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Changes streamlined ED registration process
The ED verification staff, registration staff, case managers, emergency nurses, and a group of patients joined together and brainstormed ideas at Bronson Methodist Hospital in Kalamazoo, MI, with the goals of reducing denials, obtaining a better understanding of each other's roles, and obtaining accurate demographics, says Tina Nadrasik, patient access manager over the ED. Here are three areas that were identified:
Surges in patient volume were causing delays.
"There is only room for three computers up there, with a nurse, the registration staff person, and a greeter," explains Nadrasik.
When a patient comes to the ED, the registrar obtains a name and date of birth and lists the patient on the tracking board, says Nadrasik. "Then we immediately step aside, and the patient goes to the triage nurse," she says. "Another nurse does a more in-depth evaluation, as to where the patient needs to go from there."
During volume surges, she says, registrars can see only one patient at a time. To reduce delays, a second registrar is now contacted by wireless phone when a certain number of patients is waiting, says Nadrasik.
Registration staff and financial counselors lacked understanding of each other's roles.
The financial counselors have detailed knowledge of Medicaid and other programs, which allows patients to get started with the financial assistance process sooner, says Nadrasik. When this information was explained to registration staff, they realized that there was a great deal of helpful information that patients could provide to financial counselors upfront, she says.
The ED verification staff and financial counselors were given laptops, pagers, and cell phones, and they met each morning, says Nadrasik. "They would figure out their day and which patients are going where," she says. "Then, they would round up on the floors and do the verification."
As a result of this new process, says Nadrasik, "we have more of an understanding of each other's roles. We make sure that before we refer an account out to a third party vendor, there really isn't anything we can do to help that patient."
Patients often qualified for assistance, but this qualification wasn't determined until later in their hospital stay.
Financial counselors previously were considered more of a "back end" function, but bringing them into the loop helped improve communication between the front and back end, says Nadrasik.
For example, the financial counselors help patients start filling out their Medicaid applications right away, she says. "We are connecting them with the right people sooner," says Nadrasik.
If patients are found to be self-pay, staff are able to immediately contact a third party vendor that the hospital contracts with and obtain them assistance sooner, she says. "They can see the patient while they are here in the hospital and help them to fill out the paperwork," Nadrasik says. "Patients appreciate the face-to-face interaction, instead of doing a lot of phone calling after the fact."