Incomplete orders down, thanks to access efforts
Worst offenders are targeted
A little more than a year ago, the access services department at Meridian Health System, in Neptune, NJ, began taking aim at reducing the number of patients who come through ambulatory care services without a complete physician’s order. The results have been dramatic, says Julie Hamill, RN, supervisor of access services, thanks to efforts by a physician liaison, visits to office managers, a regular luncheon for physicians’ staff, and an instructional folder called "New Directions." (For details on how another access manager solicits physician cooperation, see "Access airs concerns while staff get lunch," in this issue.)
"The effort began about March of 2000, and we saw a difference in the numbers in June," she says. "The percentage [of incomplete orders] went down and is now down to about 6%."
Traditionally, the access services department had a problem with physicians not putting a diagnosis on the order or, in the case of managed care accounts, failing to obtain a referral or an authorization for the procedure, Hamill explains. As patients arrived with an incomplete order, she adds, access employees would have to ask them to wait while someone called the physician’s office, explained the problem, and asked that a revised order be faxed to the hospital.
A backlog of patients was created as all this faxing took place, particularly since the hospital scheduled procedures beginning at 7 a.m., and physician offices typically can’t be reached until later in the morning, Hamill notes. When the hospital began keeping statistics and realized the number of patients who came in without the proper material for a registration, she says, her department took action.
Making it easier
After compiling a list of the worst offenders among physician offices, Hamill says, access services personnel decided to put together a New Directions folder for physician office staffs, with all the information and forms a patient needs to have a successful registration encounter. "Everything is reproduceable for the patient," she adds.
The folder includes five sections, Hamill says, which include:
• Patient instructions regarding tests and procedures.
• Master order forms for the most common laboratory tests and ICD-9-CM codes to help access staff match code and diagnosis. Physicians can use these forms for their orders, she explains, checking the appropriate box, or writing in the information for less common procedures.
• Department guide with information on where to park, where to register, and where to go for the service being performed, including which building and which floor. "We wanted the patients to know that before they came to the hospital," Hamill adds.
• Campus parking map.
• Directions and a map showing how to get to the main campus, Jersey Shore Medical Center, or to one of the other Meridian Health facilities.
"After we put this folder together, we took our list of worst offenders’ and made physician office visits," Hamill says. "We called and asked for an appointment to speak with the office manager." During the visits, she adds, the access representative explained that it is required by law that a diagnosis be provided before a patient is registered, and with a managed care plan, that certain procedures also need an authorization or precertification.
Less resistance
The office managers were "very receptive" to arranging the meetings, Hamill says, because they also had concerns. "Some were confused as to what plan needs what. When we spoke to them, in some cases, it created a healthy relationship. We didn’t meet as much resistance as I thought we would."
In addition to these appointments, the access staff also arrange office manager luncheons, where they review insurance plan requirements, and continue to emphasize the importance of physicians’ providing diagnoses on their orders, she notes. "We still have the 6% [of incomplete orders]."
Meridian Health has two physician liaisons, Hamill says, one of whom specializes in outpatient matters and helps present registration concerns to the physician practices. "I meet with the physician liaison, say, We’re still having a problem with this group or this physician or this office.’ She will address [the issue] in a medical staff setting or go to them one-on-one."
Patient education is another important facet of the physician compliance effort, Hamill points out, and it’s aided by the distribution of materials in the New Directions folder. "With this packet, there’s a page that tells the patient, This is what you need to bring to the hospital, this is the time you should arrive, and you should know your insurance company and authorization number.’ We’re hearing from the physicians’ offices that patients are beginning to say, Do I need a referral?’ or Do I need an authorization?’" she says. The patients are learning from experience what is needed at the point of registration, Hamill adds, and in some cases are taking an active role in making sure they have it.
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