patient access

Clinical Operations Insight into Revenue Cycle Revitalizations

Lisa Monteleone

Lisa Monteleone

On the surface revenue cycle revitalization initiatives for physician practice groups, hospitals and health care organizations appear to only require the involvement of patient access, patient financial services, information systems and the various functions of the health information management department. Often times it’s the areas where clinical operations overlap, areas that perpetuate patient care and cultivate patient trust, that are overlooked and are not considered part of any transformation effort.  As a result, process improvement teams that fail to include members with clinical operations insight could potentially produce a prolonged or unsuccessful revitalization initiative.

Areas where clinical and revenue cycle operations overlap are relatively easy to identify. These are areas where care is being delivered, reviewed and monitored with underlying processes that ensure continued patient access and ongoing effective revenue cycle outcomes.  Pre-admission testing (PAT) operations for clinical testing, non-invasive studies and surgical procedures require clinical personnel, (registered nurses, advanced practice nurses, and physicians) as well as revenue cycle activities (registration, scheduling, coding and financial counseling).  Exclusion of either side of this tightly integrated unit could lead to poor patient outcomes, decreased patient satisfaction, operational inefficiencies and suspension of the revenue cycle before it truly gets underway.

Care and utilization management teams as well as revenue integrity teams are examples of where the gap has been bridged between clinical and financial areas. These teams are composed of professionals with both clinical and financial backgrounds.  Their knowledge and expertise are leveraged to ensure optimal clinical documentation, discharge planning with the intent for re-admission reduction, and optimal reimbursement for the care and services delivered.   They have the ability to review clinical components and translate the information into financial outcomes. These three teams can prevent denials and are positioned to report on status issues as they occur and can positively affect the ability to improve processes that lead to greater revenue capture. Telephone nurse triage, pre-test screening, transfer center operations, and complex case management are also areas where there is overlap and a need for clinician and non-clinical alike to understand the impact they have on the revenue cycle.

These overlap areas require staff to have a broad understanding of the “business” of healthcare as well as a clear understanding of the care being delivered. Medical assistants, emergency medical technicians, registered nurses, advanced practice nurses, physicians’ assistants and physicians need to understand their impact on the revenue cycle.  The same can be said of the revenue cycle team with regard to clinical operations and its impact on the care delivery model.  The interdependencies of these two seemingly polar groups cannot be overlooked when undertaking a revenue cycle revitalization initiative, large or small.

When formulating the ideal revenue cycle revitalization project team, include team members with clinical operations expertise as they ensure there is effective translation between the care being delivered and the financial transaction being conducted, directly impacting the bottom line. Clinical operations team members add value by understanding the challenges and barriers when attempting to obtain accurate information in the clinical care delivery environment.    Process improvement teams that include members with clinical operations insight produce successful and long-lasting revenue cycle improvement initiatives.

Improving Patient Access: What’s Your 3rd Next Available Appointment?

In continuing the quest to ensure that my colleagues are seeking ways to improve patients access to care; I thought a discussion regarding the 3rd Next Available Appointment would be beneficial.  The 3rd Next Available Appointment metric is often misunderstood, and as a result, not utilized. I would venture to say, if this metric is not one of your top three Patient Access Key Performance Indicators (KPI’s), you need to make it so.  Some might say, “why not measure the calendar days between the day a patient makes a new patient appointment with a physician and the next available appointment? What makes the 3rd available appointment a better indicator of access to care?”

The 3rd Next Available Appointment is preferable to the next available appointment because it is a better reflection of slot availability within your scheduling system.  Given that patients cancel appointments at the last minute, reporting the first available appointment may give a physician practice manager a false sense of timely access.  For example, you are the manager of a busy orthopedic practice.  You are measuring the next available appointment time by physician in an effort to provide patients with a new patient appointment in under three days.  Despite the fact that you confirmed your appointments for the day, a new patient calls to cancel her visit for this afternoon.  Moments later, another patient calls to cancel his new patient appointment for tomorrow with the same orthopedic surgeon.

If you were to report on this surgeon’s Next Available Appointment, and you ran this report from your scheduling system right now, your next available appointment for Dr. Smith would be this afternoon. As a manager, I would assume this means Dr. Smith’s new patient availability is under the three day threshold and my patients are receiving timely access to care.

Now let’s run the third next available appointment for Dr. Smith. In doing so, you find that the 3rd next available appointment for a new patient is 19 days.  The two cancellations received today, while providing an open slot for another new patient to fill, is not a true reflection of Dr. Smiths’ patient availability and as such, intervention should be initiated.

Most scheduling systems include this report as part of their standard package. If you have access to it, run it for every physician in your practice.  Run it often and act on any adverse results.  You’ll find a significant increase in patient satisfaction as well as a positive boost in revenue will be your reward.

MIR_3944-Johanna Epstein

Patient Wait Times Should Be Your Priority

The firestorm over the comments made by VA Secretary Bob McDonald regarding the length of time veterans wait for healthcare has gotten me on my soapbox. By stating that Disney doesn’t measure wait times for guests’ queueing up for Space Mountain, McDonald was trying to point out that the VA should focus on the veteran’s overall healthcare experience when trying to quantify satisfaction.  I have spent years working on ways to improve patient satisfaction in the large, academic physician practices where I have been fortunate enough to have been employed.  I have conducted focus groups, spoken to patients one on one, sent surveys and read countless studies about how to positively impact the patient experience.  I have found that asking patients to wait what a patient perceives is too long for care is the single biggest driver in patient dissatisfaction. I have also found that wait times for care (otherwise known as access to care) is the single biggest reason patients leave health systems to seek care from your competitor.

Evaluating the patients’ overall experience is indeed important. Effective clinical care, responsiveness to patients’ questions, a pleasant staff and appropriate follow up are obviously critical to the continuum of care.  However, if a patient has had to wait weeks or months to receive an appointment, coupled with waiting far too long in a waiting room and examination room, the memory of the care quality is overshadowed by the often times tortuous wait.

Too many patients decide the wait is too long and choose another healthcare provider that is accessible. Unfortunately for our Veterans they have no choice.  They are forced to utilize a healthcare system that is steeped in bureaucratic and antiquated processes.  Waiting too long in the case of a chronically ill veteran could have serious health implications.

I urge my colleagues at the VA and elsewhere who are responsible for patient access to look at your patient wait times. If you think they are too long, your patients think they are an eternity.  Dig deep to find the root causes of your access problems and solve them.  Your patients and most certainly our Veterans will thank you for it. MIR_3944-Johanna Epstein

Modernizing Physician Compensation Plans: Webinar May 29th 12:30-1:30 EST

Modernizing Physician Compensation Plans

Do your physician compensation plans include incentives for improving access to new patients? Are your compensation plans based upon productivity to ensure that access to all patients from all participating insurance plans is readily available?

Culbert Healthcare Solutions invites you to join Randy Shulkin, MBA, FACMPE, Senior Consultant, for a free webinar on Friday, May 29th at 12:30 PM Eastern as he discusses how to develop a physician compensation strategy that is aligned with the goals and objectives of your organization.  As the industry continues to look for ways to provide affordable care to all patients, a responsive, flexible approach to managing physician compensation and incentives is needed to keep the focus on prompt, quality care.

This one hour webinar will discuss and demonstrate the following:



Improve Patient Access by Managing Overflow Calls

The centralized call center has become the cornerstone for providing improved access for patients in large, complex healthcare delivery systems.  As more and more provider organizations are placing a greater level of emphasis on the patient experience, savvy Patient Access Managers are looking very closely at their Call Center metrics to ensure that best practices are being utilized. 

A well designed call center can be the catalyst for revenue generation and increased market share.  The data available from your Automated Call Distribution System (ACD) can provide a wealth of opportunity for further improvements in your Call Center.  Patient Access Managers should carefully evaluate call abandonment rates and service levels; the time it takes in seconds for your staff to answer patient calls.  If either of these metrics are too high, you may want to consider an outside vendor to manage your overflow calls. 

At the most fundamental level, patient telephone calls represent revenue to your organization.  Unanswered calls are an enormous frustration to patients.  Due to budgetary constraints, many organizations are unable to staff their call centers to address call volumes at peak periods throughout the day.  As such, call abandonment rates tend to increase at the start of each day; especially Monday mornings, during the noon hour and late in the day when patients are out of work.  Call volumes also tend to increase during these times as patients make repeat calls in an attempt to get through to a patient service representative. 

An overflow vendor can act as an extension of your call center; having access to the same registration and scheduling applications that you are using internally.  A reputable vendor can assign a dedicated team of resources to your call center, assuring that consistent scheduling protocols are met.  Further, with proper vendor relationship management and training, the “overflow” team; can play a valuable part in reducing abandonment rates, reducing call volume and improving overall patient satisfaction.

Consider a vendor that can help you create a positive consumer experience.  Ensure that your vendor is a caring and compassionate partner that supports your organizations’ mission.  Carefully consider a vendor who has extensive experience in the physician access arena. 

Critical to making this decision is ensuring that  your technology, to include your Automated Call Distribution System, call recording capability and call disposition tracking methodologies are available for use by the vendor.  Additionally, select a vendor that understands the constantly changing healthcare environment; one that is committed to a rapid, high quality implementation and a long lasting relationship.  An overflow vendor, if managed properly can be a cost effective solution to a common access problem. MIR_3944-Johanna Epstein

Healthcare Reform and Patient Access


Many of the key provisions of the Affordable Care Act  will be phased in over the next  year including an expansion of Medicaid and  the creation of health exchanges that will allow previously uninsured patients to obtain health insurance.  These provisions will have the effect of expanding the population eligible for healthcare coverage and allowing for greater choice on where patients seek care. 


Some organizations, such as Academic Medical Centers, neighborhood  health centers and public clinics, may face competition for patients that heretofore had little choice on where to seek care.  Community hospitals and physician practices will now have increased access to a new insured population.  A result of improved access to healthcare services will place a burden on many components of the healthcare sector that were already struggling to take care of their patients due to a primary care physician shortage and a lack of providers in certain specialties.  At the same time, there may be increased competition for patients.


This will place increased strains on the healthcare delivery system, particularly in terms of creating access to new patient populations seeking care.  Improving patient access, promoting more efficient operations and promoting patient satisfaction will be required to remain competitive.  Neglecting these critical opportunities could  result in a significant degradation of service and performance.  It is incumbent upon every healthcare organization, and especially physician groups, to focus on these important areas in the months ahead.

 By : Jeff Wasserman-Vice President of Strategy & Executive Leadership Services -Culbert Healthcare Solutions