Providing “enhanced access” is a primary goal of Community Health Centers across the country…but there are common challenges around just exactly how to execute on that goal, and how to measure the success in doing so. We know that enhanced access is a multidimensional concept that requires a multifaceted approach. A significant element of that approach requires a conscientious and diligent commitment to a data strategy that focuses on access metrics. The following information provides details related to some of the highest priority access metrics that are critical to any practice’s long-term success in achieving enhanced access goals. These metrics not only provide essential data regarding access, but also provide invaluable insights regarding practice efficiency and effectiveness, quality, risk, experience and satisfaction, workforce drivers/needs, capacity, sustainability, and more.

Practice Capacity Utilization (Schedule Fill Rate)
Practice Capacity Utilization, or Schedule Rill Rate is the metric that compares the number of appointments able to be scheduled in the practice schedule against the actual number of appointments scheduled in a given timeframe (ie: per month). This is calculated by dividing the number of scheduled appointments by the total number of appointment slots in the schedule template.
The percentage of filled appointment slots provides you with the schedule fill rate, and the open slots provides you with the practice capacity based on utilization (example – 85% fill rate/15% capacity).

Third Next Available:
The third next available appointment (3NA) is a metric used to measure how long it takes a patient to get a routine appointment with a healthcare provider. It’s calculated by counting the number of calendar days between the day a patient requests an appointment and the third available appointment.
Factors to include/exclude when calculating 3NA:
•Include non-clinic days: Count weekends, holidays, and any other non-clinic days in the calculation.
•Exclude “same day” appointments. These are specifically reserved or allocated for same day access and should not be included in the 3NA calculation.

3NA is sometimes considered a more reliable metric than the next available appointment because last-minute cancellations can distort the days until next available appointment. However, 3NA has limited usage unless it is filtered or drilled down with specifying detail. This is a metric that is preferrable for measuring access for established patients vs. new patients.

New Patient Lag Time:
New Patient lag time is the time between when a new patient’s appointment is scheduled and when it occurs (the date of service). New patient lag time is an industry standard metric that helps measure the accessibility of care specifically for new patients seeking to establish care with the practice.
Studies have found that lag time for new patient visits is highly correlated with no-show rates. For each day that a patient’s lag time increases, the likelihood of the patient becoming a no-show increases by up to 2%.

No Show Rate
No Show Rate is the percentage of scheduled appointments that are missed (the patient does not arrive) or that the patient arrives late beyond the allowable time grace period, resulting in the patient not being seen.
No Show Rates provide us with critical information that, if used, can lead to clinical, operational, financial & quality improvements essential to success with achieving Quintuple Aim. These metrics should be tracked and trended monthly.
No Show Rates are often viewed simply as a lag indicator – but if monitored appropriately, these metrics can provide valuable lead indicators related to population trends and risks, social determinants of health, barriers to care, access issues, workforce issues, continuity of care issues, patient experience and patient engagement issues.

Cancellation Rate
Cancellation rate is the percentage of scheduled appointments that are cancelled by the patient. (These cancelled appointments may or may not be rescheduled. If the patient reschedules at the time of cancellation, the appointment may be tracked differently.)
Similar to No Shows, cancelled appointments may have a tendency to be viewed simply as a lag indicator. However, the cancellations should be tracked and trended monthly for the same lead indicators as mentioned with the No Show appointments.

Continuity of Care
Continuity of care is the percentage of time that care is rendered to a patient by their own primary care provider. Continuity of Care (CoC) is measured in two separate metrics. The first is provider-based continuity, the other is patient based continuity.
•Provider Based Continuity – [Measured as a percentage] Numerator = Patient encounters during the defined time period where a provider sees patients empaneled to that specific provider. Denominator = All encounters provided by a specific provider during a defined time period.
•Patient Based Continuity – [Measured as a percentage] Numerator = Patient encounters during the defined time period where a patient is seen by their own primary care provider. Denominator = All patient encounters during a defined time period.
A continuity rate of 75% or lower can be an indicator of access issues, workforce issues, patient experience and/or patient engagement issues. This can also be an indicator of safety, quality, cost of care, and outcomes challenges. CoC metrics should be tracked and trended regularly at both the practice and provider level.

Appointment Timeliness
It is essential to track and trend the primary factors that influence overall appointment timeliness. The practice access data strategy should include regular monitoring of five key elements related to appointment timeliness. By tracking each of these segments of time, it allows the practice to evaluate individual workflows for efficiency and effectiveness, check for areas of lag or excess wait times, identify bottlenecks, staffing inefficiencies, equipment or supply issues, process barriers, etc.
•Total Throughput – The total number of minutes/hours from the time the patient checks in to the time the patient checks out.
•Time to Room – The segment of time, in minutes, from the time the patient checks in, to the time the patient is roomed.
•Time to Provider – The segment of time, in minutes, from the time the patient is roomed, to the time the patient is seen by the provider.
•Time to Discharge – The segment of time, in minutes, from the time the encounter is started to the time it is completed and the patient is considered clinically discharged by the provider.
•Time to Check Out – The segment of time, in minutes, from the time the encounter is completed (patient is clinically discharged), to the time the patient checks out.

Patient Retention & Attrition
Every practice must remain mindful of their patient retention and attrition metrics. This not only provides valuable insights into patient experience, opportunities for growth as well as improvement; it also has significant impact on the overall success and sustainability of the practice.
Many health centers expend significant resources to market and recruit new patients into their practices. The average healthcare organization experiences growth at a rate of 45% or higher, but many have an attrition rate (leakage) that matches or exceeds the growth rate.
It costs the organization more to bring in new patients than to retain established patients, so you want to be sure to prioritize both, in order to maximize your efforts.

“Retained” Patient- A patient who has had a visit in this calendar year AND in the previous calendar year

“At Risk” Patient- A patient who had a visit in the previous calendar year, but has NOT been seen in the current calendar year (12 months or more since the last visit)

“Lost” Patient- A patient who has not been seen by the health center for any services in 36 consecutive months. “New” Patient
A patient who has had a visit in this calendar year, and had not received services by the health center for 3 years or more prior to that visit

New Patient Growth
Each health center practice should have a defined practice level and provider level new patient growth target/goal. The practice access data strategy should include the tracking and trending of new patient growth volumes monthly and benchmarking of these metrics against the practice level and provider level new patient goals.
When the practice, and each provider within the practice, has a new patient growth target, it allows the practice to formulate new patient access goals and ensure the schedule is appropriately balanced and designed with adequate access to accommodate the necessary volume of new patient visits per provider.

Waitlist Volume
The number of patients on the practice waitlist is a valuable metric to track in order to mitigate the risk of experiencing an unwanted increase in new patient lag time.
Having a waitlist can contribute positively to several aspects of a high performing health center practice. Areas that the can be proactively and positively impacted by a well-managed waitlist include:
•Patient experience
•Operational efficiency
A waitlist can help fill empty slots caused by cancellations or rescheduling. It can help manage seasonal fluctuations in demand, etc.
•Revenue
A waitlist can help you fill appointments that would otherwise be left vacant, which has direct impact on revenue.
While having a waitlist can be beneficial, it does not come without risk. It is essential that your waitlist be carefully tracked, managed, and maintained. Waitlist stagnancy or growth are indicators of access and/or capacity issues in your practice.