If goals are unrealistic, unclear, or outdated, patient access employees quickly will become unhappy, warns Craig Pergrem, senior director of revenue cycle, pre-service, and onsite access at Novant Health in Winston-Salem, NC.
"That is not something you want to have within any department," he says. "We make it very clear to the team what the expectations are and if they are meeting those expectations." Here are some pitfalls to avoid involving goals for patient access:
Goals need to be realistic.
At Riverside Regional Medical Center in Newport News, VA, patient access leaders strive to keep goals challenging but attainable, says Melanie Stanius, CHAM, patient access senior manager. "We want our team to stay engaged and not discouraged," she says. "Goals have to be clear and realistic for team members to clearly understand what they are working toward."
Staff members are required to meet goals for patient wait times, registration data accuracy report card grade, missed time of service, and quality audits. "We look for all registrars to maintain a registration accuracy report card grade of at least 98%," says Stanius. Supervisors monitor this report frequently and meet with team members if they see scores dropping.
You might want to see a 100% quality assurance score, but in reality this score isn’t possible to maintain. "Instead, set that goal at an attainable score so the team does not feel defeated by an unattainable goal," says Pergrem. "Goals should be motivational, not detrimental."
Daryl Wells, director of pre-access at Florida Hospital in Orlando, sets criteria for staff based on the number of admissions for the inpatient side and the number of prescheduled evaluations on the rehabilitation side. "Staff can feel lack of accomplishment due to not having a clearly defined, finite goal that they are striving for," says Wells.
On the inpatient side, each team member has an assigned payer split and must meet any 24-hour notification requirement for their payers. "They also initiate the authorization process as needed, for all patients with an inpatient or observation level of care status," says Wells. Staff working weekend shifts focus on the payers that require 24-hour notification.
"When representatives receive concurrent or retrospective denials from payers, they are responsible for notifying the hospital’s utilization review team," says Wells. The team either sends clinical documentation in support of continuation of the stay to the payer or works with the case management team to facilitate the timely discharge of the patient.
The pre-access outpatient rehabilitation team’s current goal is to work on accounts at least three days out from the actual date of service. "Representatives verify benefits to match the specific modality of treatment and verify if an authorization is necessary for a specific payer," says Wells.
Goals should factor in system problems.
During the rollout of the hospital’s Epic system, patient access areas had some difficulty with "bolt-on" products such as kiosks and cameras.
"That can cause a shift in the percentage of use for the goal," says Pergrem. "We can then delete the days during the outage, to make it fair for all team members."