Many patient access leaders are happy to have AccessKeys, which are key performance indicators (KPIs) from the National Association of Healthcare Access Management (NAHAM), reports Yvonne Chase, MBA, CHAM, manager of revenue cycle at Mayo Clinic’s Phoenix and Jacksonville, FL, sites.
However, they aren’t confident in how to use this new tool. “The biggest question we are getting is, ‘How can I roll this out in my department?’” says Chase, NAHAM’s current president.
To address this need, NAHAM is developing a toolkit and online blog to help patient access departments implement AccessKeys. “Once you put a couple of these in place, you will find they are really not that difficult,” says Chase.
At many smaller hospitals, patient access staff members still do everything manually. “We recognize that many departments can’t afford automated tools,” says Chase. “But they still need to measure themselves against something that is realistic.”
She suggests that patient access leaders consider these approaches for using AccessKeys:
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Choose an indicator based on your biggest pain point.
The KPIs can tell you if your department is in “good,” “better,” or “best” categories, in comparison to peers. “Average wait times were big for us, and the downside was possible cancellation and/or delay of care,” says Chase. For this KPI, the department started at the “better” category and is working toward being the “best.”
In some healthcare systems, patient access staff members measure large amounts of data, but don’t learn anything meaningful about their problem areas. “Some people measure nothing, while some people do it ad nauseum, but it’s not always valuable data,” says Chase.
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Choose an indicator for something the department already does well.
“Put that out there for staff,” says Chase. “It’s eye-opening for them to see that ‘we were good, we are getting better, but this is what we have to do to be the best.’” She suggests starting with point-of-service collections. “It’s easy to track, and staff love to see how they compare to other departments within patient access,” says Chase. “Create a healthy competiveness amongst staff.”
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Find out what other data already is being collected that might be useful to patient access.
“What we are finding is, if you reach out to some of the finance people, they already have a lot of these numbers,” says Chase. “Plug the numbers in, post them, and tell your story.”
For example, claims denials and return mail ratio often is tracked by billing and accounts receivable. “Often, the clean claim rate can be directly associated with the registration accuracy rate,” says Chase.
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Use the KPIs to justify the need for additional FTEs.
“You have to measure productivity across the board, holding staff accountable,” says Chase. “Unless you have good data, it’s really difficult to do.”
The ability to measure staff productivity allows Chase to permit some registrars to work from home. Some experienced registrars relocated, but they still are employed by the department. “Data is the only way I can know that a teleworker is productive,” she says.
Some patient access departments go short-staffed because they’re unable to show the need for additional FTEs. This short staffing results in claims denials and dissatisfied patients. “If the MRI staff is there waiting and they have to tell the patient there is no authorization, and you’ve had it in the queue for a week, they look at us, patient access staff, as the obstacle,” says Chase.
Some departments need more FTEs to keep up with payer requirements. The KPIs allow patient access to show hospital administrators that an additional FTE would decrease claims denials.
“You can show senior leaders ‘We’re just ‘good’ right now, and we need these resources to get to ‘better,’” says Chase. “You can show what you need, whether that’s electronic tools, more bodies, or more training.”
Access departments vary
Because the tasks performed by patient access departments vary widely depending on the organization, it’s difficult for KPIs to accurately compare one to another. Some of AccessKeys’ KPIs tie into NAHAM’s Registration/FTE Calculator, which addresses the disparity in areas of responsibility by different patient access departments.
Pete Kraus, CHAM, CPAR, FHAM, business analyst for revenue cycle management at Emory University Hospital in Atlanta, says, “They will become more refined as users adopt them and share their results with NAHAM and its members. Unlike the HFMA MAP (Measure, Apply, Perform) Keys, which tend to track easily measurable data points, AccessKey measurements are more subtle and nuanced due to the nature of the business.”
Good/better/best ratings make NAHAM’s AccessKeys valid and comparable in the context of the wide variety of tasks patient access staff might be expected to perform.
“The ratings are often based on the level of technology and responsibility an access department has,” says Kraus.
If a patient access department is not responsible for pre-certification, for example, it might have to settle for a lower rating in terms of overall error-free accounts. “The goal is to make AccessKeys both measureable and meaningful for all access departments, irrespective of level of sophistication,” says Kraus. “This isn’t easy.”
