Is your emergency department (ED) waiting room filled with patients who could be better served at a primary care physician’s office? In May 2015, registrars at Inova Fairfax Hospital in Falls Church, VA, took on a new role of connecting some ED patients with primary care physicians.
“Our scheduling program is innovative and one of a kind,” says Rupande Malhotra, CHAM, director of patient registration. “It was a huge undertaking.”
Patient access leaders wanted to do their part to meet an organizationwide goal to reduce readmissions. “We noticed patients were coming in using the ED as their primary care,” says Malhotra. While all discharge instructions provide recommendations about following up with a primary care physician, about one-third of patients don’t have one.
Patient access leadership met with Inova Medical Group leaders to implement direct scheduling for some patients at the point of discharge from the ED. “We actually make the appointment for them,” says Malhotra. Registrars tell patients that in the future, they can go directly to that primary care physician for non-acute needs, instead of the ED.
“We want to ensure that our patients are following up with a primary care physician who can review their overall wellness,” says Malhotra. “This can reduce non-acute utilization of the ED.”
Previously, ED clinicians often recommended that patients schedule an appointment with a primary care physician, but there was no way to tell if the patient followed through. “The patient may or may not do it themselves. By direct scheduling, it’s a great service we are providing our patients,” says Malhotra. “The impact is the reduction of emergency department utilization for non-urgent needs.”
BETTER FLOW EXPECTED
Currently, ED registrars can schedule patients only if they don’t already have a primary care physician and if the Inova Medical Group providers are in-network for their insurance.
“About 16 patients a day fall into this criteria,” says Malhotra. Many are recently employed college graduates who have coverage for the first time.
“While it isn’t a large population, it was a good starting point,” says Malhotra. “Once we do take on other insurances, we can really start to hit the ground running.” Malhotra expects to see increased patient satisfaction, improved patient flow in the ED, and decreased readmission rates.
After registration is completed, ED registrars take these steps:
• They provide patients with a referral sheet of primary care physicians and ask them, “Would you like to choose a primary care physician for your future healthcare needs?”
If the patient doesn’t know anyone on the list, registrars provide biographies of physicians based on the patient’s preferred location. “We are able to show the patients the physician’s credentials, languages spoken, and education,” says Malhotra.
• They offer to make an appointment for the patient. About 10% will schedule the appointment before they leave the ED.
“The Inova Medical Group schedulers have noticed an increase in calls into their call centers to make an appointment,” reports Malhotra, adding that this increase could be because of the education and referral patients received from registrars. “We are working on quantifying the percentages of those patients who do call back to schedule their appointment,” says Malhotra.
MIXED REACTIONS
Patients didn’t always react positively to the offer of having an appointment scheduled for them in the ED.
“Many of them asked us, ‘Is this part of a cutback?’” says Malhotra. Others wanted to know if registrars were getting some type of incentive to make the appointments.
To address this issue, patient access trainers held skill labs to educate staff. “We talked about some objections patients may give and how to address them,” says Malhotra. Scripting was changed to explain to patients that registrars were trying to provide them with better access to healthcare. [The scripting used by the department is included with the online issue. For assistance accessing your online subscription, contact customer service at [email protected] or (800) 688-2421.]
Unexpected lower out-of-pocket costs are a strong incentive for some patients. Tammy King, CHAM, senior manager of ED patient registration, says, “We explain to them that they would have a much lower copay at the primary care physician’s office than the ED.”
STAFF BUY-IN OBTAINED
At first, registrars were reluctant to take on the new role.
“Registrars were saying, ‘it’s not part of our job description,’” says King.
Staff members learned that since direct scheduling is done using Epic’s Cadence application, they didn’t have to switch back and forth to a different system. “When they realized it was pretty much just clicking a button, because there was already an account created in Epic for the ED visit, they were more receptive,” says King.
Malhotra says, “Staff didn’t understand the big picture of why we were doing this.” Trainers explained that the registrars’ role included getting patients better access to care and helping the growth of the organization.
King says, “We told them how positive a return on investment could occur with this. You are looking at only one or two patients per shift.”
Hospital leaders are planning to expand the program to all of Inova’s 11 EDs. Malhotra says, “With the assumption of 12% eligibility and a 75% discharge rate, there is a potential to enroll 84 new patients daily. The annual revenue that our Inova Medical Group could yield would be greater than $6.8 million.”
Managers give the registrar who enrolls the most patients a certificate incorporating the Inova Medical Group’s acronym, titled, “Amaz-ING Scheduler of the Week.” [The certificate is included with the online issue.]
“The number of appointments scheduled by each registrar is posted in their work area, which is visible to all to see,” says Malhotra.
SOURCES
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Tammy King, CHAM, Senior Manager, Emergency Department Patient Registration, Inova Fairfax Hospital, Falls Church, VA. Email: [email protected].
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Rupande Malhotra, CHAM, Director, Patient Registration, Inova Fairfax Hospital Medical Campus/Inova Emergency Care Center of Fairfax and Reston, Falls Church, VA. Email: [email protected].
