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When doing more with less during recession, patient safety is a concern
Automation and education should not be skimped on
Due to the economic downturn, patient access departments are being asked to maintain programs with fewer resources and do more with less. Technology investments are being put off, and staff in some cases are being cut.
In this scenario, "providing excellence becomes even more important" for patient access, says Julie Johnson, CHAM, director of health information management at Mt. Graham Regional Medical Center in Safford, AZ.
"Getting the right information the first time and ensuring quality of information becomes an opportunity to help the organization survive during a recession in reduced denials and re-work costs," says Johnson.
Johnson says that about 2,200 workers have been laid off in her community, which has a direct impact on the patient access department. "These people have different severance packages, which all include COBRA that is paid for by the company," she says. "It is up to us as access professionals to guide patients to the benefits they still have."
Johnson says that one of the most important things you can do for your patient access staff is to help them with their own financial difficulties through training.
"When someone's spouse has been laid off, the work is not the first thing on their mind, but rather their own financial problems are the focus," says Johnson. "We are helping staff members by pointing them to free resources on the Internet about how to get out of debt and stay that way."
When budget cuts occur, usually the first item cut is training and education. "But if organizations will invest in their staff, the organization will be more likely to flourish during a recession because of the new information and morale-boosting that occurs when staff feel valued," says Johnson.
If you do have to downsize, Johnson recommends getting your team together to ask for ideas. "Give them the scenario: 'We must cut one FTE. How can we creatively do this?'" she suggests. "If everyone were to give up one hour of work to save one FTE, that would be one way to solve the problem."
Belva Denmark Tibbs, vice president of medical operations of Kaiser Permanente in Cleveland, says that the current economic downturn has affected members, most of whom have employer-sponsored insurance. "We have noticed a higher involuntary termination rate due to company downsizing or changes in company-paid health benefits," says Tibbs.
Tibbs says that for patient access directors, it is important to agree on what is most important to your area such as quality, service, or regulatory requirements. "Once you have identified the critical components, engage physician and frontline staff in candid discussions on how to do more with less," she says. "This is a great time to think small."
Tibbs says that the important thing is to "communicate, communicate, communicate. Tell people 10 different times 10 different ways about the reason for the budget cuts, enumerate the changes, and invite the staff to be part of the process," she says.
Obtaining feedback is invaluable, says Tibbs, as you and your team make tough decisions to meet budgetary constraints. "Keep staff and key stakeholders apprised of budget cuts and their intended impacts. Survey stakeholders to ascertain any unintended impacts of your decision."
Consolidation is key
If you're facing budget cuts, consolidation of patient access registration locations is a must, says Katherine Murphy, CHAM, director of access services at Nebo Systems, a subsidiary of Passport Health Communications Inc. in Oakbrook Terrace, IL.
"This creates more coverage for continued excellent service," says Murphy. She recommends:
cross training staff, not only in multiple roles, but in multiple locations;
preregistering patients during the scheduling process;
eliminating decentralized registration areas as much as possible.
Exploring automation to solve time-consuming activities is another good prospect. "An example of this is the manual quality assurance process that is so prevalent in the industry," says Murphy. "Automating this process is highly productive, and, in many instances, provides the user with instant results and directs them as to how to correct any errors."
It is highly unlikely, says Murphy, that a manual process can cover every registration data element, let alone make the necessary correction prior to billing the claim.
"This could result in payment delays, reductions, or no payment if it becomes a stale claim," says Murphy.
Keep morale up while downsizing by eliminating positions as they become open, says Murphy. "When supervisory positions become open, consider hiring people who would function at a lead or coordinator level instead."
One thing that you should not skimp on is the staff education budget, warns Murphy. "That is one area that helps keep the doors open and the money coming in," she says. "Continue to take time to celebrate successes, even if in little ways. Communicate and be highly visible to the staff. They need your support more than ever!"
ROI is your best defense
"Unfortunately we are in a position where you have to sometimes spend money to make money," says Murphy. "Showing ROI [return on investment] for technology can be the key to not cutting it off or inhibiting its implementation."
You'll also want to provide information showing the impact you have on patient service, throughput, and wait times. "Ultimately, we do not want patient access to become an area where patient safety is also an issue. This can easily happen when we start to hurry," says Murphy. "Mistakes can get made there that can trickle down to the ancillary departments."
Murphy recommends referring to the cost of billing the wrong insurance, or a dissatisfied customer who talks to 10 of his friends. "ROI is out there in many forms," she says. "It is one of our best defenses."
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