Outsourcing trend includes patient access
Hospital’s costs are fixed; contractor’s at risk
Outsourcing isn’t just for business office functions anymore. At least one company Atlanta-based Transcend Services provides a complete line of patient access services for its clients.
Transcend can take on the entire function of the access department registration, precertification, upfront collections, financial counseling, and utilization review when it contracts with a hospital, says Ed Katz, vice president for marketing and operations in the Southeast region. The company even assumes responsibility for social services and discharge planning, or transportation and switchboard, if those areas fall under a hospital’s patient access umbrella.
Transcend started out 10 years ago as a consulting company "great at making recommendations, but not accountable for implementing them," says Katz. At the urging of clients, it moved into providing hospital information management (HIM) services.
"Because of the overlap and duplication of certain tasks and operations, we were then asked to assume management responsibility for access services," he adds.
Staff cutbacks not favored
Normally, when Transcend contracts to provide a hospital’s access services, the employees in that department are transferred to its payroll, Katz says. "We don’t make our savings by reducing individual payroll we don’t feel staff reductions are cost reductions."
If the company sees opportunities to reduce the number of employees through re-engineering, it tries to do so through attrition. If that isn’t possible, it tries to relocate employees to another part of the hospital, he notes.
Transcend saves money for its clients primarily by using benchmarking to achieve the best and most efficient practices, enhancing productivity standards, renegotiating existing contracts such as those with software vendors and process improvement. "If we need to modify a process, we tear down, start over, and rebuild," Katz says.
A hospital pays Transcend a flat fee, usually equal to or less than its current departmental budget, to provide access functions, Katz says. The contract establishes baselines that are equal to or better than the existing department’s performance in certain areas physician and patient satisfaction, wait times, and accuracy and completeness of registration, for example. Transcend measures outcomes and shares them with the hospital on a monthly basis, he adds.
"If we exceed [the baselines] we are financially rewarded," Katz explains. "Generally, when we provide a service, we do it at our cost, with no margin built in, so the only way to make money is to perform above the objectives."
Transcend is able to make process improvements in part because it can provide variable staffing drawing from other resources in the company while a hospital relies on a fixed staff, he points out.
If, for example, the company determines that part of a hospital’s problem is that documentation of the medical record is not good enough, it brings appropriate staff in from other sites to train HIM employees.
Simple changes can save big bucks
When Transcend contracts to provide access functions, it improves the "collectibility" of the hospital, says Beth Ingram, CHAM, director of professional services, Southeast region.
It does that in several key ways, Ingram says. One of the biggest improvements the company makes is in the area of not-filed bills (NFBs), which are bills that are held until they can be properly coded.
"We reduce that so the hospital is able to drop the bill a lot quicker," she says. For many hospitals, speeding the bill drop date by a couple of days can mean $1 million in extra cash flow. It’s simply better procedures, "not reinventing the wheel," that make the difference, Ingram notes. For one thing, Transcend can bring in extra coders, as needed, from other company sites, she says.
Along with NFBs, two areas where Transcend typically makes significant improvement are patient wait times and precertification, Ingram says. "You’d be surprised how many hospitals are not preregistering." Preregistration can slash wait times, as well as get the proper insurance preauthorizations. For expensive procedures such as CT scans and MRIs, that can save a hospital thousands of dollars, Ingram points out.
Other examples of simple innovations that help Transcend improve a hospital’s bottom line include the following:
• Chart reassembly.
Frequently, when medical records employees receive a report on a patient to add to the patient’s file, they take the patient’s chart out of the file and completely reassemble it, making sure it’s in perfect order. Each time a piece of paper is added to the record, someone is working on that chart, which requires a lot of time and manpower.
Transcend’s method is simply to stick the new piece of paper in, and wait to reassemble the chart until the next time it needs to be pulled out and sent to someone.
• Physician signatures.
In some hospitals, charts awaiting a physician’s signature are placed in the doctor’s box. If two or more physicians need to sign the chart, one physician might come in to take care of paperwork and could miss a chart that is in the first physician’s box. By the time it shows up in the second physician’s box, and gets a signature, it’s delinquent.
Transcend’s solution is to put all incomplete charts in terminal digit order in a specified area, and put a list of charts to be signed in each physician’s box. If the physician calls ahead, the staff pull the charts and have them waiting for the doctor’s signature. If not, it takes just a few moments to pull them when the physician arrives.
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