Health Care Reform Is Coming: Will You be Ready?
Source: Healthcare Registration – October 2009
By: Laura L. Merisalo
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Preparing patient access for reform
As the nation is rocked by the voices of politicians, citizens and others offering disparate views on what health care reform should entail, the nation’s health care industry can hardly turn a deaf ear. Rather, health care delivery organizations should pay close attention as reform debates rage and, at the same time, should quietly begin to prepare for what may ensue.
If historic patterns of behavior remain in place, however, it is more likely that the vast majority of health care provider organizations will be ill-prepared for health care reform initiatives once they begin to roll out, for any number of reasons. Among them: health care providers, as well as the agencies that regulate them, have poor track records of holding to and/or meeting deadlines when implementing even the most basic new policies and procedures, much less something as complex and wide-sweeping as national health care reform.
As reform debates continue and the shape and scope of reform remains a moving target, patient access leaders have options in managing reform initiatives. Patient access leaders can maintain the prevalent attitude, which is to take a more lackadaisical approach, awaiting the details of an actual plan and only then begin to react and respond to change. Or, patient access leaders can begin preparing now to embrace and adapt to reform—when and in whatever forms it rolls out—by developing a work environment and culture in which employees capably rise to meet the challenges of change.
Reform to Usher in Culture Change
Although the details of health care reform may evolve slowly, one detail is certain: the shape of health care reform, to a certain degree, will require a cultural change in how health care delivery organizations function. Thus, the first thing patient access leaders can do to prepare for reform is to prepare front-end employees to embrace and adapt to change, according to Ron Wince, president and chief executive officer of Guidon Performance Solutions, LLC.
“You have to get ready for the cultural impact” that will accompany health care reform, Wince says. “Change alone is a challenge, and (with reform) people are trying to get ready for something that means culture change.”
Historically, organizations that embrace change are best poised to adapt to it, according to Wince. Thus, to best prepare for reform, patient access leaders need to develop among employees a liking for, rather than an aversion to, change and its related challenges.
An ability to embrace and respond to change will be critical for patient access, as front-end employees will be the front-line in dealing with the complexities of reform. The reason, says Wince, is that the current primary focus of health care reform is on payment issues rather than the cost of health care or how health care is delivered. And health care payment issues are best and most appropriately managed on the front-end, as excellent patient access processes are critical to effective revenue cycle management.
In other words, once patients gain access to clinical care, the delivery of that care will remain relatively unchanged. Thus, the initial changes that will occur under reform will occur at the point of access, where patients begin the health care delivery encounter and where front-end employees must manage the data and documentation required for payment of health care services.
“One thing I can certainly say is, whether reform includes a new federal plan or modifications of existing plans, there will be huge change,” Wince says. “So even if (health care providers) are dealing with commercial, employee-based programs, (the health plans) will change their rules on how they will get paid … to mitigate costs, so you are talking about 70 percent to 80 percent of what (patient access employees) do today will be different” once health care reform rolls out.
The pace of health care reform is unpredictable. As of press time, there was talk of taking action before the close of 2009. Yet reform will require new definitions and redefined processes, which take time to develop, review and approve. Still, Wince notes, there is a strong likelihood that changes will begin to happen swiftly, although it may take two years or more before health care reform is fine-tuned and rolled out in its entirety. Thus, the time to prepare for reform is now, by taking proactive steps as it evolves, rather than reacting to reform once all the details are fleshed out.
The Malleable Face of Reform
As noted, precisely what shape reform will take is unknown and remains in a state of flux. As example: The idea of a public plan met with loud protests at August town hall meetings across the country, which led to backpedaling and talk of further revisions to the public plan concept, or even its elimination.
Although a clear picture of health care reform has yet to emerge, Wince says that there is one certainty for patient access. That certainty is that, at a minimum, reform will require significant revisions and redefining of patient intake processes. The reason, he says, is that health care reform initiatives likely will change the way American health care consumers are covered, whether that health care coverage is through employers, through a national health plan, or some variation. For example, simply the implementation of any type of national health plan, regardless of its reach, will drive changes in private health plan coverage, just as will the lack of any type of new national health plan.
Thus, for patient access, the implication of health care reform is large volume change, as health care reform initiatives are likely to alter how health care coverage is provided to health care consumers and front-line employees are charged with ensuring accurate and complete documentation of that coverage, according to Wince. Changes in private and public health plan coverage will require that front-end employees document new and/or different data elements for many if not all patients, as uninsured patients gain coverage and/or as insured or underinsured patients switch insurances or experience revisions in insurance coverage due to changes brought about by health care reform measures.
“We don’t know enough about what the new system will look like” to make precise adjustments in patient access processes, Wince notes. Now, however, “is the time to start sharpening the saw so we are ready when that comes.”
Preparing for Reform
Although the precise picture of reform remains fuzzy, Wince offers some guidance for patient access professionals to begin preparing now to be well poised to embrace and adapt to the change that is to come. for the unknown to come. The first step is to take stock of the current status of front-end operations, to identify and build upon areas of strength and to identify and address areas of weakness.
In short, Wince suggests that to best prepare for health care reform, determine the current level of patient access performance and bring it to its highest level. To do so, Wince suggests patient access leaders:
- Examine how patient access registers and otherwise manages patients with Medicare and Medicaid coverage versus patients with private insurance. It will be important employees have a depth of understanding in the scheduling, registration and other required front-end documentation for these patients, as any new public health plan more than likely will be more like existing Medicare and Medicaid.
- Identify any current breakdowns in front-end operations and take steps to eliminate them. Cleaning up current operations is key, Wince says, as patient access will need to be agile in responding to change, and that agility will be compromised if the front-end is struggling to manage and meet performance standards and expectations for current processes.
- Take advantage of current data available regarding patient volume, types of insurance coverage and other data to track and understand the current make-up of patient populations served within your particular health care delivery facility. This data then can be used to engage in what-if planning with colleagues within and beyond patient access, as well as with chief executives. It is imperative, Wince says, that there is an open dialogue between patient access and chief executives.
- Take advantage of technology to improve current processes, so that front-end employees are clicking on all cylinders and effectively and efficiently managing current responsibilities to their highest potential. Patient access leaders need to take full advantage of moving to a pre-service environment, for example, with an emphasis on handling registration, insurance verification and payment issues prior to service, so that the time-of-service encounter is an expedient process and so that payment for services, from patients and/or payers, is timely.
Wince underscores that patient access leaders should take the time now to streamline and improve existing processes so that front-end responsibilities are managed in as efficient a manner as possible. The reason, he notes, is that implementing change will require more time from employees, so tasks that today may take five or 10 minutes may take up to 15 minutes or more, until employees are up to speed on the changes and able to efficiently meet new quality standards. Thus, operating at a high level now is essential or adapting to reform will take a greater toll on productivity and the costs of adapting to change will escalate if front-end employees embark on that process falling short of meeting current expectations and standards.
Readers’ Resource
Ron Wince is co-founder, president and chief executive officer of Guidon Performance Solutions, with nearly two decades of experience in leading performance improvement and cultural transformations within service and other organizations. For more information, go to www.guidonps.com.
All contents © 2009 Healthcare Registration. All Rights Reserved.
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