Spring 2017  
Taking Your Access Center to the Next Level
By Johanna Epstein
Patient Access Centers have come a long way over the past decade. Fifteen years ago, health systems that offered a single point of access for patients to schedule appointments with physicians or ancillary services were considered trailblazers and risk takers. After all, why would a physician in a busy practice allow a centralized, homogenized group of “telephone agents” access to their scheduling templates? The physician schedule is the lifeblood of any successful practice. Ludicrous indeed!
Fast forward to the year 2017. For the most part, large academic medical centers and complex integrated healthcare delivery systems have embraced the Access Center concept as the front door to the enterprise. Leaders of high functioning Access Centers know that the patient experience starts with the first interaction. This interaction may be an online chat or a telephone call to the Access Center and it must exceed the patients’ expectations in some very fundamental ways. An average experience just won’t do in today’s competitive healthcare environment.
The Access Center of today must be extraordinarily patient-centric. The goal for the Center must be patient “keepage” to avoid patient “leakage”. The mission of any Access Center is to get the patient to the right provider, at the right time and in the right location. Keep this simple premise in mind as you strive to take your Access Center to the next level and you can’t go wrong.
Take a moment to review what is happening in Access Centers across the country. Consider these things as you plan your improvement strategy.
  • Offer a single web portal or one telephone number for patients regardless of provider specialty or service needed.
  • Minimize complex Automated Call Distribution System (ACD) criteria. Be sure that your telephone tree doesn’t have too many branches.
  • Record patient telephone calls and use these recordings as a training tool for service recovery. These recorded calls can be used as a basis for measuring staff performance evaluations.
  • Offer clinical triage for patients who need help in determining what type of provider should be consulted for a specific diagnostic condition. Provide nursing staff to process prescription refills and act as a link between the practice and the patient.
  • Ensure that your provider scheduling templates have enough capacity to help patients obtain appointments in a timely fashion. Is your definition of “timely” that of the patient or the provider? Think long and hard about this.
  • Require that your Access Center staff complete a full demographic and insurance registration during the appointment scheduling process. Verify patient insurance benefits in real time and inform the patient of any co-pays, co-insurance and deductible due at the time of service. For patients who want to pay in advance, be able to process credit/debit cards during the call.
  • Provide financial counseling/assistance in advance to those patients who need help.
  • Send patients any required clinical questionnaires via encrypted email to be completed in advance of the patient’s arrival.
  • Offer appointment confirmations via call, email, text, and in a variety of languages.
  • Measure Access Center performance by way of an Access Dashboard. Routinely review performance metrics such as service Level, abandonment rate, appointment lag, and provider slot availability. Regularly report these metrics to the provider stakeholders that you serve.
  • Take good care of your staff by offering soundproof cubicles with plenty of natural light and comfortable chairs, high-end headsets and robust telecom technology.
  • Value quality of the patient interaction over quantity of calls received.
  • Survey your patients to determine the level of patient satisfaction during the scheduling and registration process.
  • Work closely with your physician practices to ensure that improvements made in the Access Center translate into a better experience at
Access Centers in today’s healthcare environment must stay relevant and remain nimble and open to change. Hopefully the suggestions above will provide your health system with food for thought so that you can also take your Access Center to the next level.
The Impact of Rising Consumerism in Healthcare
By Dr. Nancy Gagliano
Spotlight Article
While healthcare executives are focusing on payment reform, MACRA, optimization of their EHR and physician burnout, among other things, there is one more worry to add to their list: the rise of consumerism. Gone are the Marcus Welby days, when the patient was loyal to their one heroic doctor and they would never think to question the diagnosis and treatment plan. Today’s consumer of healthcare is sophisticated and far less loyal. Just as consumers anticipate exceptional service from non-healthcare entities (i.e., Apple, Google, etc.), they are placing these same expectations on the world of healthcare. One of the biggest challenges for health systems now is to understand patient expectations and take the necessary measures to accommodate the consumer, or else risk major organizational disruptions.
Patients want several key items when it comes to their healthcare experience: 1. Access  2. Empowerment  3. Value
Patients want services and care that make their lives easier. They seek appointments within 24 hours and they don’t want to jump through hurdles to get them, plain and simple. This expectation makes alternatives, such as retail clinics, urgent care centers and now telehealth, so potentially disruptive. Patient loyalty and connection to their PCP, particularly among the millennials is not strong, with 72% saying they would be willing to see someone other than their own provider. In that same arena are telehealth services, such as American Well and live video visits, which 74% of American consumers say they would consider using.
Access to information, whether it be from a website or a wearable device, is growing at an astounding rate. Unfortunately, consumers are less particular about the quality of their information than they are regarding the ease of use of websites. Health systems should be aware that a consumer is much more likely to look up information on WebMD than their organization’s website.
Venture Capital money is pouring into digital devices and healthcare application-based companies. Solutions for chronic disease management (i.e. Omada), wearables (i.e. FitBit), and Nokia’s Withings digital device company purchase, should make health systems realize they need to be prepared to interact with numerous healthcare offerings outside of their own institution to truly compete in the future.
Care is becoming a commodity and patients are seeking the easiest and most cost-effective form of healthcare services. They want price transparency and to know upfront what the cost of care will be, but, with the complexity of health insurance, it is challenging to know the patient portion of a service. With such high deductible insurance plans, patients are more cost-conscious and are looking for lower cost options. Some people will pay more for quality, but the overall consensus is that the patient as a consumer wants what is least costly.
Strategies to Meet Consumer Expectations
Patients want services and care that make their lives easier and executive leadership can take steps to ensure minimal disruptions to their organizations:
  • Access: Consider a true centralized access center with standardized schedules so the center can book patients without connecting to another physician’s office. Increase operational efficiency to enhance physician productivity and make it easier to efficiently use the EHR
  • Value: Provide real time insurance verification, price transparency, consolidated billing statements and pay attention to one’s quality scores
  • Empowerment: Implement a patient portal, telehealth, digital strategy, update health system website, as well as a strategy to work with organizations outside of their own health system
  • Patient Satisfaction: Ensure practice efficiency with a well-run practice. Optimize the practice’s revenue cycle by making no errors on the bills, sending them out in a timely manner and providing the patient a single billing statement
For an organization’s leadership to make a patient’s life easier, they need to define their organizational goals and develop a strategy. Health systems need governance, physician buy-in and strong organizational leadership to minimize the disruptions that patient expectations may cause. It is imperative to understand what drives the patient to make the choices they do regarding their care services so that they may better accommodate to these growing consumer trends and keep their patients loyalty.
Many to One - How to Stop Drowning in FSCs and Love Registration Again
By Laura Smeltzer & Kiera O’Neil
Over the past year, we have worked with several GE clients who were seeking assistance with Financial Status Classification (FSC) consolidation projects. One organization had recently implemented their system but found that its initial design was not working well, resulting in excessive charge corrections, ineffective eligibility checking and extensive claim denials and resubmissions. In other cases, organizations had been using their systems for many years but over time, their FSC dictionaries became extremely cluttered. They needed a complete overhaul in order to make their systems more usable and efficient. Whatever the reason for a FSC consolidation/clean-up, there are some helpful tips and suggestions to assist health systems in planning and executing a successful effort.
Since FSCs touch many areas of the Centricity Business applications, careful planning will serve an organization well. When the time comes to start all over, it would benefit any organization to consider identifying the main driver for a FSC consolidation project. Typically, organizations are seeking more streamlined registration workflows, better denial management, more efficient reporting and dictionary maintenance and also to drive the need for change. Health systems must also identify all stakeholders and what their involvement in the project should be, including the departments that require direct involvement or that only require communication of progress.
The first critical step in the process is analysis. FSC consolidations can have impacts on many areas of the system, including TES edits, ETM workflows, referrals, electronic claims and reporting. Organizations need to analyze how each of these areas will be impacted and ensure that an FSC deactivation will not have an adverse effect on existing workflows (both manual and automated). These projects will impact and change workflows in regards to front desk/registration and billing and A/R follow-up. They should also examine the effect on month-end reporting. Organizations should also check for any interface table or conversion updates needed and for ANY downstream systems that are using the FSC information for registration (hospitals, ambulatory centers, etc.), or other uses. Health systems should also gather supporting data to create buy-in for the project, including denial reporting and time-studies.
The next key step in the process is design. The organization needs to determine the new FSC structure. Will existing FSCs be used in the new structure or will new FSCs replace all the consolidated FSCs? Mapping out the old and new structure is necessary to move forward with the build. Once the new structure is determined, required changes to impacted areas (i.e., TES edits, ETM views, claim form changes) must be mapped out.
Planning for go-live and mitigation must follow all design steps. GE delivered utilities should be reviewed to understand the automation that is possible. Organizations should plan for manual work effort to update patient registration insurance tables if both a deactivated and replacement (if it already exists) FSC are in the current insurance table. Additional manual work may be required if referrals are linked. If there is a large volume of FSCs, approach it by dividing them into manageable “chunks” (i.e., payor categories – Commercial, PPOs, HMOs, Medicare, Medicaid, self-pay, etc.), or something even smaller (i.e., all Medicare Advantage plans, PPOs by major insurance company, etc.). In addition, communication to end users and office sites, business office staff, finance and clinical system users is key to minimizing any disruption. Educational plans should be built into the project planning from the beginning.
It is important to create robust test plans to allow multiple users to run through testing scenarios. The testing scenarios need to include both manual and automated processes and include all downstream systems. Testing must include both consolidation tasks and any FSC related A/R activity.
These are some common suggestions but are not all-inclusive. They provide some insight to the amount of work that can be involved when taking on this kind of initiative. This is where experience can lend a hand. In addition to working alongside an objective, Culbert’s experienced resources can assist your organization in the planning, designing and testing of a FSC consolidation. Culbert has created methodologies and tools to help organizations through this process.
Patient Access - Create Your Own Think Tank
Melissa A. Bailey
Patient access employees are the “rock stars” of healthcare. They are the front and back door of the hospital. From a patient's request for an appointment, to the knowledge of co-pays/deductibles/OOP, time of arrival/decreasing wait times, consent forms, billing, all are vital to a patient’s overall experience. For health systems nationwide this can impact physician and patient satisfaction ratings, and also have a downstream effect and impact the hospital’s bottom line. In addition, if a patient has to wait for appointments, they often try an alternative such as scrolling the internet for remedies through sites such as WebMD. Patient access has long been considered the “problem child” of the billing process, but it is the organization’s responsibility to continue to create practices to enhance the overall patient experience. Some ways in which health systems can achieve this include:
KPIs - Organizations can improve their financial outcomes and increase performance by applying KPIs and benchmarks to the daily workflow. Creating measurements for access by tracking the wait times for patients during the scheduling process is essential. Setting goals for wait times before and during the admission process is also key for patient satisfaction.
Medical Necessity Denials - Another benchmark to monitor and add to successful practices should be medical necessity denials after admissions. Does the organization monitor denials due to changes after admission? If not, now is a great time to communicate with their outlying departments to communicate changes that will affect the outcome of the patient’s billing. Creating a tracker will decrease the number of ABN denials, create accountability and also maintain the satisfaction level of the patient.
Communication - Health systems should schedule weekly leadership meetings to share and discuss findings. They should include the scheduling and nursing staff and recommend that they share with their staff during daily huddles. At this time it may be helpful to discuss cancelled appointments, reason for cancellation and rescheduling those appointments in a timely manner.
Sharpening the Saw - Organizations can explore ways to improve the patient access experience by doing some of the following:
  • Revise scripting with any updates to improve patient care, as well as the front-end process
  • Create a policy that identifies patients who should be triaged by a nurse, based on symptoms
  • Revise patient/physician portals on the company website with any new updates/changes
  • Discuss if current survey questions are effective in improving the patient experience
Patient satisfaction begins with the elements of the front-end processes within an organization. Implementing new and creative practices to enhance patient access will ultimately benefit the health system’s goals. The future of healthcare will be exciting and new, but healthcare organizations should buckle up and be prepared for the ride!
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