Modernize Your Patient Access and Visit Mix

Let Data Optimize the Way You Manage Your Patient Access and Visit Mix

Guaranteeing easy appointment access for new patients is critical to running a successful specialty care service. Traditionally, the frequency of return visits is at the physician’s discretion in most clinical practice plans. The impact that this has on access and economics has gone unexamined and unmanaged for far too long. As a result, damaging economics develop in many academic and clinical practice organizations:

  • Return visits reduce access for new specialty patients
  • Payer mix deteriorates when well-insured patients receive their care elsewhere due to lengthy waits
  • Established E&M visits displace procedural visits, causing suboptimal revenue per CFTE

By letting CPSC reports inform your management decisions and policies, you take discretion out of the picture and replace it with proven data.

CPSC participants have pursued a variety of approaches to manage their organization’s visit mix and access to specialty care services. Notable successes include:

  • Specialists are partnered with willing generalists or mid-level providers to deliver chronic maintenance care.
  • Chronic, stable patients are returned to primary care physicians if there is constant close coordination with the specialty service to ensure quality and safety.

Keep in mind that for either of these approaches — or any disease-specific strategies that are developed through CPSC customized reports — you should always monitor both quality of care and business results.

New Patient Visit Analysis

The CPSC offers a New Patient Visit Analysis in the Clinical Activity Suite, giving you an easy way to benchmark your organization’s new patient visit percentage by department and provider against those of your academic peers. This report also allows you to identify variations in your organization’s new patient visit percentage by payer category and location — two critical factors for coding and successful charge capture.

New Patient Percentile Report

In addition to the New Patient Visit Analysis, the CPSC also offers a comparative dashboard report — the New Patient Ratio Percentile Report — that compares an organization's performance on their new patient visit percentage by specialty. For ease of use, the report employs a simple green-dot, red-dot rating system to highlight areas of strength and opportunity so that you can take immediate, decisive action.

CPSC Metrics That Measure Patient Access and Visit Mix

In the vast majority of cases in our extensive database, “new patients” receiving care from an academic specialist are referred by a primary care physician or another specialist — they are not self-referred. To get a deeper understanding of this practice, the CPSC recommends members use two metrics to measure appointment access: the new patient visit ratio and the consult code ratio.  

PATIENT VISIT AND CONSULT CODE RATIOS

The new patient visit ratio is defined as: [CPTs (99201-205) + (99241-245) + (99381-387)] / [CPTs (99201-205) + (99211-215) + (99241-245) + (99381-387) + (99391-397) + 99024]. The ratio also includes new (92002-92004) and established (92012-92014) ophthalmology visit codes, when appropriate. The new patient ratio can help groups gain insight into their referral volume.

The consult code ratio is defined as: [CPTs (99241-245)] / [CPTs (99201-205) + (99241-245)].  The consult code ratio can help groups gain insight into services provided to referring community physicians, and help enhance communications between the two.

In return for improving your communications and services provided, you may see an increase in referral volume from community physicians. Other benefits CPSC members enjoy by focusing on access for new patients include:

  • Improved clinical outcomes
  • Improved payer mix and collections per unit of service
  • More RVUs per unit of specialist time, which offers a better chance of recovering specialist costs
  • Greater volume of procedures per patient encounter