Multiple benefits gained with enterprise scheduling
Politics, technology among challenges
By Carol S. Miller, MBA
Senior Management Consultant
Superior Consultant Co.
Southfield, MI
Many hospital- and university-based systems are evaluating the concept of a centralized registration, scheduling, and confirmation center to handle most, if not all, registration and scheduling activities across the enterprise. Those who initiate this consolidation recognize the value and efficiencies to be gained from centralizing front-end office functions. In the future, many expect to gain additional efficiencies by including physician practice front-end functions in the centralization.
This article explores the benefits to be gained by integrating access services, the issues that organizations will confront during the consolidation process, and future benefits to the consolidated center from emerging technology.
Benefits of centralized services
Despite the hurdles to overcome in changing an organizational structure, workflow pattern, and employee skill set, the change to an integrated service function brings many rewards to the hospital, physicians, and patients.
- Customer service. Most facilities currently have multiple telephone numbers for registration and scheduling, including surgery scheduling, outpatient registration for routine diagnostic tests, direct or planned admissions, walk-in or clinic services, as well as special procedures in cardiology, radiology, and nuclear medicine. With an integrated center, skilled and trained personnel will be able to handle the registration, scheduling, and confirmations in a consistent, one-call, one-stop manner. With a centralized rules-based service, multiple tests in different departments can be scheduled contiguously, factoring test and travel time between appointments, and pretest orders and communication can be consistent. As a result, delays in processing are virtually eliminated, registration and scheduling time cycle diminishes, patient flow-through improves, and communication breakdowns dramatically decrease. That simplified process increases physician and patient service satisfaction and dramatically improves their perception of the facility. In addition, with enhanced communication and efficient processes, physicians are less willing to recommend the services of competitors.
- Marketing augmentation. Improved communication and service mean that marketing can communicate the service element to patients and physicians, as well as use that information in its overall marketing approach to the primary and secondary communities. It becomes a selling point, a branding, to one and all.
- Increased revenue and cost reductions. Through a detailed, consistent front-end process, staff will be able to obtain accurate demographic and insurance information, eligibility, and authorization before the visit; secure copayments at the time of service; and significantly decrease no-shows through the contact and appointment confirmation process. Those improved work processes dramatically reduce rework in the back-end functions, resulting in full-time equivalent savings in billing and collections. Days in receivables are reduced and revenue capture increased when overall billing information is improved by eliminating isolated pockets of manual, semimanual, and decentralized registration. Centralization also allows the organization to track resource utilization and productivity more efficiently.
- Physician, hospital, and patient linkage. A centralized registration and scheduling service provides a seamless operation among multiple departments and providers of care. That process alone improves the communica-tion among all entities and strengthens the confidence and reputability of all involved.
Issues to be confronted
The change process is not as easy as might be expected. There are lessons to be learned from organizations that have embarked on consolidation of front-office functions. As hospitals begin the change and reengineering, they sometimes believe that executive management agreement on respective reorganization will lead automatically to appropriate staff placement or required cross-training. Several have begun the process only to be caught in the milieu of politics, personnel issues, and hospital traditions, creating setbacks in realigning the organization. Here are several issues that can affect the organization:
- Breaking tradition. Over the years, hospitals have been performing the same business with similar day-to-day functions, using the same staff for the same services. Changes affect the lifestyle, habits, and security of those individuals and often result in noncompliance, passive aggressive and disruptive behavior, resistance to change, or resignation.
- Departmental silos. Some department staff and leaders tend to protect their territory as if they are the only individuals who fully understand the integral services and accurately provide pretest information, description of tests, and appropriate scheduling times. Those individuals want to continue to control all aspects of their business unit, place roadblocks to change, and destroy employee morale and initiative, and they are unwilling to conform to new structures.
- Incompatible technology. With consolidation, many if not all of the hospitals have experienced varying levels of technological incompatibility, including software or hardware inconsistencies, multiple dissimilar names for the records of a single individual, different test names in multiple systems, and overall database incompatibility. Those incompatibilities result in delayed implementation and discouraged employees. Even the process of deciding on the best software or hardware is cumbersome.
- Space. All hospitals have space issues, making reorganization of departments and staff difficult. Even though the on-line services with centralized registration and scheduling can be virtual, most hospitals have not fully understood or embraced that concept. Therefore, many organizations are still trying to realign departments in nonideal spaces.
- Inconsistent skills. When registration processes are carried out in multiple locations by multiple staff, each employee receives different training and develops a different skill set. That produces an inconsistent registration and scheduling experience, plus mixed interactions with patients and physicians, resulting in negative impressions of the organization.
To create solutions to those problems, the consolidation of front-office functions needs to be clearly mapped, with careful attention to the people and processes affected. Working through the people and process barriers includes these steps:
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— building a shared vision of the outcome of easy access for customers and physicians;
— involving the people who own the work function in the redesign process;
— tapping the managers who will reap the benefit or failure of the redesign process in the development of rules, standards, and training manuals;
— choosing for the initial consolidation those functions that can provide an early win for all involved.
Solutions also may include:
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— ongoing education and communication of the change process;
— responding to negative feedback;
— placing individuals in appropriate positions;
— offering choices;
— making a site visit to another facility to see the end results;
— developing special targets or rewards for achievement.
Services for the future
As technology, Internet connectivity, communication resources, and system integration improve, patients and physicians will realize the luxury of registering and scheduling via Internet connections. That is true regardless of the hospital, physician practice, specialty, subspecialty, or the patient’s location. For example, a physician completing an examination will be able to register a patient for follow-up tests or other procedures before the patient leaves the office.
A patient will be able to register once — within the physician’s office, for example — and demographics and payer data will transfer via the system to the next point of service, eliminating the need for re-registration.
On-line systems from such vendors as Scheduling.com, Atlanta-based McKesson-HBOC, and San Diego-based Healthline provide the initial capabilities of using the Internet to provide the front-end registration, verification, and scheduling functions. Other companies are working on improved solutions to develop a better system and means of communicating, registering, and scheduling in a more automated manner.
With interactive telecommunications and technology, the enterprise solution will not be limited to the hospital and its multiple departments, but will expand to a communitywide solution involving physicians, community health care services, organizations, help groups, and home services. This will create a truly integrated working solution for all health care partners involved in the service process.
The hospital’s business environment will continue to change as a result of technology and system enhancements. Individuals will want to automate and improve operational efficiency as reduced revenues necessitate changes in the existing structure and service. Barriers will be eliminated, and silo operations will evolve into an integrated, supportive environment with everyone seeking a common goal — supporting the services of the hospital and supporting the physicians and patients in the community.
The right solution for every facility may not be a completely centralized model, but one that combines a degree of centralization along with a decentralized focus. Each hospital system must do a thorough evaluation to determine the best configuration — one that will be successful with physicians and patients and that will be a model for the future.
[Carol Miller’s health care career spans 25 years and includes expertise in physician/hospital communications systems, telecommunications strategies, and hospital operations. She can be reached at (248) 386-8300 or at [email protected].]
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