Patient access is the ease and ability patients have to access healthcare resources and services. It encompasses the entire process from when a patient makes the decision to get care to the beginning of their first appointment. For multi-site medical groups, patient access is what determines the speed of patients getting care and the fullness of providers’ schedules.
Also called: front-end operations, front desk operations, patient access services. In hospital settings, it’s also part of the front-end revenue cycle.
What does patient access include?
Patient access covers a sequence of related functions, each of which is important in expediting the process.
- Phone coverage: Answering all inbound calls quickly and thoroughly, even during peak or after-hours, and regardless of location.
- Scheduling: Assigning patients to the correct provider, setting up the right visit type and location, and filling each provider’s template correctly.
- Referral intake: Receiving incoming referrals, converting them into scheduled appointments, and tracking their journey through that process.
- Patient intake and registration: Processing vital patient information such as medical history and demographics, as well as collecting consent forms and other necessary paperwork.
- Insurance eligibility verification: Confirming a patient’s active insurance coverage and benefits before the visit begins so claims are clean from the start.
- Prior authorization: Obtaining approval from the insurance company for patient’s services before any procedures, tests, or treatments are carried out.
- Reminders and confirmations: Contacting patients before their visit to confirm they are still available for their appointment, and rescheduling or cancelling unattended appointments to ensure templates stay filled.
Why does patient access matter?
Patient access is an important part of the healthcare journey for a variety of reasons, but some of its biggest impacts include:
Patient experience
During the patient access phase, patients are forming their first impression of a practice. If, during this time, they experience long hold times, aren’t given a clear time and location for their appointments, or they have to repeat themselves to multiple different people, it puts a sour taste in the patient’s mouth before they’ve even received care.
Revenue
Poorly managed patient access leads to appointment slots sitting empty and insurance claims getting denied, which snowball into major revenue loss over time.
Provider productivity
When providers have full schedules, filled with patients who are the right fit for their care, providers and their teams make better use of their time and efforts.
Competition for new patients
When competing with other practices in your niche, it pays to be easy to contact and schedule appointments with. This makes both patients and their referring providers more willing to book with you and follow through.
Who owns patient access?
For most medical groups, there isn’t one distinct “patient access team.” The responsibility of patient access spans a handful of different groups, including front desk staff, schedulers, those coordinating referrals, and the billing department, depending on which part of the patient access process is in question.
Because patient access tends to have many owners, many practices are prone to letting tasks fall through the cracks as they change hands between teams. Many practices choose to remedy this problem by consolidating patient access work under one umbrella.
How is patient access measured?
The most commonly used metrics in the patient access process include:
- Third next available appointment: How many days until the provider’s third next available slot? This is a standard metric in healthcare because it adjusts for one-offs and last-minute cancellations, and gives the most reliable, everyday estimate for how long a patient typically needs to wait to be seen.
- Referral-to-care time: How long does it take from the time an incoming referral is received to the time the patient has completed their first visit?
- Call abandonment rate: What percentage of callers hang up before they can speak to someone?
- No-show rate: What percentage of scheduled appointments do patients miss without giving prior notice?
- Template utilization: How much of the available time in a provider’s schedule is actually filled with appropriate patient visits?
Related terms
- Patient access outsourcing: Contracting an external partner to handle all or a portion of your patient access functions, like phones, scheduling, and intake.
- Centralized scheduling: Managing multiple locations’ appointment scheduling functions through one team and one playbook.
- Patient intake: The process of collecting a patient’s information and filing their necessary documentation as preparation for their visit.
- Front-end revenue cycle: The revenue cycle activities that happen pre-visit, such as scheduling, registration, eligibility verification, and prior authorization, that set the patient up for accurate billing.
FAQs
Is patient access part of revenue cycle management?
There is overlap between the two, in that some patient access activities like registration, eligibility verification, and prior authorization do make the claims and payment processes smoother. However, patient access has a broader scope, setting up the entire process for success and compliance, not just the financial aspect.
What’s the difference between patient access and patient engagement?
Patient engagement refers to a variety of tools and communication functions that keep patients informed about and engaged in their own care. Patient access refers broadly to the operational work of getting patients smoothly to their first appointment.
