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Data show how staff measure against peers
Before a patient access employee starts work at Bronson Methodist Hospital in Kalamazoo, MI, he or she takes a proficiency exam, says Patti Burchett, director of registration and central scheduling. "That is the first level of us being able to assess whether they 'get it' or not, before they even hit the door."
Verification and authorization weren't something that access staff had to concern themselves with a few years ago, notes Burchett, but those processes have moved to the front end. "Accuracy when the patient is still here is absolutely critical now," she says. "Those skills have been added into our training."
Burchett says that data on accuracy, collections, denials, and patient calls are her primary tool to assess the skills of staff. "We are very heavy on measurements. We do a lot of monthly reporting," she says. For the first time, the department is using individual-level blind data, which allow employees to see how they measure up against their colleagues.
"The other tool we use is a gainshare program, which is based on the hot topic of the year," says Burchett. "If we want to focus on point-of-service collection, we will set targets for the year. Every quarter, the department has an option of receiving a benefit if those targets are reached."
While bar graphs showing individual staff members' performance are currently blinded, next year Burchett expects that the employee's name will be revealed. "If you are the low man on the totem pole and you are stopping the department from receiving the bonus that quarter, they're going to know that," she says.
Goal: 100% compliance
Burchett does random audits for areas such as verification. The department is currently aiming for 100% compliance with employees giving the notice of privacy to patients, she says.
"We will go through 30 employees on a weekly basis so we have a benchmark," she says. "It's more real-time than waiting for the end of the month, or worse, the end of the quarter."
Burchett also does some direct observation to assess customer service of her staff. "We don't do secret shopping, but process management is out there. At times, staff aren't aware that they are being observed," she says. "Thankfully, I've never been in a situation where somebody treated someone poorly."
Burchett continually looks for ways to improve processes, in order to reduce wait times. "It may be that if there is only one printer that staff keep running to, that you need another printer. If you spent the money and had four printers, it could decrease wait time by two minutes," she says. "Employees might be happier as well."
Managers routinely monitor calls to see if staff are obtaining all of the required information from the patient, says Burchett. "The managers absolutely love that tool, and not only from the perspective of customer service," she says. "If you get a denial and you can prove that, 'On the call, we discussed X, Y, Z,' that lost paperwork all of a sudden reappears."
Managers look for recurring errors on the calls, says Burchett, as an indication that staff need some remedial education. "It may be a specific requirement for a payer, such as needing an authorization within 24 hours," she says. "The industry changes so quickly in terms of those kinds of requirements."
While authorizations were always needed for Medicaid patients, commercial insurers typically required these only for high-dollar services. "Now, it's a brand new world out there," says Burchett. "You have to get verifications and authorizations for every kind of procedure that you can think of. The time that it takes to obtain those is increasing."
To help with this, says Burchett, a new data accuracy system is being implemented. "It's so important that the claim drops cleanly," she says. "Hopefully, we will see claims go out more quickly and payments come back more quickly."
The hospital's patient and family advisor council is another source of valuable input for Burchett's team. "They bring their perspective on whatever we are trying to work on, including a number of patient access initiatives," she says. "This is done primarily in the form of Kaizen events, which are a Lean process improvement tool."
The team makes the final decision on what the process should be, says Burchett, and then it is tested and re-evaluated. "The council members have assisted in work on our ED triage process, verification process, and notice of privacy process," she reports. "They have also worked on developing content for patient brochures that discuss wait times, physician information, and billing expectations."
[For more information, contact:
Patti Burchett, Director, Registration and Central Scheduling, Bronson Methodist Hospital, Kalamazoo, MI. Phone: (269) 341-6370. Fax: (269) 207-0848. E-mail: BURCHETP@bronsonhg.org.]