especially critical in a consumerism-based world increasingly designed to help new and established patients obtain care whenever and wherever they need it.

Managing variation in demand is as vital as managing supply. It is important to predict and anticipate when a clinic may need to adjust its schedules. Cold and flu season, allergy season, start of school and pandemics such as COVID-19 may increase the demand for appointments at specific times of the year. During times of lower demand, clinics may choose to schedule more elective visits so that supply and demand are consistent. Improving access helps your practice or organization predict and absorb demand as needed. 

Improving workflow and eliminating waste will help your practice balance supply and demand. 

Tips to help balance supply:

• Extend return intervals for return appointments based on medical necessity, adding supply to the system because fewer future appointment slots will be filled
• Do as much for patients while they are in office, reducing need for extra appointments 
• Improve communication between staff and providers
• Review provider schedules and appointments to make sure that there are open slots that would reduce third next available appointments to zero days: same-day appointments available for primary care and within two days for specialty care
• Review gaps in staffing to assess what is needed
• Cross-train staff
• Reduce variation in how office visits and documentation is completed by different providers
• Reduce scheduling complexity (Access MGMA’s COVID-19 Recovery: Patient Engagement Flowchart to help manage this aspect of supply.)

Tips to help balance demand:

• Telehealth visit options and availability
• Telephone check-ins with high-risk patients using nurses and nonphysician providers (NPPs)
• Patient portal for refill requests, nurse questions, test results
• Nurse triage/nurse advice line for urgent concerns
• Increase nurse/NPP visits and/or nurse only clinic 
• Group visits in which several patients meet with provider and/or care team for specific conditions
• Decrease no-show rates 
• Engage patients in self-care
• Open communication with patients and community as needed (Access MGMA’s COVID-19 recovery resource, Patient engagement best practices and sample scripts, to help in this regard.)

MGMA Stat 

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat. 

Additional resources:

• MGMA COVID-19 Recovery Center — Operational resources and stories for responding to the pandemic 
• MGMA Stat: COVID-19 polls — Find the latest COVID-19-related MGMA Stat data stories 
• Medical Practice COVID-19 Recovery Toolkit
• Lean Patient Flow System
• “Balancing the supply and demand of patient access” (MGMA Connection article)
• Using Lean and Six Sigma to improve clinic and patient flow
• Lean tools: Utilizing Swim Lanes to optimize productivity