Technology dollars finally flowing to patient access: Make your voice heard
It's 'the last frontier' for investment
For many years, patient access was "the red-headed stepchild of the revenue cycle, straddling the fence between patient care and financials," says James Hicks, CHAA, CHAM, CAM, patient access manager at Southeastern Regional Medical Center in Lumberton, NC.
As a rule, patient access was overlooked in terms of its importance to the overall health of the hospital, but this is changing fast. "Within the last few years, there has been a sudden realization of just how important patient access is," says Hicks. "This change has brought about an explosion in technology catering to patient access."
And in some cases, this technology is among the most advanced available. For example, palm vein recognition scanners the newest biometric identification technology on the market are now being used by hospitals to identify patients prior to service. "With an accuracy of 99.9% it is better than fingerprint scanning, which can be affected by dehydration or skin conditions," says Hicks.
In other cases, though, older technology is only now being introduced to the patient access world. For instance, patients probably have several plastic cards in their purse or wallet with some type of bar code or magnetic stripe that can be read by scanners, but their insurance cards are likely to be a flimsy piece of paper or a plastic card with nothing machine readable.
But machine-readable insurance cards are on the horizon. In November 2007, the Workgroup for Electronic Data Interchange issued a Health Identification Implementation Guide to standardize the cards. Hicks guesses it will take "two or three years to roll them out." (Go to www.wedi.org and click on "Health ID Card Implementation Guide" on the left-side navigation bar.)
"Registrars who are not technologically savvy or who don't adapt to change will struggle to keep up in the new world of patient access," Hicks warns.
Patient access managers are in for big changes and expanded roles as a result a far cry from the days of being known as "admissions" or "registration."
"Those were the two primary services we provided," says Jessica Murphy, CPAM, corporate director for patient access services at Methodist Le Bonheur Healthcare in Memphis, TN. "Other than our access to whatever ADT/registration system was used by our facility, we required little technological support."
However, all that has changed dramatically within the past few years. "We have broadened our scope of responsibility significantly and are now well known in the industry as patient access services," says Murphy.
Patient access is now commonly referred to as "the last frontier" for most organizations when considering the revenue cycle, according to Julie Johnson, CHAM, director of health information management/HIPAA privacy officer at Mt. Graham Regional Medical Center in Safford, AZ. Johnson is the current president of the National Association of Healthcare Access Management (NAHAM). "Many of the technologies that have been available to providers have focused on the back end."
However, as providers expand their reach to improve patient satisfaction, processes on the front end now are being targeted. "Patient access impacts the entire organization. It has become an area of focus for new technologies," says Johnson.
Mt. Graham is now considering many other technologies, with the goal of capturing reimbursement dollars and at the same time, improving the patient experience. These include digital signature pads, electronic forms, patient charge estimates, eligibility verification, and a fully automated quality assurance program.
"In this age of consumerism, transparency, and pay for performance, hospitals can derive many benefits from moving to a technology-driven strategy to improve customer service and reimbursement," says Johnson. These include cleaner claims, continued financial viability, using staff time more effectively, and increased job satisfaction.
However, Johnson says that coming from a small rural facility, she's found that the dollars needed to purchase technologies to improve processes and the patient experience are sometimes not available.
"Patient access managers need to be sure their voices are heard with administration to ensure technology strategies are used effectively on the front end," says Johnson. "Be an active participant in new technology."
New tools mean new roles
Technology promises less re-work, but on the other hand, expect to see new roles in your department. At Southeastern Regional, access managers started capturing patient photos in March 2008, with plans to print them on patient identification bands after an upgrade to another system is completed in 2009. Staff were trained to operate the cameras, crop the photos, and save the images. Registrars use scripting to explain why the photos are taken and to respond if the patient refuses.
It was anticipated that some patients would not want their photo taken for religious or other personal reasons, but this hasn't been much of a problem. "So far, when we've explained to the patient that we want to prevent identity theft, they have been very willing to have their photo taken," says Hicks. "We expected more resistance in the ED, but even in that environment, patients have been willing."
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Machine-readable cards on horizon The largest health plans appear to be in the process of adopting guidelines from the Workgroup for Electronic Data Interchange (WEDI) for machine-readable insurance cards, according to Peter Barry, of Peter T. Barry Co., a Milwaukee-based consulting firm specializing in health care and information systems. Barry is chair of WEDI's initiative on health identification cards. Barry expects some 50 million standard insurance cards based on the WEDI guide to be available within the next 18 to 24 months. Several states including Texas, Colorado, and Utah are currently considering mandating standard health insurance cards. Each of these states is considering basing its mandate on the WEDI guide, which requires only essential information. "It leaves all other information that may be put on the card to the discretion of the card issuer, trusting that the card issuer desires the most effective card and is in the best position to decide these things," Barry says. "Some states feel they should mandate certain information elements that the WEDI guide leaves discretionary." While a card must be functional in both an automated and manual setting, the goal is toward increased automated usage. "Implementation of automated use in provider systems will probably take some years," adds Barry. The most important new development for health insurance cards is the introduction of a standard health plan identifier, which is 10 digits and begins with "9." Why is a standard health plan identifier critical? Consider the example of a bank charge card, says Barry, which has a long number on the front that we think of as the charge card number, but it is really two numbers the first six digits identify the bank and the remaining digits are the account at that bank. "Consider what charge card use would be if the first six digits were not there, if a person had to interpret text on the card, then convert that into a code selection on a computer to tell the computer what bank to send the transaction to," says Barry. "Inefficiency and errors that's where the health industry is. That's why providers photocopy the front and back of a card." With a standard health plan identifier, the card is able to convey complete and accurate identifying information using only two numbers: the health plan ID and subscriber ID. "Some payers still also require a group number," Barry says. "The largest ones are looking into means to remove that requirement so as to reduce errors and make it simpler for a provider to get the essential information over a telephone from a patient." For more information, contact:
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The hospital has less risk of exposure to fraud from patients using false IDs while at the same time patients are protected from identity theft. Patient safety also is a concern. If someone steals a patient's ID for medical care and the care he or she receives is inserted into the record, it could change the way the patient is treated when he or she comes to the hospital, which could lead to an adverse outcome. For example, if an individual using a patient's ID reports an allergy to a certain medication, an alternate medication might be given needlessly.
Hicks is now looking at a solution that again would expand the roles of his patient access staff. "I have a vendor demo lined up for a product that will print a list of all medications taken by the patient in the last year, with the intent that the registrar will have the patient verify this information," says Hicks. "This may require some basic training on pharmacy and medical terminology."
Work with vendors for ideal solutions
Find customized options
If the solution you need to improve patient access isn't commercially available, don't stop there. Instead, contact vendors and ask them to give you what you need.
When patient access managers at Mt. Graham Regional Medical Center in Safford, AZ, needed an automated function for quality assurance to ensure accurate information, they were unable to find a solution that fit their exact needs. So they contacted their health information systems vendor, CPSI (Computer Programs and Systems Incorporated in Mobile, AL), and told them about the problem.
"The programs being marketed at the time would not interface with CPSI. And the pricing was not in our ballpark," says Julie Johnson, CHAM, director of health information management/HIPAA privacy officer. "Since we were unable to address the problem with an outside vendor, we pressed CPSI for programming that would help through a new module. They heard our plea and implemented an upgrade that does exactly what we needed."
There are now many solutions on the market that are more cost-effective, but this wasn't the case at the time, says Johnson. "Many vendors have pricing for smaller facilities, but many times the pricing is still beyond our means," she adds.
The solution allows every registration to be processed through edits for immediate correction at the time of registration. The module also provides a report by registrar, to provide accountability for registration accuracy.
"Our accuracy rate has improved by 4% per registrar on average," Johnson reports. "The numbers are constantly changing, but we have seen an improvement in reimbursement and returned mail through this module."
Registration accuracy also is tied to the employee's job description and career ladders so better accuracy is tied to bigger paychecks. Here are three suggestions from Johnson to find specific solutions for your department:
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Meet with vendors at conferences.
Johnson recommends attending the National Association of Healthcare Access Management's access solutions marketplace at its annual conference and participating in industry-sponsored learning labs.
"This provides an opportunity to link patient access managers with vendors who work one on one to provide needed solutions," says Johnson. "This is a time when vendors truly listen to their customers and potential customers, to provide needed services for patient access."
When meeting with vendors, bring a "wish list" or "if only" list such as "if only the system would give us this information." Ask the vendors what's new and what they are working on, and ask who is beta-testing their new solutions. "When you get that information, call the facility and see what they like about the product and what more would they like it to do," says Johnson.
- Provide information for your administrative team through spreadsheets and informational conversations.
For example, you can spread the word about new technology that provides patients with a written estimate of charges. "Consumer-driven health care drives the need to provide pricing for patients who wish to shop for the best pricing," explains Johnson.
Another area you can bring to the attention of others is quality assurance on the front end. "Many vendors now have excellent automated QA products," she says.
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Ask to be part of information services steering committees and your own admissions/discharge/transfer program team.
Patient access is the most important piece of the revenue cycle, and this should be communicated "frequently and loudly" to each of your facilities, stresses Johnson.
"If we become more proactive in committees and have an increased presence in technology-related committees, our chosen profession provides more satisfaction for patient access managers and the patient experience."
When the committees meet, simply having a voice can bring the focus around to patient access. Remind others that it all starts at the beginning, so patient access should be a priority when it comes to dollars being spent. "It took a few years and perseverance, but we have been able to make our case and continue to have a seat on all the technology-related committees," says Johnson.
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