(Originally published in Healthcare Call Center Times in October 2020.)

WASHINGTON, DC—So, just how well is your patient access effort doing? The answer to this question may well be of great interest not only to scheduling call centers but to those C-Suite executives whose focus is on patient satisfaction and maximizing revenue into the organization/practice. That’s because patient access is intertwined with no-show rates, cancellations and staffing levels. For the latter, if patient demand is huge and physician supply in a particular specialty is small, then there are going to be patient access issues that will be hard to correct without hiring additional staff.

However, there’s something else going on if staffing seems appropriate, patients are still being booked months out and cancel/no show rates are high enough that there is plenty of slack in the physician’s schedule.

Patrick Randolph was not in the healthcare world; his background was in economics. However, his father was a doctor as was his father before him. His mother came from a family of nurses. “He was (and still is) an allergist in Connecticut and would tell me that patients had to wait two to three months to get in to see him, and that he was also losing 20 percent of revenue,” Randolph says. “I thought this would be an easy problem to solve.”

His initial solution would be to create a wait list and text patients with appointments farther in the future when a same day or near term opening came up so it could be filled. That was really the beginning of his company in 2013, the Washington, DC-based QueueDr. Randolph, who is Founder and CEO, says that those practices that used this system had great success, filling more than 90 percent of their open slots. However, only 5-10 percent of the practices that initially signed on actually used it.

That caused a rethinking of the process. Eventually, “we automated the entire process so there is no staff work,” he says. “As soon as a cancellation comes in, we try to fill it. We find five to 10 people who have appointments far out and text them.” The first one to reply with a special word listed in the text gets the appointment. The company does it this way so the text is not mistaken for an appointment reminder. If others reply too late, appointments are offered, if available, to them that are earlier than their assigned appointment.

Doing this work led Randolph to wonder about what kind of measure could be created to capture an organization/practice’s patient access success rate. In late 2019, the company introduced The Patient Access Score™. It had its roots in a 2016 study by athenahealth that indicated that 10 percent of same day appointments for new patients will be canceled and not rescheduled for at least six months. 

That 10 percent becomes part of the denominator calculation in the company’s formula. This may not be the same for everyone, but the principal is the same—to use in the denominator calculation that percent of same day appointments that are canceled either proactively or through no-shows.

In an example on the company’s website, the denominator is shown as 1 minus 0.1 to equal 0.90. The numerator is comprised of an overall no-show rate for whatever period the organization wants to measure. (This no-show rate can also be broken down into specific day periods between when an appointment is scheduled and the actual appointment time. Here, the break is 0, 1, 5, 14, 21, 28, and 45 days.)

This numerator figure is 1 minus the average no-show rate. So, in the company’s example, the average no show rate is 23 percent. That means the numerator becomes 0.77. Dividing the denominator into this number gets a patient access score of 85.

Using data from the company’s clients, Randolph constructed a scale to place the score in context. One hundred is perfect, 90 to 100 is very good, 80 to 90 is an okay patient access score and 80 and below is a bad patient access score.