Changing the Face of Patient Experience with the Net Promoter System®

Case Study: Legacy ER & Urgent Care

Before the mid-1980s, there were few options when it came to getting quick medical care on an outpatient basis. From unbearably long emergency room wait times (and the associated large bills) to the growing difficulty of actually finding or booking an appointment, there was a mounting frustration in the healthcare space.  Ultimately, this gap led to a rise in what we now call “urgent cares”, and an emphasis on providing a better patient experience.

 Jay Woody, M.D. Founder of Legacy ER & Urgent Care examines one of the 30k plus kids who visit Legacy ER & Urgent Care every year.  

Jay Woody, M.D. Founder of Legacy ER & Urgent Care examines one of the 30k plus kids who visit Legacy ER & Urgent Care every year.  

Legacy ER & Urgent Care has expanded this model further, offering dual emergency room and urgent care locations to meet the needs of patients in the United States. Today, they are the largest dual provider of both emergency and urgent care services in the country, and a leader in delivering superior patient experience.

News of their success and innovative business model has garnered a high volume of interest from major healthcare providers and hospital investors looking to provide similar access to communities across the country. To ensure a high standard of patient satisfaction and retention through their continued expansion, Legacy ER & Urgent Care implemented CustomerGauge—a Net Promoter System® that helps them track and improve patient experience- across their locations.

Getting Started with a Net Promoter System

Before partnering with CustomerGauge, Legacy ER & Urgent Care found that one of the biggest hurdles when it came to focusing on their patient experience was that the healthcare industry simply wasn’t built for it. Prior to CustomerGauge, Legacy ER & Urgent Care always paid close attention to patient feedback, but did not have the detailed processes for improvement and tracking they do today.

That all changed in 2016, when Legacy ER & Urgent Care implemented CustomerGauge, which enabled them to track and respond to patients in real-time and analyze satisfaction. Chief Marketing Officer, David Apple, attributes the success of the implementation to first and foremost, employee buy-in of the system and its value,

“We streamlined the process by empowering our leaders, on both the care and administrative side, to lead the NPS program and really hone in on not just the bad experiences (we have a workflow process for that), but also to celebrate the wins. It was spreading the word about our promoters that got everybody excited.”

By establishing buy-in with their employees, Legacy ER & Urgent Care built out their Net Promoter System across their locations, which enabled them to track patient satisfaction.

Closing the Loop to Improve Patient Satisfaction and Retention

As part of their CustomerGauge workflow process, Legacy ER & Urgent Care uses consistent survey best practices. Patients are sent surveys about their experience within 24 hours of their visit via email. If they do not receive a response within 36 hours, they send out a secondary email reminder, which has led to improved response rates and higher retention within their patient base.

“We’ve taken everything that healthcare typically does [when it comes to patient satisfaction and patient experience] and thrown it out the window. " - David Apple, Chief Marketing Officer

Once a patient has submitted a survey, as part of their follow-up workflow, leaders at each location are notified of detractors or passives in real-time via email using CustomerGauge’s issue escalation. At this point, the clock is ticking. To ensure dissatisfied patients are contacted ASAP, every facility has designated ‘first-responders’, such as a nurse or physician leader, to reach out for solutions. Legacy ER & Urgent Care will not consider a case closed until the issue is resolved.

In addition to care-based first responders, billing and insurance-related issues also include separate first-responders—meaning issues are always designated to the right person in the company. Issues are processed and closed in no more than 36-48 hours of notification. When asked if this process has noticeably improved their patient experience, CMO David Apple stated:

 “100%. Knowing how important promoters are to our business, we implemented improvements as issues arise. For example, if we see any consistent issues in billing, co-pay, or other procedures, we make changes in our operational process to improve based on that patient feedback.”

Best Practices for Winning Patient Experience and NPS

Proper employee training, good survey procedures, and streamlined follow-up are just a few of the best practices that Legacy ER & Urgent Care have employed over the last few years. Since investing in patient experience and retention, Legacy ER & Urgent Care has experienced a 15-point increase in their NPS score overall. But how did they get there?

For Legacy ER & Urgent Care, following the status quo didn’t cut it:

 “We’ve taken everything that healthcare typically does [when it comes to patient satisfaction and patient experience] and thrown it out the window. It’s a complete transition away from a typical healthcare experience. Our NPS score and patient experience comes from the whole package. Before patients are even done checking in, somebody is greeting them in the room and bringing them in. We’re aware that a majority of the people we see are probably having a bad day, so it’s important to set that initial tone very high, even when people first walk in.”

Legacy ER & Urgent Care employ numerous best practices to ensure success within their NPS program to increase satisfaction and grow their business:

•       Employee buy-in, encouragement and thorough training of the tools and procedures

•       Fast and proven survey process and follow-up

•       Consistent patient/customer experience procedures across multiple locations

•       Tying revenue to a patient/customer experience program to justify investments

"Knowing how important promoters are to our business, we implemented improvements as issues arise." 


With CustomerGauge, Legacy ER & Urgent Care hopes to continue delivering consistent, outstanding patient experience, and tie their efforts to revenue and growth as they continue to expand.


According to, the average Net Promoter Score for the health care industry—from primary care to physical therapist—is 75. However, according to a third-party survey of N. Texas Free-Freestanding ERs and Hospital

EDs, the industry benchmark is even lower. Healthcare has been slow to adapt NPS or any customer feedback tools. Legacy ER & Urgent Care’s NPS score of 81 is a significant achievement considering it is on par with top retailers and customer service-oriented brands.

By the end of the year, Legacy ER & Urgent Care expects revenue from existing patients to grow by 200%. Given both their ability to justify their patient experience program via revenue and the value in their business’ dual model, Legacy ER & Urgent Care is looking forward to an exciting year of expansion and growth:

“There’s going to be a seismic shift in healthcare across the country. People are looking for better access and experience. As such, we are looking to expand. We have a lot of major hospitals and healthcare systems around the country that are interested in partnering with us to deliver our model to states that don’t have any community access care that. We’re in a good position to grow rapidly, and we have the people and the system [CustomerGauge] in place now to help us with this expansion. It’s going to be an exciting year.”

About CustomerGauge

CustomerGauge is a software-as-a-service platform that improves customer experience using the industry-standard Net Promoter System. The system helps companies automatically measure and analyze feedback in real-time, act to reduce churn through close-loop tools and grow their bottom line.

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About Legacy ER & Urgent Care

Legacy ER & Urgent Care is the largest dual provider of both emergency and urgent care in the country, and runs on one simple premise: there has got to be a better way to deliver emergency services while providing extraordinary customer experience and only billing for the care you need.