Easy-chair entry: Is the patient’s living room the access center of the future?
Internet solutions shift scheduling, registration focus
What if overburdened access departments — faced with dwindling staffs and bare-bones budgets — could shift much of the responsibility for scheduling and registration to the patient? That’s a not-so-distant scenario, thanks to inroads being made in using the Internet for health care communications, says Michael Kaufman, vice president of new business development for Delray Beach, FL-based Eclipsys Corp. Furthermore, patients will welcome this opportunity to take control of their own health care destiny, Kaufman suggests.
At least one Eclipsys client, Newton Wellesley Hospital, part of the Boston-based Partners Healthcare System, has patients filling in their own demographic information and medical histories on electronic tablets as they wait to see a physician, he notes. "The patients, especially the older ones, like it because it allows them a chance to give information that, because of time, they can’t give to the physician during their appointment," Kaufman says.
Since it takes a 45-minute interview to obtain the average woman’s medical history, and most physician appointments last closer to 15 minutes, the potential for efficiency and quality improvement is obvious, he points out. The logical next step, he says, is to have patients complete that medical history form via the Internet before their appointments.
With patients e-mailing requests for appointments, on-line physician referrals, and instant checks for insurance eligibility, the future of access management and the Internet is now, says Stephen Sullivan, MD, vice president for product management at Dallas-based Healthvision. That company, founded by Eclipsys and the Voluntary Hospital Association in Irving, TX, was created to pursue Internet health care solutions.
Health care organizations with cutting-edge access management, Sullivan says, are focusing on these areas:
• putting Web-based "front ends" on traditional registration systems;
• interactive patient care, with patients given more and more access to the health care organization’s database.
An electronic data interchange product from Envoy Corp. being marketed by Healthvision allows health care providers to look directly into a payer’s database to check eligibility, notes Sullivan.
Nearly all providers using software
Nearly all of the health care providers in Santa Cruz, CA — including two competing hospitals and two managed care organizations — use Elysium, a product of Mountain View, CA-based Axolotl Corp., to share clinical data. The community’s 160 physicians, most of whom work with a large independent practice association (IPA) that holds the managed care contracts, use Elysium for on-line authorization and referral requests, with a savings of $13.79 per request, says Steve Sedlock, Axolotl vice president.
The problem in Santa Cruz, explains Sedlock, was that physicians spread over a large geographical area faced ongoing "telephone tag-itis" in trying to communicate with their colleagues. "The referral process is generally physician to physician, or supporting staff to supporting staff," he points out, "but most of the time the physicians are seeing patients. Either way, someone has to track the physician down to relay questions."
With Elysium, Sedlock says, the authorization or referral request is embedded in an e-mail form, with all the relevant patient information tagged to that form. Three key items are required:
• patient demographics, including insurance information;
• medical notes and history;
• appropriate ICD-9-CM and CPT-4 codes for authorization requests.
"It’s just common sense that there will be less back-and-forth dialogue between whoever’s initiating the request and the recipient, whether it’s another physician or an authorizing agent," he adds.
The process works as follows: "The physician fills out the form on the computer and routes it to the computer of the IPA that serves an MSO [medical services organization] function," Sedlock says. "There is software on its side that maintains eligibility and benefits databases. The elements in the form the clinician completes are checked against the database. If approved, an automated approval is queued back in a few minutes to the physician or health care administrator."
The system allows either the referring physician or the referred physician to look up authorization status quickly, he adds.
When a patient is admitted to the Baptist Health System (BHS) in Jackson, MS, an infor mation sheet is automatically sent by computer or fax through Elysium Access to the office of physicians listed as admitting, referring, or consulting on the admission form, says Maribeth Slinkard, director, regional health care information services.
Clinics get timely information
About 200 BHS-affiliated physicians use a standard Web browser to receive admission/transfer/discharge information, as well as laboratory results, transcription reports, and radiology results, Sedlock notes.
"The information sheet provides demographic and insurance information about the patient being admitted," Slinkard says. Clinics receive the information in a timely and reliable manner "without having to place a phone call and wait on hold’ or depend on hand delivery. Cost reductions have not been tracked, only talked about, but when you reduce the amount of time clinic personnel spend on a process, you save dollars. Clinic satisfaction with this process is high."
The BHS business office also benefits from the process, Slinkard notes, because calls for information are reduced.
From an access management perspective, the efficiencies of interactive patient care are virtually limitless, Sullivan notes.
With patients sending in requests for appointments, access personnel "can perform their tasks in an asynchronous fashion, when they want to, without phones ringing in the background," he adds. "It will be a much more controlled environment."
Patients send e-mails
That environment exists now at Boston-based Partners Healthcare System, for example, where access personnel can work a queue of e-mail messages from patients who have sent their appointment requests through the system’s Web site (www.Partners.org).
"What’s very interesting to us," Sullivan says, "and we expect this soon, is being able to expose a bill through the Web, in a secure system. If the patient owes a balance of $150, they can pay that, as well as paying the co-pay on-line before the visit. We’re looking at which institutions want to do it."
Consumer concerns with Internet security constitute one obstacle to widespread e-commerce in health care, Kaufman acknowledges. "Many people will give their credit card number over the phone easily but won’t give it over the Internet."
However, he sees that reluctance disappearing as people become more comfortable with paying all kinds of bills on-line.
This kind of e-commerce, he notes, is particularly significant for hospitals, which struggle to achieve timely bill collection. "It gives the patient the ability to see the problem [with a bill] immediately instead of having to call back and forth."
Provider surveys, Kaufman points out, have shown that the majority of calls to hospital billing offices are patients asking why their insurance didn’t pay. In other cases, when rejected bills are sent to patients, they simply don’t respond at all, he adds. "With an account on the Internet, you can get to them through e-mail."
Ultimately, he says, the idea is that the patient — having already checked in via the Internet and perhaps settled the co-payment — simply will show identification and go directly in for service. The patient registration department of the future, he suggests, could be the patient’s living room.
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