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Glossary - Enhanced Access

TERM
DEFINITION
4-Cut Method

A proxy method, using data over the last 18 months to determine the “assignment” of each patient to a particular physician, considering:

  1. If a patient has only seen one physician in the practice, assign the patient to that physician.
  2. If a patient has seen more than one physician in the practice, assign the patient to the physician seen most frequently.
  3. If a patient has seen more than one physician in the practice the same number of times, assign the patient to the physician who did the patient’s last comprehensive assessment.
  4. If a patient has not had a physical, assign him/her to the physician seen most recently.
Access Scheduling Model A method of offering patients an appointment on the day of their choosing by balancing supply and demand.
Activity Actual number of short appointment slots used that day. If the provider had add-ons or squeeze ins, then the number will be higher than supply. If the provider had no shows or vacancies, then the number will be lower than supply. Activity = Appointments Booked + Squeeze Ins – No Shows.
Backlog

Number of appointments booked between now and TNA (what we should be doing but haven’t).
Note: you do not count planned backlog appointments.

  • Planned Backlog: Appointments that are booked due to patient choice or physiology.
  • Unplanned Backlog: Appointments that are booked due to lack of availability and are NOT due to patient choice or physiology.
Care Team The people in a practice who contribute to the care of the patient.
Carve-out Scheduling Model A predetermined number of appointment slots that are blocked off and protected to accommodate same-day/urgent requests for certain types of services.
Constraint or Bottleneck A rate-limiting step in a process
Continuity

The number of times a patient can see their own provider compared to any provider in the same discipline. Continuity above 80% is the aim.

Provider Continuity: Percentage of patients seen by their usual primary provider.
Cycle Time Total number of elapsed minutes from patient arrival for a medical appointment to patient departing and walking out the door.   
Demand

Panel size x visit rate. 

  • Internal demand: Appointments made today for a future date, as the patient leaves the clinic. 
  • External demand: Call-in/walk-in requests for an appointment.  
Full-time Equivalent (FTE) A 1.0 FTE is a full-time worker and a 0.5 FTE would be a half-time worker. 
Future Open Capacity Used when TNA is consistently 0 and it’s the percentage of open appointment slots within a specified period of time, e.g., 150 slots in four weeks; 70 are open. 70/150 = .46 or 46% 
Huddles Brief team meetings to improve communication and visit flow.  
Ideal Panel Size Formula Panel Size x Expected Visits Per Patient Per Year = Expected Provider Visits Per Day x Days Worked Per Year 
Max Packing Visits A way to maximize visit efficiency by doing more than one task during a visit, to reduce future visits. 
Non-Appointment Work Demand  Includes documentation, prescription refills, lab reviews, messages, referrals, forms management and phone calls. 
No Show Rate Number of patients who fail to keep their appointment and do not give prior notification of their intent to cancel the appointment.  
Red Zone Time Total number of minutes a patient spends in direct (face-to-face) contact with his/her care team.  Also known as value-added time. 
Return Visit Rate (RVR)

Divide the number of unique patients seen in the last 12 months into the number of visits to the practice that these patients generated within the same period.  

Also referred to as revisit interval. 
Panel Size The number of individual patients under the care of a specific provider. Also known as roster size.  
Supply The number of appointment slots according to the schedule (daily/weekly/annually). 
Time to Third Next Available (TNA)

The sum of the days between ‘now’ and the third next available appointment. Include today and all weekend days even if the clinic is closed.  

Note: carve-out appointments are excluded.  

TNA is the gold standard for measuring the length of time patients are waiting for an appointment. 

 

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Additional Resources

Access to Continuity Change Package Summary Relational Continuity Resources
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