Providers satisfied with call center
Offices make their own rules for scheduling
Before a Patient Contact Center was implemented at Pittsburgh-based UPMC, providers accustomed to handling their own scheduling were skeptical, reports Karen Shaffer-Platt, vice president of patient concierge services/access in UPMC’s Corporate Revenue Cycle department.
"Nobody felt like felt like a centralized call center could know enough about the details and clinical pathways of the specialties to act on their behalf," says Shaffer-Platt. "That was the biggest cultural obstacle we had."
In response, leaders built decision support into the hospital’s EPIC system. This decision support allows call center agents to schedule based on the exact same rules as the practice. "If a patient calls and says, `I want to see a doctor for my hip,’ by inputting hip’ as the chief complaint, it leads us to all of the appropriate doctors or a series of questions to garner the information to lead to the right appointment," says Shaffer-Platt. Patients are asked if they prefer a specific physician or if they would like the nearest physician or the first available appointment.
"That response leads you to the next three appointments that you can offer to the patient," says Shaffer-Platt. "The individual scheduler does not have to have expertise or recall for every scheduling scenario."
Agents follow questionnaires
The decision support questions that lead to an appointment are based on the provider offices’ scheduling preferences.
Diane Zilko, senior director of the Patient Contact Center, says, "It kind of takes the call center agent out of the decision-making equation. They just follow the questionnaire."
Practices can choose to have all calls handled by the center or only those calls that aren’t answered in the first six rings.
Shaffer-Platt says, "If patient calls a cardiology practice in the community, and staff are distracted or busy, it goes to the center. When it gets to our agent, information about the office takes over our screen."
Staff members can view directions, parking instructions, and local restaurants, which allows them to tell patients the same things anyone in the provider’s office would.
Initially, many providers wanted to maintain control over their scheduling. "There was always that attitude of, Oh, but you don’t know where I can squeeze people in,’" says Shaffer-Platt. "We started with the approach of let us take the low-hanging fruit.’"
Call center handled the simple calls
Using this approach, the call center handled all simple calls and allowed the practice to handle more complicated calls.
"Then we followed what the real patterns were. We could then say, Let’s be truthful. You do four add-ons that you build into your template every day,’" says Shaffer-Platt.
Providers realized that the call center was able to schedule just as well as their office staff. Here are some things that satisfy providers:
• The center also handles discharge planning to ensure that recommended care is obtained.
Zilko says, "We get a set of discharge orders and call the patient on behalf of the doctor’s office to be sure tests are scheduled."
Outstanding orders also appear on the screen. Shaffer-Platt says, "We use it to push what I call our access agenda. If the goal is to get them back in, why not have access be the ones to follow up with the patient?"
Staff members can say, for example, "Hey, while I have you on the phone, I’m looking at Dr. Smith’s order for a mammography. Would you like me to go ahead and schedule that?"
• When staff get a cancellation, they can go to the wait list to contact patients who are waiting for appointments to open up.
"This keeps the doctors’ schedules full," says Shaffer-Platt.
• Patients can make appointments after hours, which possibly prevents hospital admissions.
In some cases, emergency room (ER) physicians are able to comfortably discharge a patient home because they know a follow-up appointment is already in place.
"What a service we offered, if we can say to the patient at 2 a.m. in the ER, I can get you an orthopedist appointment or get you in for an MRI at noon tomorrow,’" says Shaffer-Platt. specific measures of financial, administrative, and transactional performance. These measures provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers. Rankings are derived from athenahealth’s athenaNet database, which includes more than 52,000 providers. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013.
The 2014 report reveals these trends:
• Medicaid’s lackluster performance continues.
For the 9th straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as days in accounts receivable (DAR), denial rates, and electronic remittance advice (ERA) transparency. While some Medicaids, such as Medicaid Connecticut, performed especially well on select metrics, such as enrollment, as a whole the category continues to underperform.
Even though it is too early to determine the impact of the Medicaid expansion on payer performance, with an expected 85 million enrollees by 20211, all providers who serve Medicaid populations should be aware of their state’s expansion status and performance metrics. Understanding strengths and weaknesses related to Medicaid enrollment efficiency and denial rate can help providers prepare for increased Medicaid patient volume and potential associated administrative burden, as well as mitigate risk to their business.
• Providers’ burden to collect on claims varies widely.
Provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly, data indicates. Historically, findings reveal that providers in the West are experiencing higher collection burden than those in other parts of the country. Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection.
Providers who shift their payer mix to include Medicare and Blue Cross Blue Shield plans might see their collection burden increase. Those providers also might be increasingly asked to explain the meaning of items such as co-insurance, deductibles, and co-pays to patients.
• Blue Cross Blue Shield plans pay providers the fastest.
As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer days in accounts receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers, and they displace major commercial payers’ historical position as the leading category.
As major participants on the health insurance exchanges, Blue Cross Blue Shield plans’ performance signals a positive indicator that providers who serve patients covered by these plans can cater to increased patient volume without cash flow disruption.
• Commercial payers offer the most efficient enrollments.
While Medicaid enrollment proves particularly burdensome, national commercial payers’ enrollment proves simplest. According to PayerView data, no commercial payers require enrollment for electronic data interchange or for enrollment documents to be sent via mail. As providers contemplate potential changes to the mix of payers with which they work, enrollment requirements and associated efficiencies should be considered.
Findings show that the industry has not adopted transaction-based enrollment, despite the existence of the ANSI X12 274 transaction. This transaction most likely would be the most efficient method for payers and providers.
To see the full 2014 PayerView Report, go to www.athenahealth.com/PayerView. An infographic accompanying this release is available at http://bit.ly/1rCXkFd.
Humana ranks no. 1 in being easy to work with
For the second year in a row, Humana ranked first in overall performance amongst 148 payers, according to the 2014 PayerView Report, an annual report from athenahealth in Watertown, MA. Athenahealth is a provider of cloud-based services for electronic health record (EHR), practice management, and care coordination.
The 2014 PayerView results rank commercial and government health insurers according to specific measures of financial, administrative, and transactional performance. These measures provide an objective, comparative benchmark for assessing how easy or difficult it is for providers to work with payers. Rankings are derived from athenahealth’s athenaNet database, which includes more than 52,000 providers. The 2014 PayerView data set analyzes 108 million charge lines and $20 billion in health care services billed in 2013.
The 2014 report reveals these trends:
• Medicaid’s lackluster performance continues.
For the 9th straight year, Medicaid performed worse than commercial plans and Medicare on key metrics such as days in accounts receivable (DAR), denial rates, and electronic remittance advice (ERA) transparency. While some Medicaids, such as Medicaid Connecticut, performed especially well on select metrics, such as enrollment, as a whole the category continues to underperform.
Even though it is too early to determine the impact of the Medicaid expansion on payer performance, with an expected 85 million enrollees by 20211, all providers who serve Medicaid populations should be aware of their state’s expansion status and performance metrics. Understanding strengths and weaknesses related to Medicaid enrollment efficiency and denial rate can help providers prepare for increased Medicaid patient volume and potential associated administrative burden, as well as mitigate risk to their business.
• Providers’ burden to collect on claims varies widely.
Provider collection burden (PCB), measured as the percent of charges transferred from the primary insurer to the next responsible party after the time of service, is increasing slightly, data indicates. Historically, findings reveal that providers in the West are experiencing higher collection burden than those in other parts of the country. Medicare and many Blue Cross Blue Shield plans require providers to collect large percentages of payments from patients, while Medicaids require minimal collection.
Providers who shift their payer mix to include Medicare and Blue Cross Blue Shield plans might see their collection burden increase. Those providers also might be increasingly asked to explain the meaning of items such as co-insurance, deductibles, and co-pays to patients.
• Blue Cross Blue Shield plans pay providers the fastest.
As a category, Blue Cross Blue Shield plans reimburse providers most quickly, with an average of three fewer days in accounts receivable compared to all other payers. On this measure, Blue Cross Blue Shield plans represent 20 of the top 25 performers, and they displace major commercial payers’ historical position as the leading category.
As major participants on the health insurance exchanges, Blue Cross Blue Shield plans’ performance signals a positive indicator that providers who serve patients covered by these plans can cater to increased patient volume without cash flow disruption.
• Commercial payers offer the most efficient enrollments.
While Medicaid enrollment proves particularly burdensome, national commercial payers’ enrollment proves simplest. According to PayerView data, no commercial payers require enrollment for electronic data interchange or for enrollment documents to be sent via mail. As providers contemplate potential changes to the mix of payers with which they work, enrollment requirements and associated efficiencies should be considered.
Findings show that the industry has not adopted transaction-based enrollment, despite the existence of the ANSI X12 274 transaction. This transaction most likely would be the most efficient method for payers and providers.
To see the full 2014 PayerView Report, go to www.athenahealth.com/PayerView. An infographic accompanying this release is available at http://bit.ly/1rCXkFd.
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