Patient Satisfaction Planner: Bedside registration: Wireless system’s a hit

Technology, focus on efficiency produce results

Bedside registration in the emergency department (ED) and a new transfer center are the latest innovations helping to define the department of patient access and business operations at Philadelphia’s Presbyterian Medical Center.

The creation of the new department began in July 2001 with the hiring of Anthony M. Bruno, MPA, MEd, as director of patient access and business operations.

"When we spoke before," he adds, "[the admissions department] was only open five days a week. As of July 1, we’re open seven days a week, and the hours are 6 a.m. to midnight. It’s all part of developing a department that didn’t exist a little over a year ago."

Although a wireless system for bedside ED registration has been approved recently, the ED process has greatly benefited from the paper bedside registration already in place, Bruno reports. "We’ve moved the registration process from the front-desk triage window to the bedside. We’re working with the clinicians to get the patients back to the exam rooms more quickly and to not have people languishing in the ED waiting area."

In addition to enhancing patient satisfaction, bedside registration has reduced the left-without-being-seen number that every ED tracks, he notes.

Another advantage of wireless bedside registration will be its ability to coordinate with the EMTRAC (emergency medicine tracking and charting) system, a product that allows clinicians to enter orders and chart information for ED patients directly into the computer, he says.

In effect, the ED will be paperless, he says, "with everything entered [directly] into the system. By having wireless [registration], we’ll be able to put in that information more quickly, which will allow [clinicians] to do their EMTRAC more quickly. It will help expedite charges for the billing system as well."

One of the biggest accomplishments of the fledgling patient access and business operations department has been the establishment of the transfer center, Bruno says. Helping to oversee that effort, he notes, has been admissions manager Karen Randall, one of several members of the management team Bruno assembled soon after taking his position. "Karen and her staff have worked to set up a much tighter screening process for patients who arrive uninsured and candidates to be transferred," Bruno reports. "We have the ability to screen patients and make decisions as to whether we can accept patients who are uninsured from other facilities. We have a very strong insurance pre-certification process that wasn’t in place in the past."

Immediately after a physician from another hospital calls a physician at Presbyterian Medical Center to ask about transferring a patient, Randall explains, "we turn around and call the other hospital and ask for an admission sheet."

"When we find out the patient is uninsured," she continues, "we ask why the patient needs to come here. Then we contact the financial counselor, and she calls the referring hospital to find out if a Medicaid application has been started for the patient. If so, we continue where they left off. If not, we start one. Once we find out there are no hitches, we approve the transfer. It usually takes about three hours."

"This is another example of admissions and the business office working together as a team," Bruno adds.

A physician is brought into the process to decide whether there is a medical need for the patient to be transferred to Presbyterian, Randall says. "[The physician from the other hospital] has to plead the case, and it has to be clinically approved." Before a formal admission process was established for transfers in January 2002, "patients were just called in and transferred with no questions asked," she notes. "It was just like an open-door policy."

In the case of a patient who is insured, Randall says, an access employee calls the insurance company to confirm that the coverage is in place and that the hospital participates in that insurance plan. "Then we go back to the bed board and confirm that a bed is available. It takes about half an hour." If there is a problem with the insurance, she notes, the hospital administration makes the decision on whether to accept the patient.

Efficiency decreases amount of free care

As a result of the new transfer process, the amount of free care provided by the hospital has declined, Bruno points out. "It’s not that we don’t want to give free care," he explains, "but we want it to be something we control."

Broadening its scope in another direction, the admissions center recently began performing all the insurance pre-certification and verification for the 35 physicians in the hospital’s cardiology groups, Bruno says. "We made the commitment because cardiology is one of the major product lines, and [the physician groups] had difficulty trying to manage all of the pre-cert requirements. We felt we could help them do it very efficiently."

"We started the pilot in March, with four physicians and one practice, and as we were praised and given accolades, everyone wanted to jump in," notes Randall, who previously worked as the manager of admissions and outpatient services for a specialty heart and lung center. "By June, we took on all the cardiology practices."

Although no formal figures were available, the amount of collections has increased since admissions took over the pre-cert duties, Bruno says. "There are no more denials because insurance companies were not called. All authorizations are put into the [admission/discharge/transfer] system and go to the [case managers] so they have the information at their fingertips."

In the past, he adds, insurance companies often were called two or three days after patients arrived, resulting in reimbursement "carve-outs" for the days that weren’t preapproved. "We are now looking to expand to the department of surgery and perhaps orthopedics."

To handle the increased duties, the admissions center recently hired a second pre-certification coordinator, Bruno notes. "On the outpatient side, we’ve taken on the responsibility for registering the cardiology patients as well."

As part of what Presbyterian Medical Center’s practice partnership program, he has put together a hospital services directory describing the different services offered at Presbyterian Medical Center. The directory was designed to be a guide for physician offices, allowing them to more easily contact various departments within the hospital, Bruno adds.

"If you want to contact medical imaging services, for example, the directory will tell you the location, the phone and fax numbers, the hours of operation for inpatients and outpatients, and lastly, will describe who the management is," he explains.

Although there is a telephone book for the University of Pennsylvania system, it has about 300 pages, he points out, making it difficult to pinpoint the right number for the specific service needed. The book also gets out of date pretty quickly, Bruno notes.

"We’ve gotten a lot of feedback [from physician offices], and they love it," he says. "They’ve asked for multiple copies to give to the staff."

[For more information, contact:

Anthony Bruno, MPA, MEd, Director of Patient Access and Business Operations, Presbyterian Medical Center, Philadelphia. Telephone: (215) 662-9297. E-mail: anthony.bruno@uphs.upenn.edu.]