EXECUTIVE SUMMARY
Patient access representation on hospital committees can avoid problems during system conversions or process changes throughout the organization. Some examples:
- Patient access can get feedback from finance on which metrics to monitor.
- Patient access can help the organization comply with new legislation and regulations.
- Patient access can train employees in standardized patient identification processes.
A few years ago, Stamford (CT) Hospital’s IT department and physician leaders carefully planned a new process to scan consent forms automatically into the hospital’s electronic medical record (EMR). They made the mistake of not asking patient access for input.
“What they didn’t realize was that we were still doing the consents, even though they were being scanned into the system,” Patient Access Director John Hegarty recalls.
Also, patient access terminals weren’t connected to the printers, so documents were not arriving at the appropriate destinations. “By not including us, everything got put on hold while we figured out the workflow,” Hegarty says. “It got worked out pretty quickly, but it was ugly.”
The needless glitches made a strong impression. “Now, anytime this committee wants to make a change, they first ask, ‘What’s it going to do to the front end?’” Hegarty says, noting that a specific IT employee partnered with patient access to keep the department apprised of planned changes. “If anything comes up in the IT world, we have someone who will give us a heads up.”
Even seemingly minor changes can wreak havoc on productivity if the facility overlooks patient access, Hegarty warns. If a mistake is made in other departments, it typically affects just that visit, he says. “But mistakes made by patient access send ripples throughout the entire organization, regardless of the department the patient is having their service in,” Hegarty says. “That is why patient access is the most important department, in my view.” Here are some hospital committees in which patient access can participate:
- Finance. Monthly meetings with the hospital’s finance committee allow Hegarty to drive home an important point: Registration quality matters.
“We look at other pieces of the revenue cycle to see what we can do better on the front end to decrease the work that needs be done on the back end,” he says.
Recently, patient access invested in price estimation software. Registrars now offer self-pay discounts and set up patients on payment plans. “I have very clear expectations from the CFO, who holds patient access in very high regard, as to what we need to be monitoring,” Hegarty adds.
- Regulations. At Stamford Hospital, this committee recently focused on two big changes that directly affect patient access: the state’s “surprise medical bill” legislation and federal 501(r) regulations on financial counseling. “Patient access is very important from a compliance standpoint,” Hegarty emphasizes.
- Privacy. Protecting patients’ privacy “all starts with us in patient access — how we obtain information, talk to patients, and stay in compliance,” Hegarty says.
- Patient satisfaction. Hegarty is involved in multiple patient satisfaction committees throughout the hospital. “You name the department that has a steering committee for patient satisfaction — surgery, dietary, the Breast Center — and I’m on it,” he says.
Arguably, patient access plays perhaps the most important role in the entire hospital, in terms of overall patient satisfaction. “The experience starts with us,” Hegarty says. “If the patient has a negative experience walking in the door, it’s hard to get them back.”
The goal for registrars is to either give patients a “wow” experience, or have patients not recall the registrar at all. “It’s great if they don’t even remember what they did with you,” Hegarty says. “That means the experience on the front end was as smooth as possible.”
- System conversions. Maria Lopes-Tyburczy, director of patient access at Hackensack UMC Palisades, North Bergen, NJ, says, “Patient access will be using the system. The more they are involved in the conversion, the more efficient and successful the ‘go-live’ date.”
Patient access staff know what fields are neccessary to capture required information, such as race and ethnicity, birth place, and preferred language. “There are multiple fields that need to be tested thoroughly to ensure accuracy,” Lopes-Tyburczy stresses.
Stamford Hospital is planning a system conversion, and while it’s early in the process, it’s not too early for patient access to have a say. “As we look to move to a different system down the road, patient access is involved in vendor presentations and demos right from the beginning,” Hegarty explains.
- Patient safety. “Anytime there is a patient safety issue, they bring in patient access,” Hegarty notes. Sometimes, an adverse event can be traced back to a front-end process. For example, if a patient was misidentified, patient access can identify if there were any gaps in the process. This is less likely to occur if the hospital standardized patient identification processes.
“Previously, there was not one clean, consistent way to identify a patient within the system,” Hegarty recalls. “Departments were doing things their own way.” Recently, patient access worked with the hospital’s health information management department to train 400 employees on how to correctly identify patients. “We are considered the system experts,” Hegarty adds.
If patient access doesn’t identify the patient correctly in the system, says Lopes-Tyburczy, a lot of negative outcomes can come from this. On the patient safety committee, patient access alerted other departments to some of the challenges associated with properly identifying patients. “Patients may come in unresponsive, give a fake name, or give misspelled names or nicknames,” Lopes-Tyburczy says.
- Patient throughput. At times, decisions are made on how ancillary departments should operate without involving patient access. “Patient access needs to be involved in these decisions, so that the ancillary departments can operate efficiently,” Lopes-Tyburczy says.
Patient access must be included when metrics are set for door-to-discharge, or door-to-inpatient status, for instance. “We need to ensure all demographic and insurance information is obtained timely, so the continuum of care is not disrupted,” Lopes-Tyburczy adds.
SOURCES
- John Hegarty, Director, Patient Access, Stamford (CT) Hospital. Email: [email protected].
- Maria Lopes-Tyburczy, Director, Patient Access, Hackensack UMC Palisades, North Bergen, NJ. Phone: (201) 295-4028. Email:
[email protected].
Patient Access Feedback Prevented Problems
At Saint Francis Hospital – Bartlett (TN), patient access leaders and high-performing employees participate on multiple committees. These include regulatory compliance, the privacy incident response team, hospital throughput, outpatient growth, revenue cycle, Cerner process improvement, quality, and employee engagement.
Patient Access Director Angela D. Jordan, CHAA, CRCR, estimates that patient access affects 75% of processes throughout the facility. “We use these committees to expose and mentor staff on how our processes affect the big picture,” she says. Here are two problems that were avoided, due to feedback offered by patient access:
- During a recent meeting of the hospital transfer committee, no one mentioned anything about how the patient’s insurance would be verified. Without verifying insurance, there would be no way to ensure the hospital was in network. When Jordan brought it up, a committee member replied, “We never thought about that.”
“We immediately resolved the process by incorporating validation to ensure reimbursement,” Jordan recalls. The department also implemented a system to notify users of errors in real-time.
“This system combines multiple systems already used by patient access to accomplish a one-stop view of potential registration errors,” Jordan explains. “This supports clean billing and faster reimbursement.”
- Recently, patient access was asked to expand its hours to accommodate the physicians’ end-of-the-day patients and direct admits. Otherwise, the patient would have to register in the ED for services, which could mean a longer wait.
“Patient access supports initiatives to better serve patients,” Jordan says. “We reviewed current schedules and cross-trained employees.”
First, patient access reviewed the volume during the requested hours. It also reviewed volume at patient access entry points during peak times.
“We accommodated the request by reallocating resources,” Jordan explains, noting patient access employees were cross-trained to register patients at all entry points. “The cross-training included entering in the correct clinic codes, touring the area, and the authorization process.”
SOURCE
- Angela D Jordan, CHAA, CRCR, Director, Patient Access, Saint Francis Hospital – Bartlett (TN). Phone: (901) 820-7755. Email: [email protected].
Department should not be without a voice in critical decision-making.
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