Enterprise scheduling may improve patient access
`Transparent' registration is the goal
At most hospitals, scheduling outpatient appointments is an unwieldy process that requires patients to call the department where the test will be performed and receive pre-test clinical protocols over the phone from clinical staff. There's no discussion of insurance coverage or other financial information, which often results in cancelled appointments when a procedure isn't covered - an inconvenience for the patient - or lost revenue for the hospital down the road.
"The patient is not speaking with someone who's financially trained, so you don't know if the insurance is still current or even if the patient is at the facility they're eligible to be at," says Molly Drake, director of regional patient administrative services for ScrippsHealth in San Diego.
"Generally, that information is not obtained until just before or just after service." That system may be inefficient, but under current scheduling practices, it's considered patient-focused care because patients don't have to go to a central registration area before reporting to the endoscopy department or the radiology center. It's also destined to become ancient history for innovative health care systems, say leaders in the access management field.
The future of scheduling will be driven by sophisticated software that supports an enterprisewide scheduling system. With one phone call by the patient or physician, the scheduling system allows providers to obtain and/or verify patients' demographic and financial information, schedule an appointment, provide the clinical protocol required for a particular procedure, and even offer the patient a choice of facilities within the health system. This can be done by staff or an automated voice system.
Once such systems are fully integrated, the payoffs promise to be enormous, supporters say. The concept is so new, however, that it has yet to be embraced throughout the industry. In fact, even health systems that lead the way on enterprise scheduling are still in the early stages of implementation, with perhaps a pilot project or a couple of sites on-line within a multifacility system.
An enterprisewide scheduling system addresses several potential glitches inherent in the more traditional scheduling method, Drake says. Currently, the hospital sometimes doesn't find out a procedure isn't covered by the patient's insurance until several months after it was performed and several bills were sent to the wrong insurance company. Even if someone catches the problem before the procedure is done and calls the patient to cancel, that's not an ideal situation, she says.
Hefty return on investment expected
ScrippsHealth hopes to resolve such problems with a comprehensive new scheduling system that will cost $1.7 million in start-up investment but is expected to create a return of $15 million over five years. A good portion of that payback is expected to come from clean claims - with correct insurance information, correct authorizations, and improved collection of deductibles - that will be generated from the outpatient area, she explains. Most of the start-up price tag, roughly $1.2 million, is for converting workstations from "dumb" terminals to personal computers for access personnel at the health system's six acute care hospitals, she says.
"The reason it's important to have computers instead of video terminals is that having a modem gives the ability to link electronically with the insurance companies," Drake explains. "So while [the scheduler] has the patient on the phone, the insurance is being verified."
Currently, just one terminal at each hospital allows electronic verification of Medicare coverage, she says. Registrars handling preregistrations have to hang up the phone and leave their workstations to verify an account. For that reason, she explains, it's feasible to verify only high-dollar accounts.
With the new scheduling software, an SDK module that will interface with ScrippsHealth's existing SDK patient accounting and registration systems, that will change, Drake says. Little support is required from the information systems department to install the new module, she adds, and the cost is relatively low - about $100,000 for all six hospital sites.
After the scheduling system is installed in the appropriate departments, the task will be to build the databases that will give prompts for the various procedures being scheduled. "First we'll install it in all the departments and let them work with it," Drake says. "As the departments become ready, we'll go through a rollout where it becomes centralized."
The new scheduling system will allow a truer form of patient-focused care, she says. "We want to make the admitting process transparent to the patient, not move it closer."
When a patient calls to schedule a mammogram, for example, the scheduler/registrar will obtain, or in many cases simply confirm, her demographic and insurance information and electronically send that information to the mammography center, Drake explains.
If the scheduler is arranging a procedure for which clinical instructions are required, the system brings up the list of instructions and related questions to ask the patient, she notes. If the procedure is particularly complicated or invasive, the system will instruct the scheduler to transfer the call to a preadmission nurse.
That in itself constitutes a better use of resources, Drake points out, since the patient is not speaking to a nurse until it's established the procedure is authorized by an insurance carrier or HMO.
The new system will spark other staffing efficiencies as well, she says. It will eliminate the need for a clinician in the outpatient department to input information that would just be entered again by the registrar, since the scheduling system is connected to the registration system. "Most of the time, once the patient comes in the first time, you have the majority of their information," Drake says. "You don't want to have them repeat that information time and time again - you just want to verify it."
Verification is crucial, however, since ScrippsHealth deals with a large number of patients who change HMOs frequently, she points out.
"You can't really depend on the record even on accounts that are only two months old," she says. "It takes seven minutes [by telephone] to verify insurance, which doesn't sound too bad, but if you're seeing 100 radiology patients a day," it's time-consuming. The idea, she emphasizes, is that "if you want [the process] to flow smoothly, take control of it as soon as possible."
Another goal is for the scheduling system to give departments a better resource for scheduling their own staffs. With the new system in place, they'll be able to print schedules weeks or months ahead and block out times for vacations or system maintenance, Drake says.
The system will offer patients more convenience, as well. If a patient's radiology procedure must be canceled, for example, a staff member will be able to see if the patient is scheduled for another procedure or physical therapy session, which also could be changed.
Right now, that kind of coordination is difficult, if not impossible, because scheduling is so individualized, with some departments using personal computers, some writing appointments in books, and others depending on notes stuck to a calendar.
The plan calls for coordinating the software systemwide, with the ability to refer patients to a time slot at another ScrippsHealth facility if there's no opening at the one they've called, or to change an appointment to another location if a radiology technician is unavailable at one facility, Drake explains. At present, she adds, there are still "partitions" between the computer systems at different facilities that prevent seamless communication.
ScrippsHealth also anticipates some savings on staff costs as a result of scheduling centralization, but those figures aren't being put into the equation until the year 2000, to allow for a "gradual roll-in," Drake says. "There will be benefits rolling out for numerous years."
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