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Patient intake center aims to improve patient satisfaction, POS collections
Automated dialer, on-line tools designed to streamline the process
A longtime dream of "one call does it all" is becoming reality with the creation of a centralized patient access intake center (PAIC) for the 13 hospitals that make up Texas Health Resources (THR), says Jeff Ferrell, director of the new center.
THR was formed in 1997 when Fort Worth-based Harris Methodist Health System merged with Dallas-based Presbyterian Healthcare Resources, and then joined with Arlington Memorial Hospital. The focus has always been on having "one hospital, 13 locations," says Ferrell.
Specific goals of the PAIC are to improve patient satisfaction and increase point of service (POS) cash collections, Ferrell adds. Pre-services staff at the 13 entities will have the opportunity to transfer to the new Arlington-based center.
"We want to have patients scheduled, with reservations posted and demographics verified, so that when they show up there is not a huge wait," Ferrell explains. "They can just sign a form and head to their services."
"It's going to be a great initiative," says Patti Consolver, CHAA, CHAM, corporate director of patient access. "We'll be doing a lot more with less because of automated tools."
Chief among those may be an automated dialer that will pull from a list of patients and make outgoing calls from the PAIC, she explains. "It will leave an automated message, saying something like, 'We're trying to contact you to register you for an upcoming procedure. You may either register on-line or call an 800 number.'"
Consolver notes that while such dialers are used by many other hospital systems for back-end processes, she is not aware of any that are using such a tool for preregistration.
"Today, preregistration staff take up a lot of productive time making outgoing calls and leaving messages," she adds. "The dialer will make those calls for us and [PAIC staff] will be handling only inbound calls."
In conjunction with the dialer, THR is implementing a system that will record all inbound and outbound calls, Consolver notes. "It's really a training tool that will help with customer service. We're excited about that."
Managers will, for example, be able to have call center staff listen to several of the calls they've made and give suggestions for improvement, she says.
Scheduling will not be performed in the PAIC at this point, Ferrell says, but that function will be included "down the road."
Patient access staff working at the PAIC will contact patients after they are scheduled by the physician's office or have scheduled themselves using THR's on-line reservation tool, he says. From the THR web site, he notes, customers may click on a link that will take them through the process of preregistering for maternity care, CAT scan or MRI, among other services.
Patients will be asked for demographic and insurance information, which will be sent via e-mail to the preregistration staff at whatever THR hospital has been selected to post a reservation and create an account, Ferrell adds. Depending on the option selected by the customer, he says, staff will contact the person by telephone or e-mail to complete the transaction.
On March 1, 2007, the first THR hospital — Presbyterian Hospital of Dallas — will become part of the PAIC; in May it will be joined by Harris Methodist Fort Worth and Harris Methodist Northwest, and the remaining hospitals will be added each month after that, Ferrell says.
As the PAIC opens, THR also will be in the process of converting its hospitals to one registration pathway. The east side, or Dallas-area hospitals, which have been longtime users of the SMS registration system, will upgrade to that vendor's Envision Gold product, notes Ferrell, who says that change "will be like going from a scooter to a brand-new car."
The west side, or Fort Worth facilities, which have been using a homegrown system, will also convert to the SMS system, he says. For those hospitals, Ferrell adds, the practice has been to "just ask the programmers to do it and they did it." But with all the requests "out there waiting to get done," the hospitals' needs have outgrown the system, he says. "We've customized ourselves to death."
Harris Methodist Southwest is scheduled to be the first entity to go live on the new registration system, sometime in the first quarter of 2008, Ferrell says. Until the registration pathway conversion is complete, the PAIC will operate on two different systems, he adds.
In preparation for the PAIC opening, Ferrell notes, he has been making site visits to the hospitals. While all 13 are supposed to be doing things the same way, he says, "there are different nuances with each entity. I'm looking at the processes, getting to know the [staff], finding out what works and what doesn't work."
Those visits "confirm the amount of work we have to do," Ferrell says. "There is a lot to do from the ground up — having procedures in place, ordering PCs and printers."
Part of the challenge, he says, is making procedural decisions such as what to do when a patient can't pay or when staff can't reach the patient to do the preregistration but the person has recently been in for a service.
In the latter case, Ferrell suggests, "maybe we need to say [the data] are good to go if the person has been in within the last 90 days and paid."
Communicating with other staff
A key element of the PAIC process, he notes, will be an on-line tool for communicating with the financial counseling and case management staff at the THR hospitals.
"Say a patient has insurance, but has a large deductible and doesn't have the money to pay that," Ferrell says. "From the call center, rather than be on the phone a long time with one patient, we need to get that patient back to the entity to discuss payment options, [perhaps via] an on-line web form indicating, 'This patient needs assistance.'"
This on-line tool also would be used to communicate with hospital case managers regarding, for example, a patient's change from observation status to inpatient, he points out. "We want to be able to say, 'It looks like this patient just got transferred to inpatient status. Has precert been started?'"
Similarly, if a patient comes into the emergency department (ED), is admitted overnight for observation, and the tests results are not good, or the level of care changes and the person goes to the intensive care unit, Ferrell adds, "we need to know to start the clinical authorization process to make sure we get paid."
As of January 2005, he notes, THR's policy is that patients who have an outstanding balance and are coming in for an elective procedure are not registered until that balance has been paid.
The communications tool, Ferrell says, will be used to inform registrars at the various hospitals of such situations. Staff will be able to see the notes regarding that account and suggest to the patient, for example, that an application for charity care be filled out, he adds.
If patients don't meet the guidelines for financial aid and do not make payment arrangements, Ferrell says, the registrar will offer to reschedule the service when the person can take care of the outstanding balance.
To facilitate upfront collections, he says, access employees use an on-line estimator, developed by the managed care department for every payer with which THR contracts, to provide patients with an estimate of their copays and/or deductibles before the time of service.
The registrar enters the patient's insurance and coinsurance amount, as well as the amount of the deductible and how much of it has been met, Ferrell explains, along with the CPT-4 code for outpatients or the diagnosis-related group (DRG) for inpatients.
The on-line estimator — based on the managed care agreement and the patient's coinsurance percentage — pops out an estimate of the amount owed, he adds.
The estimate is presented to the patient at the time of service, Ferrell says, with an accompanying explanation. (See box, below.)
Presenting Patients with Estimates
When registrars at Texas Health Resources hospitals present patients with an estimate of their financial obligation for a service, this explanation is included:
The following procedure prices are estimates only. The estimate is provided to you with the best of our knowledge according to the information that we received at the time of your request. We are unable to guarantee the hospital charges being equal to or less than the estimate provided. Hospital charges are sometimes greater than the estimated amounts, dependent upon each individual's needs and medical circumstances. This estimate is based on average cost and is valid for 30 days. We cannot determine in advance the exact cost of a procedure, to include all possible additional costs that may arise in the course of treatment.
The estimate provided is based on routine care and recovery. Your hospital bill may include specific charges for services requested by your physician — including hospital room charges, surgical charges, and all ancillary charges such as nursing care, lab tests, X-ray, pharmacy and supplies, etc. In the case of medical complications, additional charges may be necessary.
This estimate does NOT include any fees for physician services (surgeon, radiologist, pathologist, anesthesiologist, etc.).
Site visits valuable
The biggest challenge during the development of the PAIC, Consolver notes, was getting buy in from the different hospitals involved. Their concerns, she says, were about losing staff and letting go of control of the preregistration process.
"They were concerned about [the handling of] a late add-on, for example, and about whether [the PAIC] would meet all their patients' needs," Consolver adds. She says she expects the ability to monitor calls provided by the recording system to allay some of those concerns.
Both Consolver and Ferrell say they benefited a great deal from making site visits to hospitals in North Carolina and Oklahoma to observe their processes. "We learned a lot even from those that don't have a [call center] in place," Consolver says, "just understanding how they did preregistration."
The North Carolina visit provided the idea for the on-line communication log, she notes. "We tweaked it and came up with our own version."