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In the ongoing debate over delivering patient access services, Carolyn Strange says she’s a staunch supporter of centralization especially when it comes to maintaining control of routine financial data gathered during registration. On the other hand, she’s also in favor of decentralizing by taking the service to the patient, she says.
Strange, who oversees 11 registration centers as manager of patient access at Promina DeKalb Regional Healthcare System in Decatur, GA, says that a successful new outpatient service center and registration process combine the best of both worlds, showing that centralization and customer service are no longer mutually exclusive.
Strange’s brainchild is the outgrowth of her efforts to accommodate what seemed to be two opposing requirements: the need to maintain control over and ensure accuracy of registration data amid decreased staffing and pressure to increase productivity, and the desire to provide good customer service and satisfy clinic managers who want to register their own patients.
"All of the specialty outpatient clinics cardiac rehab, the pain clinic, the sleep lab first want their own registrar, and if they can’t have that, the next statement is, Well, let us register our own,’" she says. "But I’m a firm proponent of maintaining control of financial data. Taking into consideration all those things, I had to find a mechanism so that the patient is happy, the clinic is satisfied, and we control the patient data."
Strange calls her idea an outpatient service center. A kind of "virtual" registration center, it opened last year serving four specialty areas, or clinics, and now serves nine. That figure is likely to grow, she says.
The outpatient service center happens to be housed in the professional building next door to the medical center, but its location is really immaterial, Strange points out. "It could be anywhere. It’s a small office, with three registrars, with a fax, phone, and headsets."
"The patient goes directly to the clinic for service," she explains. "Depending on what works best for that center, the patients register either by fax or by phone when they arrive. We held our breath and crossed our fingers, but it really has flourished."
Registration may involve the patient at a clinic dialing a telephone hotline to the outpatient service center and then being interviewed over the telephone. If using the telephone is ot the best scenario for that clinic, the patient fills out a one-page information sheet, which the clinic staff faxes along with a copy of the patient’s insurance card to the outpatient service center. Clinic personnel also are responsible for getting the consent form signed. If more information is required, registrars at the outpatient service center call the clinic and tell staff what they need.
"Everybody’s needs are met," Strange explains. "The only thing I’ve really relinquished is the signing of the consent form, which I empower [the clinic staff] to handle."
The fact that many patients between 65% and 70% are preadmitted and preregistered facilitates the process. The remainder are handled at the point of service.
Another reason development of the outpatient service center was crucial, she says, was the need to maintain control of three off-site primary care centers that perform radiology functions for the Promina DeKalb health care system.
When colleagues to whom she has described the process ask for a tour, she tells them, "We would love for you to come and visit, but there’s really nothing to see. It’s the concept and the process that’s meaningful."
She borrowed from existing full-time employees to staff the center, pulling people from several registration areas, and expects it to "grow like wildfire" over the next fiscal year. "Nutrition services came to me recently about [registering] dietary classes," she adds. "Those are patients I hadn’t even thought of."
Especially for patients who aren’t preregistered, one key to the concept’s success is a good relationship between central registration and the individual clinics, Strange explains.
"Before we bring a new service in, we discuss it thoroughly with the clinic staff, see what their needs are whether phone or fax works best and make sure they understand the empowerment of the consent form."
The outpatient service center is not meant to be all-inclusive some patient populations are best served by on-site registrars, she notes.
"My intent is to have four or five main registration points on campus. The phone center would be one, the ED [emergency department] would be one. That’s what I call centralization of service with the objective of patient-focused care," she says.
One of the registration sites that’s likely to continue having registration on-site is the diagnostic imaging center, where a high enough volume of outpatient tests and procedures is performed to justify its own staff. "It sees 200 patients a day, and I foresee leaving that intact," Strange says.
When Strange speaks to professional groups about her outpatient service center and its registration by phone and fax, she leaves them with some food for thought about the future of access management.
"If you can have people all located in one place, on or off campus, doing registration, why couldn’t they do this from home? You could have registrars with modems that perform this very service in the comfort of their own home," she explains.
That could offer a solution to the currently tight labor market, Strange suggests. "It’s difficult to recruit qualified patient access professionals with all the skills needed for front-end processing. This concept provides for innovative recruitment and scheduling options in order to continue to meet all the objectives of patient access management.
"What if you took potential employees with registration experience somebody that couldn’t come to your location but had that financial knowledge and background and offered them the option of working at home? Stay-at-home moms, for example, would be a great target."
[For more information on the outpatient service center, contact Carolyn Strange, manager of patient access, Promina DeKalb Regional Healthcare System, 2701 N. Decatur Road, Decatur, GA 30033. Telephone: (404) 501-5196.]