Rethinking and Reinventing Access Management Cindy Dullea, RN-BC, MBA, CHAM Chief Clinical Coach Marbella Technologies, Inc. Assistant Professor Uniformed Services University
The Alphabet Soup of Access Management Rules Based Scheduling Patient Focused Revenue Cycle Maximizing Efficiency RAC Audits Patient Flow Referral Management Self Scheduling ICD-10 Pre-Arrival Unit Electronic Orders POS Collections Self Service Eligibility Patient Loyalty Referral Management Clinical Management FRONT DOOR Medicare and Medicaid Changes Authorization Management Financial Clearance HCAHPS Employee Retention Insurance Verification
Source: Organization for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
Medical Care … is the Fastest Growing CPI Category
Implications Consumer Driven Healthcare Passing Medical Inflation to Consumer Spending Your Own $$ Curbs Excess Spending High Deductible Insurance Catastrophic Coverage Only Provider Impact Lower Utilization Increased Bad Debt Pricing Transparency Patient Confusion Decreased Satisfaction
Patient Confusion Quality Food Tastes Good and Everyone Was So Nice Pricing Concerted Effort At Deception? Trend toward Efficiency Service Convenient Friendly Easy What was the Patient Experience?
Current Healthcare Environment Credit Markets Frozen Economic Recession 17.% of All Americans Uninsured (2012) 60% of those Commercially Insured on High Deductible Plans with 10 million + Beneficiaries Bad Debt Skyrocketing Nationally National Debt Skyrocketing – averaging $1.311 trillion per year Healthcare Reform – new taxes
Hospital Strategic Response Develop a Strategy for Market Consolidation Assess acquisition opportunities Consider sale or affiliation opportunities Evaluate asset performance and ownership requirements Evaluate physician network strategies and ACO Adoption Manage the Balance Sheet Deploy cash judiciously Manage relationships with financial entities Restructure long-term debt Monitor balance sheet closely Update strategic capital plan Strengthen Operating Performance Improve throughput to increase capacity and revenue Fine tune growth strategies Rationalize programs and operations
Key to Success Physicians Consumers Enable a Great‘Front Door’ Experience Enable a ‘Smart’ Start to the Revenue Cycle Access ManagementOrdering, Scheduling, Registration Processes Utilize Resources Accurately andOptimally Care DeliveryProcesses BillingProcesses
Good Access Management Helps Hospitals Improves Physician Networks Connectivity = Better Service = MD Stickiness Strengthens Operating Performance Increase Utilization of Resources Decrease Labor/Supply Costs Reduce Bad Debt and Denial Write-offs Improve Cash Flow Basis for Great Customer Service Convenience and Courtesy = Positive Patient Experience Management Reporting Continuous Operational Improvement Development of Marketing Initiatives
Keys to Good Access Management 100% Coverage Pre-Registration Revenue Cycle Activities Identify Problems Early Start in the MD Office or Patient’s Home Utilize “Smart” Systems Goal to Replace Labor Understand the Nuances of Healthcare Learn From the Past Aggressive Data Collection and Feedback to Improve Operations Know Your Customer’s Preferences Self Service
Intelligent Scheduling Key Features Rules Engine Ensures Accuracy All Locations Search across Enterprise Provider Portal Self-Scheduling, Appointment Itinerary, and Online Order Submission Consumer Portal Self-Scheduling, Re-Scheduling, Appointment Details
What the Rules Engine Can Do… Based on the resource (or any resource detail), the task (or any task detail), and/or the patient (or any patient detail), the Rules Engine can: Prompt a question Insert a task Replace a task Delete a task Modify the duration of a task Delete a resource Add a resource Replace a resource Place an entry on a Worklist Update an entry on a Worklist …and, based on the answerto a question, the rules engine can do all this as well as promptanother question.
Expert Scheduling Knows the Rules Rule Rule Question Question Answer Answer
Multiple Locations – Service and $$ • First available time/date at each location where test is performed • Spreads demand across health system • First available time/date at each location where test is performed • Spreads demand across health system
Start the Revenue Cycle Early Goal is 100% Coverage Work Flow Mandatory MD Office Authorization and Referral Management Medical Necessity Checking (Coding) Pre-Registration as part of Scheduling Call Smart Eligibility Data QA Support Financial Counseling/Self-Pays Pricing Transparency Automate ABNs Screening for Govt and Charity Programs
Work Flow Insures 100% Coverage • View of All Arrivals • Rules define when items are ‘escalated’ • Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”) • View of All Arrivals • Rules define when items are ‘escalated’ • Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”)
Financial Counseling During the FC Visit self-pay pricing and other payment options are discussed.
Physician Stickiness Improve Their Efficiency On-line Ordering and Results Reporting Fewer Disruptions Medical Necessity Issues Illegible Orders Improve Their Office Efficiency Faster Scheduling (One Call or Web) Fewer Disruptions No Lost Orders Happy Patients Convenience with No Surprises Reminders (Appointments actual and preventative)
Results Reporting Attach results to the order or referral
Download to Smart Phone Exporting appointments to Outlook can be done right from the Appointment Book with a few clicks
Customer Self-Service Convenience Scheduling Pre-Registration Appointment Reminders No Lost Orders or Schedule Delays Patient Arriving Check-in Update Registration Payment Location Maps
Scheduling Convenience Option to pick preferred location
Avoid Registration Lines Option to pre-register for appointment
Eliminate Bad Prep Cancellations Links to onlineforms
Patient Itinerary Avoids Confusion Links to onlineforms
Why Not? Check In With Personal Devices
Labor Optimization Centralized Call Centers MD Referral Patient Scheduling Order Collection Pre-Registration Revenue Cycle Activities Resource Utilization Eliminates “Country Club” Scheduling Automates Manual Tasks (e.g. Eligibility, Order Tracking) Decreases “No Shows”
Call Center Productivity The Key is Expert AM Systems because - Faster Training - Cheaper Labor - Multi-Task Performance - Multiple Facility Coverage - Better, Consistent Customer Service Better Patient Experience!
Resource Optimization Block Times Allocated On Experience Resources Only Allocated for Time Required Open Slots that may be overlooked
Ritz Carlton Service Too Many Places to Call Lack of Information Integration Constant Replication of Information Patient Dissatisfaction Long Wait Times Confusing Campus Discourteous Employees