March, 2016:

Mixed Use Patient Access Centers Improve the Patient Experience

Lisa Monteleone

Lisa Monteleone

By Lisa E Monteleone, RN-BC, BSN, MHA

Mixed use centralized patient access centers are an important investment for medical groups and health systems as they provide an access point for current and prospective patients. A decentralized or splintered patient access design or a poorly performing centralized center can result in patient frustration and lost revenue.

Patient Access

Effective implementation and management of a mixed use centralized patient access center is key to attracting and retaining patients. What is “patient access?” It’s everything that affects a patient’s ability to get to the right care, at the right time, for the right reasons, at the right location. Patient access most often includes the operational functions of referrals, scheduling, insurance, registration and payment collections.  It also includes IT systems, facility and workflow design, staff training and management, the right mix and number of providers, as well as the coordination of care and services between multiple sites across the full continuum of care.

When it goes wrong

In the recent past you have likely been subject to a poorly performing patient access workflow that resulted in multiple calls, repetitive requests for information, long hold times and inadvertent disconnects. It’s likely this experience left you frustrated and questioning your choice in care provider.  In today’s healthcare environment this experience can be detrimental to the success of the healthcare provider.  To be successful, providers must focus their patient access efforts on the complete patient experience. Overlooking steps adds to the risk of losing the patient to another group or system or generating a less than desirable patient outcome.

When it goes right

I had a recent experience during peak hours with a patient-centered provider of health care services. During the call the representative was alerted via their IT system that there was a financial hold on my account.  The hold did not allow the appointment to be scheduled. I thought to myself, here we go, this is going to take FOREVER!  Boy was I surprised!  In one call that lasted less than 15 minutes, touched three departments, and had minimal repetition of patient information:

  • An outstanding payment – rectified
  • An appointment – scheduled
  • A non-urgent medical request – triaged by a nurse

Positive Outcomes

Mixed use centralized patient access centers accomplish many things for a medical group or health system, not the least of which is call demand management and appropriate routing. In addition to improved efficiencies and operational savings the centers create multi-practice, provider, and service line visibility.  The centers reduce voicemail and email related frustration and eliminate the need for multiple calls.  Mixed use centralized patient access centers are a one-stop-shop for the patient and a command center for the provider:

  • Appointment scheduling & reminders
  • Physician & service referrals
  • Pre-registration functions
  • Follow-up calls / patient outreach
  • Prescription refills
  • Test result communication
  • Symptom based nurse triage
  • Revenue cycle management

Which shape and size fits your need?

Mixed use patient access centers come in all shapes and sizes. The centers can be centralized in a single location or virtually though IT applications and systems.  They can be operational during business hours or 24-hours a day 7 days a week.  The centers can be staffed in-house by the medical group or health system or they can be outsourced to regional or national call centers.  And lastly, the centers can be brick and mortar based or deployed remotely.  Larger medical groups and health systems are likely to use more than one of these models to effectively manage the needs of the patient population and their providers.

Meeting the challenge head on

Health care providers are faced with several challenges at once: an aging and more consumer-oriented patient population alongside reduced payments and a more competitive marketplace. Investing in top notch people, policies, and processes are key to health care provider survival.  Mixed use centralized patient access centers allow medical group and hospital based staff to focus on face-to-face patient management needs at their facilities and offices and as a result improve operational efficiencies, patient satisfaction, and patient outcomes. How does your patient access measure up?

Why a Thin Line Separates EHR Optimization, EHR Replacement

Healthcare providers will have their reasons for choosing EHR replacement or EHR optimization, but a thin line may be all that separates them.

Jerrilyn Ivey-Director of Consulting Services -Culbert Healthcare Solutions shares her perspective with

access here

The Value and Challenge of Patient Generated Health Data (PGHD)

Way back in 2009 I found myself at the Chicago HIMSS conference watching the Google presentation of their PHR, Google Health. As a fan of Google products in general I was interested in what the presenter had to say.  His message was that we, as consumers, could be responsible for our own health data and that Google Health was a repository for that data.

[Their] “goal was to create a service that would give people access to their personal health and wellness information. [They] wanted to translate their successful consumer-centered approach from other domains to healthcare and have a real impact on the day-to-day health experiences of millions of our users.” -Google Blog June 24, 2011

What really got me curious about their PHR was, just weeks prior, I was at an Endocrinology specialty go-live, where at one point I was asked into an office to assist a provider. The provider presented a thumb drive and asked “what do I do with this?” The thumb drive being the data that the patient had collected from his glucometer. At the time there really weren’t any tools were we could capture that data directly into the EHR without manually entering those results. This was frustrating for patients and providers alike. Patients having collected that data and providers who would like to see that data trended in a flowsheet to make decisions on patient care.

I was curious at the time if a PHR could be the solution. I wondered if a patient would take the time to enter in their data and if so would that data be available to their providers. A few short years later Google announced the retirement of Google Health stating:

“We’ve observed that Google Health is not having the broad impact that we hoped it would. There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people.”  -Google Blog June 24, 2011

But now there is a shift. Patients and providers alike are looking at Patient Generated Health Data [PGHD] in a new light. What we are seeing is that patients are now at the center of their care. I spoke to a friend and colleague working on this topic, and she put it to me this way:

“If I am nervous at the doctor’s office and my blood pressure is elevated, well then it is hard to trend that information with only one or two points of data during the visit and the provider may prescribe treatment for hypertension. However, if I am keeping a record of my BP and know that I have a history of low blood pressure then, I may choose not to take the prescribed medication.”

I myself have been wearing a Fitbit to track my steps and heart rate for a better understanding of my own wellbeing. Doing this inspired me to start capturing my food intake. I’ve got an app where I log every meal. The amount of data I can collect about myself is greater than the data my doctor will ever collect on me. Even if you’re going to your doctor every month, you still have the ability to gather significantly more information yourself at home.

Interoperability still remains an issue. Increasingly we have apps and devices to capture our data and, there’s a lot of us that would like to have all my data sent to one repository. I may want to change my apps or I may update my devices in time and if all my data’s in one place, it’s not that big of a deal to change my apps.

“There are a lot of people out there today with activity monitors and consumer medical devices, but that data is not currently being used in the clinical context,” “Why is that? That’s because there is no structured reporting of that data. Physicians don’t want to take a lot of data in without using it properly.”

PGHD on its own can be a valuable source of information, but ideally it should be combined with EMR data. When this is done providers have a more complete, of the overall picture of the patient.  We are still struggling on how to capture and use of PGHD. Some of the struggle, may be due to a lack of standardized data and best practices for implementing PGHD into the clinical workflow. Ideally we need a system in place where patients can monitor their vitals and transmit that data through their phone and securely transmit that data to their electronic medical record. That kind of mechanism is very valuable.



The Road to HIMSS Stage 7- Webinar March 25th 1:00-2:00 EST

The path to demonstrating a successful implementation of an electronic health record continues with ever-changing technology and process advances. Achieving HIMSS Stage 7 recognition exhibits an organization’s continued focus on patient-centered, safety-oriented, clinical information systems. HIMSS Stage 7 organizations set the foundation for quality improvement initiatives, value-based payment models and interoperability while raising the bar for information technology progress. Culbert Healthcare Solutions invites you to join Rachel Miller, Epic Practice Manager, and Jaclyn Bernard, Senior Consultant, for a FREE WEBINAR on Friday, March 25th at 1:00 pm Eastern for an insightful look into leveraging insight across organizations in progress and who have already achieved Stage 7. This one hour online webinar will discuss and demonstrate strategies for organizations to:

  • Assess current state practices against HIMSS EMRAM criteria
  • Key Stage 7 challenges
  • Approaches to implement program requirements to achieve this prestigious recognition

Date: Friday, March 25, 2016 Time: 1:00 – 2:00 EST
register here

Improving Your Financial Health Through Patient Engagement

Jill Berger-Fiffy , MHA, FACMPE Senior Consultant

Jill Berger-Fiffy , MHA, FACMPE
Senior Consultant

Maintaining financial stability at the practice is no longer easy with high deductible plans passing the cost of care on to patients. One of the effects of consumer driven health care is that patients no longer can expect that their health plan will pay the entire bill leaving only a small copayment for the patient as their responsibility.   Many plans now have a complex mix of copayments, deductibles and co-insurances which need to be met prior to the plan paying for any part of the visit or procedure.  Two statistics that confirm this are:

  • The National Center for Health Statistics reports that in 2008, 19.2 % of patients were covered by a high deductible plan which has now increased to 32.5% in 2013.
  • The Milliman Medical Index (MMI) indicates the increase in patient out of pocket expenses increased 78% between 2007 and 2013.

Practices are combatting this by implementing new revenue cycle programs to enhance cash flow by engaging their patients. Two solutions which go hand in hand are the use of “Time of Service Estimates” (TOS) and “Credit Card on File.”

Time of Service Estimates (TOS) are defined as the process of creating an estimate of the patient’s total financial responsibility. In the past, this information was gathered by a staff person calling the insurance company on each individual patient which is time consuming as one waits in a cue to speak with a person.   Some health plans now offer this functionality free on their website, however, the time spent navigating each payer site and obtaining website access for this task can be significant.  Because website requirements and design are different, this is not an efficient tool.

Benefits to the practice of creating estimates can include a reduction of days in A/R, self-pay accounts, paper statement costs and accounts going to collections. Disadvantages are less; but there may be an increase in refunds if not administered carefully and staff selection is key as they must be engaged in the process.  Some software programs utilize the practice’s own claims data to develop these estimates.

Practice staff can now develop a written estimate which can be reviewed; verbally, in person or on the telephone; and provide an avenue to review the expected patient responsibility prior to the service being rendered. The addition of this function changes the workflows in the practice may include financial counselors or billing staff in the discussion of payment options at the time of check out when a procedure is to be scheduled.  This allows the patient to ask questions and understand their options for payment.


Practices can centralize this function and then follow up with a written quote which can be emailed or mailed to the patient inclusive of the branding of the practice including logo, names of physicians and locations of service. The creation of an estimate can offer a transparency of pricing while engaging the patient and setting the upfront expectation of payment.

Once the estimate is developed and accepted by the patient; it is essential to have a process in place to obtain payment.  Practices can be proactive and collect the monies due to them in advance by offering a “credit card on file” option for patients. This option moves the back end billing process to a front end collection process while enhancing cash flow to the practice.

Credit Card on File offers patients two options for payment. Practices can accomplish this task by collecting and storing credit card information to adjudicate the claim once the patient balance is known.  Additionally, practices can process an electronic check.  There is no need for the patient to wait in the office or call on the telephone as the process includes an emailed receipt to the patient upon conclusion of the transaction.  A distinct advantage to “Credit Card on File, is that it may offer flexibility by processing a one time or a series of scheduled payments to satisfy the patient balance.

Staff training should include policies and procedures to integrate this into the practice workflow, scripting, role playing, and training of staff to access the system and monitor payments. Procedures for patients whom do not wish to leave a credit card need to be in place.  This is a successful retail model (similar to pay pal or amazon) which can easily be applied in the medical practice setting.

The processing of payments is different since 10/1/15 with the new Payment Card Industry (PCI) standards. All transactions must be encrypted and protected. PCI compliance eliminates the process of staff writing down credit card numbers, expiration dates and other data on pieces of paper or storage of these details in non-secure locations.  PCI standards designate the minimum set of requirements for protecting account data. These include; proof of maintaining a secure network, protecting card holder data, maintaining antivirus software, implementing access control, monitor and testing of networks and maintaining information security.

The ability to administer and automate payment plans is essential to remain financially stable. As the deductibles grow in size, practices may find patients require a longer period of time to pay their debt.  Automation through a practice management system or vendor software can ease the burden for both parties.  Developing improved collections is appealing to hospitals, physicians and healthcare organizations. It also relieves the stress on patients when options exist to repay their debt. Time of Service Estimates and Credit Card on File creates a win-win for the patient and the practice.