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Make data your 'best friend'
Patient access departments are, without question, "under the microscope" in this recession. Managers need to prove their competency and show the impact of the department on the hospital's bottom line, while facing the threat of budget cuts that could reduce staffing, technology, and education resources.
Data just might be the answer to all of these challenges.
"Data can be the best friend to the patient access manager," says Ed Erway, chief revenue officer at University of Kentucky (UK) HealthCare in Lexington. "Of course, the department should always be operating in a cost-effective manner. However, leadership of the organization needs to understand the importance of access."
Data can demonstrate to leaders timely appointment scheduling, accurate pre-registration data collection including address and insurance verification, benefit determination, and pre-certification. "This ultimately leads to improved financial outcomes and improved customer satisfaction," says Erway.
"Lack of data makes the manager look unprofessional, like he or she doesn't know what's going on," says Peter Kraus, CHAM, CPAR, a business analyst with patient financial services at Emory University Hospital in Atlanta. "In terms of budget cuts, good data can't stop the inevitable when finances are really bad , but they never hurt. They can also prepare the 'powers that be' for eventual likely consequences, such as service disruptions, longer wait times, and less quality assurance monitoring."
According to Kraus, the most important set of data an access manager should have at hand has to do with the economic health of the institution. Does your hospital have a daily or weekly executive summary of key indicators, such as census, daily cash, daily revenue, and days in receivable? If so, you should receive this and be familiar with it, particularly with respect to the goals of the organization and how the goals of the access department affect them.
"This helps mold the image of the manager as a knowledgeable leader in the organization, not just the access department," says Kraus.
Next, you should know how your department is doing with respect to its own goals, be it number of registrations or wait times. "Finally, if there's a special project going on, or the manager's boss is focusing on a particular departmental activity, the manager should be conversant on all pertinent stats," says Kraus.
Here are some ways that patient access departments can use data to their advantage:
You can show that access supports the hospital's clinical areas.
According to Fairon F. Fitzhugh, senior practice operations manager at Children's National Medical Center in Washington, DC, data can be used to reflect how the activities of patient access support the hospital's clinical areas.
Currently, the department is tracking returned mail patient statements and letters to referring physicians and families returned by the Post Office for bad addresses. "Obviously, we're paying for postage; we want the mail to get to its destination," says Fitzhugh. "In these recessionary times, every penny and every referral matters. We're not getting paid if families don't receive statements, and our referring physicians need to hear from us about their patients or they'll stop referring."
Since physicians have complained about erroneous mailing addresses, these data are used to work with staff to improve their efforts in demographic information collection.
Missing charges are tracked for appointments that do not result in a charge in the billing system. "We use these data to ensure that every visit has a charge or, at least, an explanation why it isn't being charged," says Fitzhugh. "Often, this is because a charge ticket was not received by the staff. We use these data to go back to the physicians with the patient's name and date of service to get a completed charge ticket. "
You can decrease claims denials.
Fitzhugh says that as her staff is responsible for obtaining insurance benefits and authorizations, data on denial information have been used to identify the need for additional intervention in certain areas.
"This then builds the case for why you need access staff," she says.
For example, the neuroscience clinic is home to neurology, the EEG/evoked response labs, and physical and occupational therapy. "Needless to say, pre-authorization requirements for these services have escalated fairly dramatically over the past few years," says Fitzhugh. "Denial data are used to justify the need for more FTEs."
Similarly, the urology division was receiving denials on circumcisions, not realizing that the services required authorization. "When we reviewed denial data, which include CPT codes and insurance carriers, we saw a problem," says Fitzhugh.
Access staff then contacted the insurance companies that were denying the claims to clarify referral and authorization requirements. "Once we understood what was needed, we were able to stop those denials altogether," says Fitzhugh. "It's not always this easy, but this is a great example of how data can drive behavior."
You can make better business decisions.
"We are reviewing appointment utilization to determine the viability of sending specialists to our different locations," says Fitzhugh. "We're finding that there is greater demand for some specialties at some of our locations than others."
The data are being used to recommend that some specialties reduce or discontinue service at one location and increase at another. This creates clinic space for specialties in higher demand, reducing the need to expand or take on additional lease expenses.
You can identify extended wait times.
Fitzhugh says that her access department is currently using utilization data to help clinical areas identify problematic no-show rates (how many scheduled patients fail to show up for their appointments) and/or extended wait times for appointments.
"We have as an institutional goal a specific number of days in which we want new patients to be seen," says Fitzhugh.
Access tracks how long it takes to get a new patient appointment and no-show rates.
"When we look at how long it takes to get an appointment in the context of how many patients fail to show, the trend that is most often revealed: The longer it takes to be seen, the greater the likelihood of a high no-show rate," says Fitzhugh. "It becomes a vicious cycle; new patients can't be seen but we have clinics that aren't filled."
This has allowed some of the hospital's clinical areas to adjust their appointment slots to address long wait times, even on a short-term basis, to increase patient satisfaction, and decrease no-show rates.
You can measure customer satisfaction.
When UK HealthCare's clinical departments updated their telephony systems, data were provided to the departments to show their abandonment rate, average speed to answer, and hold times. The data showed there was a wide variation in the departmental telephony metrics. Generally, those areas with low marks in the metrics also scored low in patient satisfaction.
"The goal is to effect improvements, leading to increased availability of appointments and customer satisfaction," says Erway. "The ability to measure customer satisfaction is crucial for success and not just using the traditional metrics."
Focus groups are used to evaluate current and new processes. "As we redesign our patient access model, establishing a call center, we will use the focus group to determine the impact on the patients and referring physician's reactions," says Erway. "We are interested in not only the first appointment we have with the patient but the subsequent visits as well. Long-term loyalty of our patients and referring physicians is important."
You can improve throughput.
"Many of the newer emergency department systems now track time of a patient's initial check-in, triage evaluation, and the movement to a treatment room," notes Erway.
The systems also will track patients as they progress through the treatment process, including nurse assessment, physician evaluation, ancillary testing, treatment, and eventual discharge.
"These times can help a customer service representative assess and explain patient complaints about access when they occur," says Erway. UK tracks trends in patient arrival to rooms, boarder hours, patient diversions, and patients who leave without being seen.
"Also, the data in most institutions are aggregated to assist leadership in making process changes to improve patient access and throughput," says Erway.
At UK, these metrics are monitored by a patient throughput group consisting of physicians, ED, and hospital leadership. The group has initiated several projects to minimize patient boarder hours, diversions, and patient who leave without being seen. "Those are not only major points of patient dissatisfaction, but also have a negative impact on the financial operations," says Erway.
Erway says that data must be "retrievable, reportable, and easily understood" in order to effectively communicate the benefits of any access initiatives. He offers the below "must have" data for various patient access settings:
For a call center: abandonment rate, average time to abandon, average speed to answer, average hold time, service level objective (the percentage of calls answered within a specific time period, usually seconds), and agent occupancy.
For an outpatient ambulatory setting: next available appointment, no-show rate, patient bump rate six-12 weeks, patient bump rate < 6 weeks, new patient rate.
For a hospital setting: average registration time, registration accuracy, number of registrations per shift per FTE, patient satisfaction with the registration process, co-pay collection rate.
Fitzhugh says that her department's "key indicators" data include no-show rates, wait times, time-of-service collections, eligibility denials, no authorization/no referral denials, template utilization, missing charges, and late charges.
"We use these data largely to refine what we're doing, what we already know is working, and could work better," says Fitzhugh.
The department uses data to answer these questions: Are time-of-service collections low? Are we collecting deductibles? How do we prepare ourselves to know co-pay amounts? Do we have enough staff to obtain necessary authorizations? Do we know the insurer's requirements? Are we keeping up with carrier newsletters? Can we use online authorization?
Sharing data with staff has even given rise to competitions among some of the clinical areas, for which has the highest time-of-service collections or the fewest errors on different reports. "We have used data to educate and engage staff, clinicians, and leadership," says Fitzhugh. "Staff have gained a better understanding of how their work impacts our services, our families, and our physicians."