Patient access world is changing: Prepare for new service challenges

Warning: Your staff must be 'very skilled'

(Editor's Note: This is a special issue of Hospital Access Management that is focused on patient access and customer service. Inside, we give strategies for handling the most challenging customer service situations, including using feedback from patients to improve their satisfaction, giving patient access staff members the ability to provide excellent service, and evaluating the customer service provided by members of your department.)

"I've already been asked for that information 100 times. Why are you asking me again?" This commonly heard question is one example of patient frustration being directed at registrars through no fault of their own.

"The patient access world is changing, in terms of trying to collect co-pays, increasing ED utilization, security issues, fraud, and complex family situations," says Patti Burchett, director of registration and central scheduling at Bronson Methodist Hospital in Kalamazoo, MI. "There are an increasing number of questions, authorizations, and verification requirements that patient access specialists must consider during the process."

All of these factors make satisfying patients harder than ever for registrars, says Burchett. "Staff has to be very skilled in how to manage those situations," she says.

Registrars are one of the first "faces" seen by patients and their families when they come to the hospital, says Lynn Craven, patient access director at St. John Providence Health System in Warren, MI. Craven confirms that staff members smile as they greet patients and family members and say, "Hello. How may I help you?"

A few registrars have been recognized by Craven as "service excellence associates." "Their purpose is to help others within the department to develop and hone skills to improve interaction with our customers," she says.

Here are some strategies for particularly difficult customer service scenarios:

• Obtaining accurate registration information from an emergency department patient.

Patient access staff members are committed to obtaining complete insurance and demographic information before patients leave the facility, even in the emergency department, says Burchett.

"They work with the physicians and clinical staff to ensure the patient is promptly seen and treated, while balancing the need to capture demographic and financial data prior to discharge or admission," she says.

As part of Bronson's commitment to patient and family-centered care, initial registration is completed at entry and asks for name and date of birth. The full registration is completed in the patient's room, where the patient has more privacy and is better able to provide details once symptoms are addressed.

Previously, staff used stationary computers with their backs to the patient, says Burchett. "The computer laptops are now on carts, so staff are always face-to-face with patients," she says. "This improves patient and staff satisfaction, since it is more personal and safe."

• Having to ask for information the patient already has provided.

Staff now use scripting to explain why the same question is asked multiple times, says Burchett. "We stress that it's in the patient's best interest," she says. However, the department is also looking for ways to reduce the number of times patients are asked for information.

Bronson is installing software based on the concept of "one patient, one record," says Burchett. For example, if a patient presents to a primary care physician practice, his or her information will flow over to the hospital and all of the ancillary departments, she explains.

"If it is a current registration, staff shouldn't have to be asking for that duplicative information any longer," she says. "We expect that to be a huge satisfier."

• Explaining to patients why others were seen before them.

Some patients come to the outpatient testing area for scheduled tests, while others are unscheduled, which can cause dissatisfaction, says Burchett.

"We are looking at better ways to route those two different types of patients," she says. "Right now, they all come into the queue the same way."

An unscheduled patient might have 10 people ahead of her, says Burchett, and that patient sees a scheduled patient taken right in.

"It looks like that person got to cut in line ahead of them," she says. "We are trying to address that from a flow perspective and a customer perception perspective." One possibility is to have separate areas for scheduled and unscheduled patients with good signage, says Burchett.

• Explaining benefits when patients don't understand their coverage.

"For various reasons, such as language barriers or age, many patients do not understand what their insurance policies cover," says Craven. "This creates a need for us to educate the patient and family, at a time when they may already be under stress."

Staff members make an extra effort to explain the various payment plans offered. "This allows families to determine the option that will best work for their situation," says Craven. "Financial assistance and other social programs are also offered when necessary."

• Registering a patient who arrived without all the necessary information.

To prevent this, a pre-registration process was implemented in Erie, PA-based Saint Vincent Health Center's outpatient area. "Prior to a patient presenting to the hospital, we will pre-register them if they have been a patient here in the past 60 days with the information we have," says Rose DiLuzio, patient access manager.

Registrars obtain necessary authorizations or referrals before the patient comes in the next day. Once the patient arrives, registrars verify their demographic and insurance information, copy the patient's insurance cards and driver's license, and ask them to sign any required forms.

"We then put the armband on the patient, hand them their orders and labels, and direct them to the appropriate outpatient area," says DiLuzio. "All of this is done in about three minutes."


For more information on providing excellent customer service in patient access areas, contact:

Patti Burchett, Director, Registration and Central Scheduling, Bronson Methodist Hospital, Kalamazoo, MI. Phone: (269) 341-6370. Fax: (269)341.6648. E-mail:

Lynn Craven, Patient Access Director, St. John Providence Health System, Warren, MI. Phone: (248) 849-3429. E-mail:

Rose DiLuzio, Patient Access Manager, St. Vincent Health Center, Erie, PA. Phone: (814) 452-5006. E-mail: