Pros ask: Where are the access benchmarks?
NAHAM standards due at end of 2002
Access managers increasingly are seeking reliable benchmarks against which to measure staff productivity and revenue management achievements, saying there is little or no meaningful information available.
Anxious to establish fair standards for their own employees, and to illustrate for higher-ups the strides their departments are making in cash collection and billing accuracy, they find few definitions for excellence in access management.
"We need some common-denominator standards," says Beverly Varshovi, associate director for admissions at Shands Hospital at the University of Florida in Gainesville. "I want to know if anybody has any good standards. Data that is out there is sometimes so raw that it doesn’t always help me."
"Where do you find productivity measures, and how do you know what the standards are?" adds an admitting director who works for a large hospital in the Midwest and asked not to be identified because of an organizational policy. "How do you develop standards for admitting employees — number of registrations and the time frame for doing them?"
"It’s always good to have an objective goal," she notes, "and when you don’t have benchmarking statistics, it’s subjective. It’s one thing for me to say, I expect every employee to do 60 registrations because that’s what I think.’ But if I could say, We fit into this category, so we should average this many registrations,’ then it becomes objective."
While her admitters have to deal with the Medicare Secondary Payer letter and getting conditions of admission forms signed, she points out, "other departments are doing different things. Some of them have financial counselors, for example."
Varshovi says her organization did some management engineering and established its own guidelines for registrars.
"When we have registrars who don’t verify accounts or collect cash, but who collect demographic and third-party payer data, create accounts for billing and review patient rights and responsibilities, their minimum standard is 40 registrations per day. But with financial specialists, the minimum is 20 per day," Varshovi adds.
They do everything from sponsor referrals to verification to collection. In doing "sponsor referrals," she explains, the employees look for "sponsorship" of a patient account, which might involve arranging for coverage by Medicaid, Supplemental Security Income, or another source.
"How [the guidelines] compare industrywide, I don’t know, and I would like to know," Varshovi says. "I would like for the access management people to step up and say, We’re going to define this and say what are the acceptable [comparisons] and what are the carve-outs, regarding some common elements that we all experience.’"
These "carve-outs," she notes, would have to do with such things as the degree of managed care penetration and state-sponsored coverage for a particular organization, which would affect a hospital’s percentages on upfront collection, for example.
"I’ve talked to [access managers] at hospitals where 50% of the patients are state-sponsored," Varshovi adds. "Obviously they’re not collecting from that portion of their patients."
The fact that her facility has a transfer center, with five full-time equivalents means that her department is paying for functions that are not applicable at many other organizations, she points out. Dividing the bottom-line budget by the number of admissions — a common form of comparison in the industry — wouldn’t take that transfer center function into account, Varshovi adds. "If at your organization it costs $7 to process an admission, it might take $12 at mine, she says, which wouldn’t be an accurate measurement of efficiency.
Some departments don’t handle emergency department (ED) registrations, she notes, and some close at 7 p.m. and transfer their functions to the ED.
Developing a formula that takes into account such variations would be one answer, she suggests. "We might say, Plug in the number of this and this, subtract this, then multiply the number of Medicare patients by this.’ It could be customized by location."
Those in the patient accounting field routinely use standards promulgated by a quarterly financial publication called Hospital Accounts Receivable Analysis that is put out by Aspen Publishers in Gaithersburg, MD, Varshovi says. "That data is pretty much the bible for accounts receivable management."
To her knowledge, she adds, there is nothing comparable in the access field. "You work against [your own best performance], but at some point, you have to show how you compare to others in the industry."
Standards may be on the way
The National Association for Healthcare Access Management (NAHAM) is working toward the establishment of benchmarks and best practices for access management, notes Steven Kemp, executive director of the Washington, DC-based organization.
At a meeting in November 2001, he says, NAHAM’s board of directors identified as a strategic goal the establishment and application of metrics to the patient access continuum.
"The project’s scope will be to develop a standard, measurable data set of demographic, financial, and clinical prerequisites for a patient encounter that allows for local interpretation and implementation while maximizing the patient experience," according to an article on NAHAM’s web site, www.naham.org.
The organization will seek the assistance of its members in the endeavor, the result of which is expected to be available at the end of 2002, Kemp says.
Monitoring outcomes
It’s important to look at and measure what happens on the back end of the billing process that is a direct result of registration initiatives, Varshovi points out.
"What I keep talking about is to continue to monitor outcomes," she says. "What is your bad debt? Maybe you’re paying a lot of people on the front end, but it’s worth it because of what happens on the back end."
Among the outcomes that should be monitored, she suggests, are point-of-service cash collections and first-pass yields (bills that are able to go out electronically without being touched by human hands). "Look at pre-cert denials and unmatched charges — charges that get put through by different departments, but for which you can’t find valid accounts, either because the account was never created or because something was keyed in wrong."
Through efficiencies achieved by the admissions department, she says, Shands’ unmatched charges for any given week have decreased from about $1 million in 1997 to about $60,000 at present.
As her health system faces the challenge of standardizing operations at hospitals throughout the system, the director from the Midwest notes says she is looking for answers to questions such as, "How many registrars should it take to do this many registrations?" and "What’s the benchmark for accuracy of the data?"
"What one hospital in the system needs isn’t exactly what I need because I register 60,000 more patients than they do," she points out. Instead of just saying, "I need more employees than that," she says, she’d like some industry statistics to back her up. "Where do I go to make it more than just my opinion?"
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content