Access role crucial in hospital-practice alliances
QI, training skills needed for enterprise computing
As more hospitals align themselves with medical group practices in the growing trend toward integrated delivery systems (IDS), a strong access management role may be the make-or-break piece of the evolving puzzle.
As health care has evolved into a consumer- centered industry, customer service has become critical to survival, says Robert Bohlmann, FACMPE, senior consultant for the Medical Group Management Association Consulting Service in Denver. And today’s consumer is not only the patient, but the employer, the union, the government and the health plan. The key to providing the excellent service that today’s competitive health care marketplace and savvier consumer demands lies with the access management function, suggest Bohlmann and other industry observers.
But growing pains often are apparent when hospitals and group practices unite to form a creature that’s neither fish nor fowl. "Some of the organizations ink the document [joining hospital and group practice], and nothing changes," Bohlmann says. "Other times, they integrate, try to put the hospital methodology [into the group practice], and it doesn’t work."
"The problem is that hospitals don’t know how to run clinics," says Eileen M. Kanewske. Now director of business services for PhyCorp of Ruston/Green Clinic LLC in Ruston, LA, Kanewske has been a hospital access manager and has overseen the business services at a clinic associated with a hospital. "In a clinic, there’s a birth-to-death relationship [with the patient]. At a hospital, it’s a single visit. The collection effort is different [at a clinic] because of the personal, one-on-one relationship."
But when a hospital and a clinic join forces, there is valuable expertise to be gleaned from the hospital, says John Woerly, RRA, MSA, CHAM, director of patient intake for St. Vincent Hospitals and Health Services in Indianapolis.
"Unless you’re talking about a huge clinic operation, no one’s ever specialized in registration at most medical group practices," Woerly points out. Instead, he says, they’ve had "managers who wore many hats marketing, patient accounting, medical records."
In fact, many group practices aren’t even familiar with the term "access management," Bohlmann says. They do understand the importance of the concept, though. "It may be the patient service director, the appointment supervisor, or the ask-a-nurse service [director]. The eed is recognized."
And awareness is growing among medical group practices that patient dissatisfaction with multiple registration points and regulation-heavy managed care plans can be alleviated with strong access leadership, Bohlmann adds.
As entities work toward an IDS, hospital access managers already have the skill set with some instruction required in Medicare Part B guidelines and physician billing practices to over-see the seamless patient registration process required, Woerly says. "Patients are asking, Why can’t my information travel with me every time I register?’ It’s important not just for marketing, but in safeguarding the level of care you provide, to be able to electronically pull up the medical record."
Because of the access manager’s ability to provide consistency, knowledge of processes and standardization, and quality improvement (QI), an enterprisewide access manager is "a new idea to many, but seems to be the trend," Woerly adds.
Medical practice/hospital mergers "are opening the door for access managers because of enterprise computing," he says. "You need someone to design the systems, safeguard the data integrity, do the QI, and do the overall training, as well as set the process standard so that any patient or customer would be handled the same way in whatever entity they’re coming into hospital, doctor’s office, or urgent care center."
Whether physicians are employees of the hospital or just associated with it, if they’re part of an IDS, "from the patient’s perspective, they’re owned by the same organization," he points out. "The patient will expect the same level of service."
Like Woerly, Kanewske says experienced access managers can play a vital role in several kinds of clinic management whether the clinic is owned by a physician practice management company, a hospital, or a health care conglomerate or is under another kind of arrangement. But she warns that the transition is not necessarily easy or automatic.
"One of the things that’s still very obvious is that clinics and hospitals are very different," she says. "It’s probably easier to move from a clinic to a hospital than vice versa. In hospitals, [registration personnel] don’t have to know as much about coding, but in a clinic environment, coding is crucial."
For that reason, she says, understanding the U.S. Department of Health and Human Resources’ Office of the Inspector General compliance issues is even more critical for clinic registration personnel than for their hospital counterparts. "In a clinic, a person who does registration may be a cross between a registrar, a receptionist, and a cashier, and could key in physician charges."
She had to expand her own knowledge base to include the professional requirements for the 35-physician clinic that comprises obstetrics and gynecology, urology, orthopedics, ophthalmology, and surgery, among others. That meant learning "what they can code and what they cannot, and what the billing requirements are," she says. "I love it, but it’s not an environment you get into and trudge through."
Her hospital access experience has been valuable, she says, particularly her expertise in centralized scheduling and centralized registration systems, and her ease in working one-on-one with physicians. Her knowledge of bed control has come in handy, as well. The physicians like knowing "that we’ve got both sides now," she says. "I know if we’re getting a straight answer or being snowballed" when making patient bed reservations.
Kanewski’s advice for access managers whose hospitals own or are associated with a clinic: "I would be involved with my counterpart on the clinic side so there’s an open line of communication and shared data. I’d make sure that when we talk about computer systems and conversions, we’re making valiant attempts to use the same codes for account types, so that when reports are necessary, we’re speaking the same language."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content