No Need for Crystal Ball to Foresee Challenges; Recession, reform among drivers of patient access complexity
Source: Healthcare Registration – December 2009
By: Laura L. Merisalo
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Ask health care industry experts what patient access professionals can expect in 2010, and the responses may vary but they also will invariably link to service and, in turn, its relationship to nearly all other aspects of patient access responsibilities and processes.
Superior service determines the success of every patient access function, from initial telephone contact to schedule services and preregister patients, through to the face-to-face encounter when patients present for care and treatment in outpatient and inpatient care settings. Health care consumers who encounter professional, courteous front-end staff members are most inclined to be cooperative during the data gathering registration process, which sets the stage for positive and successful clinical and additional administrative outcomes further down the line.
The new year also promises new requirements and regulations, as well as new technology to improve front-end processes and/or ensure compliance with the myriad governmental and insurer requirements. Complicating 2010, of course, is the still-troubled national economy and the inevitability of some type of health care reform. These issues and others serve to underscore that patient access professionals will face significant challenges in 2010.
Although there are many issues that will require diligent attention and focus by patient access, achieving service excellence tops the list in 2010, as in years prior and in the years to come. With a solid service foundation, front-end employees are best poised to meet and exceed job performance expectations, ranging from gathering complete and accurate registration data through to ensuring compliance with any of the myriad local, state, federal, and insurer requirements.
There is no greater imperative for health care provider organizations than to deliver superior service in all administrative and clinical patient encounters. It is what keeps customers loyal and what keeps them referring friends and relatives to a facility.
Word-of-mouth is the quickest route to pass on information about a patient’s experience at a particular facility, and health care consumers also have access to a bevy of ratings information. Regardless of whether the information is from a personal, published, or Internet-posted source, such ratings information offers varying degrees of reliability.
Health care quality measures available today include those from independent health care ratings firms, rankings by major national media firms, the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare tool, and consumer reports, among others. In 2010, a tool recognized as the first national, standardized, publicly reported survey on patients’ perspectives of their health care experience will begin its rollout: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Hospitals are scheduled to begin submitting data to HCAHPS in January 2010.
Word-of-mouth is the quickest route to pass on information about a patient’s experience at a particular facility, and health care consumers also have access to a bevy of ratings information.
The primary focus of hospital ratings appropriately is the quality of care. Indeed, only two of the 22 questions on the HCAHPS survey query patients on a more global view of the health care encounter, and those two questions are all-encompassing:
- Patients are asked to rate the hospital, on a scale of 1 to 10, as the best or worst in the patient’s view; and
- Patients are asked whether they would refer others to the facility.
Such surveys underscore the imperative to provide consistently high levels of service in every instance when a patient interacts with the health care delivery organization, beginning at patient access, according to Craig Deao, research and development leader of Studer Group.
“The patient’s encounter with patient access professionals is often among their first with an organization,” Deao explains. “This first impression sets the stage for whether the patient feels confident that they are in the hands of caring, skilled professionals, which contributes to their level of anxiety and their overall perception of the organization.”
To the greatest extent possible, patient access should avail itself of technology to automate front-end processes. Technology that allows for real-time verification of insurance benefits, confirmation of patients’ identity, and determination of copayment and/or deductible amounts, as examples, are among the automated options available through various vendors. Such tools are essential for effective revenue cycle management, which begins at patient access.
In addition, as technology continues to evolve, options to automate a new variety of functions emerge. For instance, a significant revenue drain in outpatient settings are no-shows. Patients are scheduled but fail to show up for appointments for any number of reasons—they simply forget, something comes up at work but they forget to call to cancel, and so on. The care provider, however, has planned and scheduled resources for every patient. The result is that the health care provider organization has expended resources without any offset of revenue. In other words, the institution is spending money to staff and stock areas to serve patients, but there is no related revenue to offset those costs when patients are no-shows.
Calling patients to remind them of appointments is a simple solution that pays for itself although few health care provider organizations invest time or tools to do so. It is not surprising, as many in patient access view incorporating appointment reminder notifications to patients as yet another to-do item on an already too-full patient access plate.
Although a live telephone call is the best solution—as it offers the ability to make personal contact, plus, if the patient has a scheduling conflict, it can be remedied immediately, technology can be the answer, via automated calling options, text messages, and/or emails. Depending on the size of the organization, and particularly for larger organizations, automated appointment reminder systems may be more appropriate than live telephone calls from front-end staff members.
The trend to require patients to take on greater financial responsibility for their health care is nothing new, but in 2010, such cost-shifting to the patient as payer will continue. Indeed, a recent survey by PricewaterhouseCoopers’s Health Research Institute revealed that 42 percent of employers plan to increase employee health plan contributions in 2010.
This continued focus on shifting costs to patients by employer is among the factors that mandate ongoing change and improvement in front-end processes, according to Ron Wince, President and Chief Executive Officer with Guidon Performance Solutions.
Patients’ increasing financial responsibility mandates that patient access leaders provide front-end staff members with effective tools and training to help patients navigate financial expectations and/or to help identify medical assistance programs for patients unable to meet their financial obligations. Front-end processes that timely identify financial issues prior to or at the time of service are essential. Further, such processes will allow health care provider organizations to move to real-time revenue cycle monitoring, a change that Earl Winter, Chief Executive Officer of nTelagent Inc., says is imperative.
“Everything from days in accounts receivable to collections to cash on hand needs to be shared. A facility cannot improve its processes and procedures if it doesn’t have measures,” Winter explains. “Up-to-the-minute reports covering everything from cash collected by front-end staff members to charity pending to payment plan reports allows a facility to see if it is doing the best it can on the front end, and where things can be approved.”
Calling patients to remind them of appointments is a simple solution that pays for itself although few health care provider organizations invest time or tools to do so.
Winter stresses that health care provider organizations need to adopt a team-based approach to revenue cycle management that includes patient access, patient finance, and clinical staff. “As more and more financial responsibility is placed on patients, a facility’s entire mindset has to change in order to be successful,” Winter notes. “For example, all patients leaving the emergency department must receive discharge instructions, which is a perfect opportunity for a nurse to take the patient to a check-out area” to set up or finalize payment plans for services provided.
The current economic climate coupled with growing patient-pay obligations heightens the imperative for revenue cycle management to begin at patient access. A key element of effective revenue cycle management is to identify patient-pay balances prior to service for scheduled patients and, for walk-ins or emergency department patients, at the time of service or as soon as possible thereafter, preferably while the patient is still at the facility.
Early determination of patient-pay balances not only allows front-end employees to request and collect payment at the time of service. Further, identifying and requesting payment of patient-pay balances prior to or at the time of service allows front-end employees to work with patients who are unable to pay or who may need to make payment arrangements over time. Simply, best practice requires that patient access employees have the tools and training required to allow them to collect cash from patients at the time of service or, in cases when patients cannot pay, to work with patients to make payment arrangements or identify patients’ eligibility for medical assistance programs or charity care.
The health care industry is replete with rules, regulations, and requirements mandated by private and public health plans, and complying with these regulations begins at patient access. From the need to meet long-standing Medicare requirements, such as the Medicare secondary payer (MSP) queries to determine primary and secondary payers, through to the more recent Red Flags Rule, patient access must be on constant alert to ensure compliance and, in fact, is first in line to set the stage for a provider organization’s overall compliance with state, local, federal, and insurer requirements.
Further, the drive to reform health care will inevitably include additional measures to crack down on health care fraud and abuse, through new regulations or toughened stances on existing regulations. For example, the Health Insurance Portability and Accountability Act (HIPAA) has been an ongoing source of challenge for health care provider organizations since its enactment in 1996. In 2010, health care providers will face tougher HIPAA enforcement with the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH), which passed in February 2009 as part of the American Recovery and Reinvestment Act of 2009 (ARRA). HITECH significantly expanded the reach of HIPAA and increased the penalties for HIPAA violations.
A key element of effective revenue cycle management is to identify patient-pay balances prior to service for scheduled patients and, for walk-ins or emergency department patients, at the time of service or as soon as possible thereafter, preferably while the patient is still at the facility.
The Red Flags Rule, enacted to combat identity theft, which is recognized as the nation’s fastest growing crime, is another regulation that requires a response from patient access. Enforcement of the Red Flags Rule has been delayed a fourth time, with the most recent extension pushing the enforcement date from November 1, 2009, to June 10, 2010. Although the extensions have provided more time for organizations to prepare for enforcement, patient access leaders must act now to ensure the tools, technology, and processes are in place to comply with the rule.
“Many facilities have just written down their Red Flags Rule policies and filed them away without changing anything on the front end,” notes nTelagent’s Winter. “This is a big mistake. Preparing for the Red Flags Rule is just good business practice: protecting the facility and safeguarding patient identity.”
As patient access leaders look to 2010 and the challenges that loom, the most assured route to success is to focus on superior service. It touches on all aspects of front-end processes. Superior service means that queries to gather patient demographic and insurance data are thorough, allowing patient access employees to generate a complete and accurate patient record that at once protects patients’ identity, paves the way for the delivery of quality care, and sets the stage for the organization to get paid for services provided.
In tough economic times, for organizations and individuals, and as health care reform looms on the horizon, 2010 promises many significant challenges for health care providers and the patients they serve. It is imperative patient access leaders prepare now for the challenges to come by improving processes, investing in technology, and providing ongoing education and training so front-end employees can successfully navigate issues related to service, technology, cost-shifting, and new regulations, in the new year and beyond.
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