EXECUTIVE SUMMARY
Patient access leadership is sometimes omitted from planning discussions involving staffing, technology, and new service lines. The following steps can help prevent problems with patient satisfaction.
- Attend meetings, even if patient access is not initially included.
- Give input on how planned changes will affect the front-end revenue cycle.
- Ask higher-ups to advocate for inclusion of patient access.
Recently, administrators at Kern Medical in Bakersfield, CA, decided to expand outpatient clinic hours of operation to accommodate evening and Saturday appointments. A target start date was announced.
However, the administrators forgot one important thing — telling patient access about the plan.
“Patient access was challenged to hire the additional human resources to accommodate the expanded services, without adequate lead time,” reports patient access director Edward Din, CHAM.
This created a delay in getting the necessary six new employees hired, trained, and scheduled. “As a result, the overtime expense was high during the transition until the new staffing could be implemented,” says Din.
More than 400 hours of overtime were needed. “New hires received two weeks of training before being assigned to their unit for specific orientation,” says Din.
Had patient access been involved from the get-go, staffing would have been in place before the start date — without incurring overtime costs.
“This would have made the patient experience better and the patient access service delivery seamless,” says Din.
Hospital’s ‘Front Door’
Many hospital leaders fail to see the link between the patient experience and registration areas. “It starts at your front door,” says Din. “Patient access, historically, is that front door of your organization.”
To improve the patient experience and service delivery, says Din, “including the patient access perspective is absolutely essential.” He recommends patient access leaders use the following approaches.
- Attend meetings about new services, even if patient access is not included initially.
Patient access leaders are not always invited to important meetings that affect their day-to-day operations. “This is often due to the arbitrary exclusion of patient access leaders in the planning process,” says Din.
Ideally, a project management template could be used whenever a new product or service line is being planned. The template would address the potential impact on all departments, including patient access, says Din.
If patient access is kept out of the loop, information is learned secondhand. This is less than ideal, since patient access has no opportunity for back-and-forth discussion with decision makers. Once problems occur, patient access then has to step in and do damage control.
“I have had to self-invite myself to attend meetings after-the-fact to offer support and suggestions regarding a new service line, once a system failure has occurred,” notes Din.
- Give input regarding how new or expanded services are going to affect the front-end revenue cycle.
Are service providers going to be obtaining referrals and authorizations, determining eligibility and benefits, calculating patient copays, or obtaining e-signatures? If so, they’ll need to access front-end revenue cycle applications. “Patient access leaders can provide invaluable insight and direction,” says Din.
- Involve hospital higher-ups.
Asking frequently about planned changes helps to build relationships with hospital leaders. “Demonstrate your ability to collaborate. Be flexible and resourceful,” says Din.
Once patient access has the support of key hospital leaders, such as the CFO or vice presidents, these individuals can become valuable allies. “Use the chain of command to escalate matters if necessary,” says Din.
- Involve registration staff in operational change planning.
“How better to ensure improved employee engagement than making sure registration staff have a voice and feel valued?” asks Din.
Constant communication is needed to alert staff about coming changes that will affect their day-to-day jobs. “Be prepared to answer questions. Offer coaching through the changes,” says Din.
Patient Access Needs Identified
At Stanford (CA) Children’s Health, an experienced patient access employee gets involved if a new site is being opened, a new program is rolled out, or new management is being onboarded.
“We assign one of our patient access leaders to lead the project, specific to the access needs,” says Andrew Ray, director of professional revenue cycle at Stanford Children’s Health.
This gives the employee a great deal of leadership experience. “It does so in a manageable way, in terms of defined scope and timing of the project,” adds Ray. Since the project is of limited duration, it can be balanced with the employee’s other responsibilities.
The hospital also created a registration leadership committee for admitting and ambulatory sites. Both hospital-based clinics and community-based practices are represented. “They review and approve any major process or system changes that impact patient access,” says Ray.
The group reviews and approves any registration-related workflow changes and sets organizationwide registration policies. “The committee also acts as the governing body that addresses registration-related issues that are negatively affecting patient satisfaction or finances,” says Ray. Below are some recent issues the committee addressed.
- Gather additional necessary data from patients.
“This is often driven by insurance, government, or hospital policy changes,” says Ray.
- Develop new processes to verify insurance eligibility or obtain authorizations.
“We are attempting to do this as efficiently as possible through submissions from our source system, rather than requiring staff to call or go onto insurance company portals,” Ray explains.
- Identify ways to improve upfront collections initiatives.
“Our front desk areas are tasked with point-of-service collections, attempting to collect prior balances, and helping patients understand the cost estimates for their care,” says Ray.
- Create strategies to ensure accurate registration and timely authorizations.
These two items are crucial to the success of revenue cycle processes. “When not performed correctly, it can lead to significant lost revenue,” says Ray.
- Develop ways to avoid financial surprises for patients.
“We are evaluating more efficient ways to provide accurate, useful cost estimates prior to, or at the time of, service,” says Ray. Patient access currently does this only if requested, by performing manual calculations. “We would like to be able to do this more proactively, and across a broader patient population,” says Ray.
- Edward Din, CHAM, Director of Patient Access, Kern Medical, Bakersfield, CA. Phone: (661) 862-4901. Email: [email protected].
- Andrew Ray, Director of Professional Revenue Cycle, Stanford (CA) Children’s Health. Phone: (650) 723-9810. Email: [email protected].
