THR continues transition to full-service call center

Training geared to 'consistent message'

Patient access specialists at Texas Health Resources (THR) hospitals are learning their job "as it was meant to be learned," one of the many positive outcomes related to implementation of a centralized intake center at the Arlington-based health system, says the center's director, Jeff Ferrell.

The new patient access intake center (PAIC) "has allowed us to centralize training for virtually all of the [13] hospitals," adds Ferrell. A recently hired training manager will not only help with the PAIC conversion, but oversee training for all patient access personnel, including those at the individual hospitals, he notes.

Before reporting to work at the hospitals, new hires will come to the PAIC to learn the system and complete on-line training modules, Ferrell says. "They will do some role-playing, go through a curriculum, and then go back to the entity to implement what they've learned."

Traditionally, he says, new patient access employees have "shadowed" existing staff — "sitting with them, looking over their shoulders" — for a week, and then switched seats to do the job for another week under the guidance of the veteran employee.

The idea behind the new process is to ensure that all access employees "get a consistent message," explains Patti Consolver, CHAA, CHAM, corporate director of patient access. "We found inconsistencies with processes [among the various hospitals], and it opened our eyes to making sure staff are all trained the same way, even though they're not all working at the PAIC."

That will include "refresher" classes for existing staff as well as the training for new hires, she says.

A powerful quality assurance tool for PAIC employees, Ferrell notes, is a monitoring system whereby supervisors can pull the actual calls made by access representatives. "When they hear themselves and there is not a lot of customer service in the voice, and they don't hear our signature question — 'Is there anything else I can do for you?' — that's the best training."

Implementation of the new PAIC, which is responsible for verification, precertification, and preregistration of patients, began in March with Presbyterian Hospital of Dallas, Ferrell says. "Staff drove to a new location, with a new setup, new computer and headset, and the same policies and procedures."

Five hospitals were up and running on the PAIC by the end of June, and 12 are scheduled to join the process by the end of October, he adds.

Results have been extremely positive, Consolver says. At the end of June, call center staff were collecting an average of $33 "for every patient that the PAIC touches." She credits much of that success to the technology that has been put into place.

"We were fortunate to have the tools to do some of the collecting, including a point-of-service [POS] system tied to the Internet so [representatives] don't have to get up from the desk to run the credit card," Consolver says. "That makes staff more willing to collect, because it's not a lot of extra effort."

Without that functionality — which at THR is accessed through the keyboard — some providers are reluctant to do POS collections in their call centers because it requires employees to leave their posts instead of staying with the telephone, she notes.

Price estimator 'tells us what to collect'

A consumer priceline portal that allows staff to request an estimate of charges for which the patient would be responsible also is facilitating the collections process, says Ferrell. "The managed care [department] came up with a database, and all we have to know is the patient's benefits, the deductibles, what has been met, and plug in those fields," he says. "Based on the price book and what the patient is having done, it tells us what to collect."

A patient having a CT scan of the head, for example, might be told, "You might as well pay for this because the deductible hasn't been met," Ferrell adds.

As representatives conduct the preregistration, he explains, they trigger the estimator as needed and it is then "running behind the scenes." When the figure is ready, it appears on the screen, Ferrell says, and the rep says something like, "By the way, we estimate your payment is this amount. How would you like to pay?"

The whole process, including inputting data from the plan, takes one to two minutes, he says. "Then we scan it to the patient's account and they sign it when they come in for services."

Despite the fact that many patients are unwilling to give credit card information during the call, he adds, "we still collect a high dollar amount over the phone."

A predictive dialer system allows PAIC staff not to have to talk to wrong numbers, bad numbers or answering machines, adds Ferrell. "It is constantly dialing two patients ahead of the patient specialist. If an answering machine comes on, it leaves a prerecorded message telling patients to go on-line [to preregister] or to call us back."

If a wrong number is reached, the system records that, he says, and automatically issues a list of wrong numbers. In some cases call center staff are working with reservations created by hospital schedulers, Ferrell notes, and when appropriate, the dialer system can send an e-mail to that scheduler saying, "You're not sending us good phone numbers."

Feedback from patient access directors at THR hospitals indicates the PAIC has "really helped with decreasing wait times," says Consolver. During the telephone encounters, she notes, call center reps help patients prepare for their hospital visits, reminding them to bring their insurance card and driver's license and to show up on time.

With the predictive dialer, the reps are able to reach a much higher number of patients than before, Consolver adds, "because they're not having to sit on the phone and leave message after message."

In the past, there might not have been time to reach and preregister, for example, patients coming in for a "low dollar" radiology or breast center appointment, she says.

Another technological timesaver has been the patient entity communication log (PECL), notes Ferrell, which "really has replaced the telephone and e-mail" as a way for PAIC representatives to communicate with hospital personnel.

"If there is an issue where a patient can't pay, we send a PECL [pronounced 'pickle'] to the financial counselor at the [hospital] and allow them to do what they do best," he adds. "It works both ways. We also use it for them to communicate with us."

The PECL is actually a dedicated web site at both locations, with messages "coming in just like e-mail," Ferrell explains. The message can be assigned to the appropriate person, with the status designated as ongoing or resolved, he adds.

The PAIC rep, meanwhile, ends the call by letting the patient know that someone from the hospital will be calling about the issue, Ferrell says.

"It's easier to go there than to remember a voice mail or e-mail," notes Consolver. "There is also a database, so we're able to track and trend and see if certain problems are consistent."

(Editor's note: Jeff Ferrell can be reached at Patti Consolver can be reached at