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Pre-registration moving out of the hospital into houses
Self-schedule, self-register, self-estimate, self-pay, and even self-screen for Medicaid or charity eligibility. "Patients will self-everything, all from home PCs and mobile devices," predicts Paul Shorrosh, CHAM, founder and CEO of AccuReg Front-End Revenue Cycle Solutions in Mobile, AL.
Pre-registration, including insurance verification, demographics verification, and financial assistance and payment plans can all be done by the patient, using a home personal computer (PC) if prior to service or at the point of arrival if using a smartphone or tablet. Identity verification using fingerprint biometrics is already pre-built into some smartphones.
"Technology firms like ours are starting to build patient access apps for the consumer to assist in their own registration, verification, application, and payment, relying on the access employee only if there’s an exception," says Shorrosh.
Today’s patients also are consumers who want convenience, speed, and control over their information. "The innovations are coming faster, with functionality that covers health records, communication between patients and providers, and now patient access functions," says Shorrosh.
Bill Malm, senior manager of revenue integrity communications at Craneware, an Atlanta-based provider of automated revenue integrity solutions, doesn’t look at the United States to determine where technology in patient access is headed.
"I look at other countries that are good at population management," he says. In the United Kingdom, for example, patients routinely use phone apps to schedule appointments. Malm expects this process soon will be happening in the United States.
The entire registration process is moving "out of the facility and into the patient’s home and the Internet," says Malm. Patients can submit insurance information electronically so preauthorizations can be obtained before arrival. In some cases, even procedures can be scheduled. "If a patient is coming in with a migraine and it’s your policy to do a CT scan, you can schedule that," he says. "Things that we used to do with the first presentation, we can do before the patient even hits the door."
If patients preregister using their smartphones or home personal computers, patient access areas can expect to see shorter wait times and better patient flow, says Malm. "This creates a more predictable access to healthcare, especially for unscheduled episodic care," he adds.
Kiosks in registration areas allow patients to check in using biometrics; view and pay liabilities; agree to payment arrangements; sign guarantor documents; and complete loan, charity, or Medicaid/exchange applications.
"It will be much like the change we’ve seen at airports, grocery stores, and banks," says Shorrosh. "Registrars’ roles will shift to a higher level and assist with overflow, questions, or patients that simply do not want to self-check."
However, Shorrosh expects mobile apps to soon overtake kiosks, which he estimates 20% of hospitals use. "The barriers of hardware cost and maintenance, adoption rates, functionality limitations, and infection control will be circumvented with mobile apps," he predicts.
Hospitals might choose to skip over the kiosk phase and go straight to mobile apps so patients can accomplish these tasks themselves. "This simplifies the work for registration employees by pushing basic information verification tasks to the patient," says Shorrosh.
If the patients’ scheduled procedures requires authorizations or fail medical necessity rules, for example, the patients can resolve the issues with their physicians and payers beforehand. "Imagine an exception-based work queue built for patients," says Shorrosh.
Patient access leaders at Advocate Good Shepherd Hospital in Barrington, IL, carefully researched kiosks, but they stopped short of actually implementing them.
"In the tech-savvy environment we’re in, we thought kiosks would be a big patient satisfier," says Wendy M. Roach, RDMS, CHAM, director of patient access. During various site visits, however, she learned that use wasn’t as high as expected. "We, as an organization, decided not to move forward," says Roach. "We want to work on our patient portal first and go from there."
Patient access took on the role of educating patients about the portal. Registrars ask patients if they want to be a part of the portal. "The patient has to declare yes or no, and if yes, the patient has to provide us an email address," says Roach. "The technical team takes it from there, but we have the conversation with the patient."
Sometimes this process takes several minutes, which adds to registration wait times. To counter this problem, a fast-track registration process is used for preregistered patients, so they can simply review their personal information and sign consents.
"This helps reduce wait times when items are added to our registration processes," says Roach.
The "big picture" of registration wait times and patient satisfaction should be carefully considered, she urges. "We are the ones who will get questions from patients about the portal," says Roach. "We have to provide an educated answer."
The patient access department at Advocate Good Shepherd recently invested in a patient tracking system (manufactured by Elgin, IL-based HealthWare Systems).
"We put a lot of money and effort into patient tracking," says Roach. "From door to discharge, we have an accounting of every step in the patient’s journey."
The tool revealed that the average time to check in took just five minutes, and the registration process averaged three minutes. However, after registration it took an average of 15 minutes for the technologist to come and get the patient.
"We were able to use time data with our radiology group to change the length of their exam times," says Roach. "We have added on extra time slots for some exams and increased time duration for others."
When the patient is called to registration, consent forms and other paperwork is automatically printed. "We don’t have to go into the system and tell it to print, so it cuts down time spent in registration," says Roach.
Registrars put notes in the comment field for ancillary departments such as "blue hat" or "pink jacket," so technologists can easily spot patients in a crowded waiting room and greet them by name.
Once registrars scan patient IDs into the system, they can see what the patient looks like, which allows them to greet the person by name on future visits. "This adds personalization to the process," says Roach.
The department is looking into connecting the tracking system with patients’ smartphones.
"Checking in is a manual process right now," says Roach. "We are looking into the option of having patients check in on their phone."
William L. Malm, ND, RN, CMAS, CRCR, Senior Manager, Revenue Integrity Communications, Craneware, Atlanta. Phone: (404) 364-2032. E-mail: firstname.lastname@example.org.
Wendy M. Roach, RDMS, CHAM, Director, Patient Access, Advocate Good Shepherd Hospital, Barrington, IL. Phone: (847) 842-4186. Fax: (847) 842-5325. E-mail: email@example.com.