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These data can have a powerful impact
Statistics can 'prove what you feel in your gut'
An ancillary department repeatedly insists that patient access staff are entering the wrong orders. If this accusation was made about your department, what would your response be?
In this case, a patient access manager used data to prove that the errors were a very rare occurrence, and one that was being blown out of proportion.
"When we actually drilled down to the details, we had an error rate of .02%, which is basically human error. The problem wasn't being viewed in terms of the total volume or scope of our responsibilities," says Karen Veselsky, CHAM, regional director of the revenue cycle at Catholic Health Initiatives in Exton, PA.
"By gathering those statistics, you can really prove your case. It really proves what you feel in your gut."
Without these data, however, Veselsky would have had no way to support her conviction that the mistakes were rare. "In all likelihood, we would have wound up changing major processes, and probably patient flow," she says.
Patient access did periodic monitoring of these errors once the base rate was established and then stopped monitoring it until the ancillary department said it was happening again. The error rate still was in the 0.2% or .03% range, proving again that it was just the ancillary department's perception. Here are some other valuable data to have:
How much cash is collected by staff at the point of service.
"Obviously, whatever is collected by patient access, the back end doesn't have to collect," says Veselsky. "Costs are saved for postage, statements, and outsourcing to collection agencies."
Once you have established your cash collection goals, you can break these down to individual FTEs in your department, says Veselsky.
"In order to be very successful collecting point-of-service cash, you need to have a very strong preregistration and verification program, and have the software tools to be able to estimate what the patient's out-of-pocket expense is going to be," says Veselsky.
If you have all those components in place and you are a target of a reduction in the workforce, Veselsky says you can now say that, "If the expectation is, I collect X amount per month at the point of service and I have ten employees and you are going to take two away, that increases that point-of-service cash collection not to mention the other work that goes with that such as the preregistration and verification. You can ask, 'Now I need to spread that amongst eight employees. Is that achievable?'"
Data on your accuracy rates.
You want to be sure that demographic information as well as insurance information is validated, so that the bill is sent to the appropriate payer the first time. "Any rework is very expensive," says Veselsky.
"There is the whole revenue cycle that can either win or lose, depending on whether that registration is accurate," says Veselsky. For example, a utilization reviewer in care management won't have the correct insurance carrier notified for an inpatient admission, for authorization, or precertification, if it's registered incorrectly. Depending on the insurance, this mistake could result in a financial penalty for the hospital or, in the worst case, a total stay denial.
"If you have the incorrect demographics, statements can't be generated to the patient," says Veselsky. "Not to mention that, in most hospitals, the physicians rely on registration data for their billing. So this error doesn't just negatively affect the hospital, it negatively affects all the providers."
An impressive accuracy rate can change the perception of patient access in the organization. "If you've gotten a bad rap, so to speak, that 'The front end is always getting it wrong,' you've got to have those data available to say, 'That might have been true five years ago, but we've done a lot of education and training of our team members and now our accuracy rate is at 98%.'"
If you are measuring individual patient access team members against the volume of registrations to determine staffing levels, Veselsky says you need to take into account those functions of preregistration, verification, and financial counseling that go on behind the scenes as well.
To use the data to improve accuracy, you need to narrow them down to the team-member level and assess whether this is just human error or a pattern of behavior. If there is a consistent pattern of behavior where the team member doesn't understand how to register a specific insurance plan or may not be familiar with all the functionality of his or her HIS system, then education and training need to take place.
"Some facilities take it a step further and really monitor the claims that are being unbilled and for what reasons, and then equate them to dollars by registration team member," says Veselsky. "On any given day, a registrar would know, 'Because I made errors on ten accounts in the last three days, those errors are holding up $100,000 worth of billing.'"
This is powerful information to give to a team member, who might not necessarily correlate registration and billing, or fail to comprehend his or her role in the bigger picture of the revenue cycle.
Data that correlate longevity in the department to accuracy.
"If you can show what a longer-term team member's accuracy rate is, compared to a new hire, you can then make the argument that we really need to sustain and maintain our employee base," says Veselsky.
"A lot of hospitals view patient access as an entry-level position, and it probably was 10 or 15 years ago," says Veselsky. "It really should not be viewed as an entry-level position any longer."
This is no longer fitting, says Veselsky, because patient access team members are expected to know about reimbursement, authorization, to be a collector of point-of-service cash, to educate patients about their rights and responsibilities, and even ask clinical questions such as "Are you allergic to latex?" at the point of registration.
"The closer correlation you can make for improved accuracy for long-term employees will help you justify a higher rate of pay," says Veselsky. "If I have a five-year team member who is at 98% accuracy consistently, and my new hires are at 75%, I really need to make sure that my turnover is minimal."
Veselsky says that the way to do that is to create career paths and ladders and provide leadership opportunities for those longer-term employees, to entice them to stay within patient access. "A lot of people leave patient access because they can make more money or work better hours in another department. And most other departments view patient access as a battleground if you can be successful in patient access, we'll take you in the surgery department, or on another nursing unit." Your job is to give the team member a reason to stay in your department.
One approach that Veselsky says isn't effective is to have only two levels in your career ladder the team member and the director or manager.
"That doesn't really provide a lot of opportunities for a team member," says Veselsky. "You can create either coordinator positions, where there is mentoring of new employees that can occur; and then, as you get into larger departments, creating managers that report to director, and providing education and certification opportunities."
The idea is to clearly show that decreased turnover will improve your accuracy rates, which is a big cost saver for organizations. "Recruitment costs can be pretty high, so as the retention numbers go up, there are cost-saving opportunities there," says Veselsky.
Veselsky says that sometimes when organizations look at cutting team members in patient access, it's done as a "knee jerk" reaction.
If cuts are related to volume, that makes sense, or if you are implementing a software tool that will make a process more efficient, it may be justification to cut an FTE, says Veselsky. "But a lot of times, senior leaders will make a 5% cut across the board," she says.
The problem is that as more consumers are left with high-deductible health plans, or no health plans because they have lost their jobs, more resources are needed in patient access and financial counseling. "Staff need to explain to these patients what their financial liability is or assist them with completing a financial assistance application, so that the hospital's financial integrity remains intact."
Data on your productivity volumes.
This information can help you make a case for avoiding staff cuts, or if that's not possible, being upfront about how it will impact your department's productivity and the services you provide.
For example, you may know that on a given HIS system, a registrar who works eight-hour days should be able to generate X number of registrations. "If you can quantify that you are still going to see a given amount of patients, and you don't anticipate a volume decrease, you know that you will need a certain amount of staff to accomplish that job on a daily basis."
If staff are going to be cut, Veselsky says you should be "very upfront with your CFO or whoever you report to" about the services you will no longer be able to perform.
"You don't have any more hours in the day, you just have less people to accomplish the task," says Veselsky. "So you just have to sit down and say, 'I'm not getting any additional bodies to do this and I'm not reducing volume, so here is what I recommend we eliminate.'"
[For more information, contact:
Karen Veselsky, CHAM, Regional Director Revenue Cycle, Catholic Health Initiatives, 367 Eagleview Boulevard, Exton, PA 19341. Phone: (610) 401-3097. E-mail: firstname.lastname@example.org.]