When “New Patients” Aren’t Really New: The Metric Access Leaders Need

By Elizabeth W. Woodcock, DrPH, MBA, FACMPE, CPC

Founder & Executive Director, Patient Access Collaborative

You’re at a yard sale and spot something with the tags still on. “Brand new!” you think—until you realize it’s been sitting in someone’s garage for three years. It’s technically unused, but it’s not really new.

The same thing happens in access reporting. We throw around “new patient” as if it means “new to the health system”—but in reality, most “new patients” are only new to a particular provider. The CPT definition, which drives how visits are billed, is clear:

A patient who has not received any professional services from the physician or another physician of the same specialty in the same group practice within the past three years (American Medical Association).

That’s fine for reimbursement. But for access strategy? It’s misleading.

A patient might have seen a cardiologist in your health system last year but is now booked with an interventional cardiologist in the same clinic. Under CPT rules, they count as “new”—but they’re not new to your system. If you’re using CPT-defined new patient counts as your growth indicator, you might think you’re attracting more people from the community when you’re really just shuffling existing patients around.

High-performing access leaders are changing the game. They’re tracking true new-to-system patients—people with brand-new medical record numbers (MRNs). If those numbers aren’t growing, your market share likely isn’t either. Monitoring MRN creation over time offers a much clearer view of strategic growth, and it’s easy to do in most EHRs. Some leaders add a time buffer, such as eight years, to account for long-absent patients re-entering the system.

Why does this matter? Because in today’s competitive healthcare environment, growth isn’t guaranteed. If you’re not measuring true new patients, you risk missing early warning signs of stagnation. And by the time market share erosion shows up in your financials, it’s often too late to turn the tide quickly.

The takeaway: CPT definitions serve billing; true new-patient tracking serves strategy. If you want to know whether your access initiatives are truly expanding your reach, start measuring who’s really new.