Patient access leaders at Sutter Health often fielded complaints from patients about registration wait times. A new pre-registration process cut average registration wait times of 20 minutes to less than eight minutes.
- Sutter Health patients are scheduled and pre-registered in a single phone call.
- Patients who have completed pre-registration at Sutter Health have a speedy check-in process.
- Day Surgery Patients Are Registered At The Bedside At Children’s Healthcare Of Atlanta At Egleston.
Patients often complained about the lengthy waits and the registration process at some radiology and breast health departments at Sacramento, CA-based Sutter Health.
“There was high patient dissatisfaction, due to backlogged waiting rooms and disjointed processes. We now have a fast track process in place, with average wait times at five to eight minutes,” says Becky J. Peters, system director of patient access services at Sutter’s Shared Services Center in Roseville, CA, which houses the health system’s newly created Patient Access Center.
Previously, says Peters, “We had very little true preregistration or financial clearance prior to services.” Most patients had to complete a full registration and pay out-of-pocket balances, prior to service. “We had dissatisfaction issues with patient wait times and delay in services, from both patients and clinical departments,” says Peters.
To shorten wait times, the department implemented a pre-service model for registration. Staff members at the centralized Patient Access Center complete pre-registration, financial clearance, and financial counseling in a single phone call.
“At our Oakland facility, we had patient wait times averaging 20 minutes,” says Peters. “Preregistration is now completed for 70 to 80% of our scheduled patients, who are then able to be fast-tracked.” Average wait times for patients to complete a full registration are now five to eight minutes.
“Once an appointment is scheduled, it populates our Patient Access Center work queues,” explains Peters. “It is then segmented to the appropriate work team.” These steps occur:
- The scheduling department transfers the call to a financial clearance representative.
- The financial clearance representative completes a full pre-registration. “He or she verifies eligibility and benefits, confirms authorization if required, provides a price estimate based on the scheduled service, and collects,” says Peters.
- Staff refer patients who need help with their out-of-pocket responsibility to a financial counselor, who assists them with payment plans and/or charity screening.
- The Patient Access Center team informs the patient, “Since you have completed the preregistration process, you can proceed directly to the department on the date of service. You will receive a speedy check-in.”
A daily appointment report flags patients as a “Go” or “Stop.” If the indicator is “Go,” registrars know the patient has completed preregistration. In this case, they just need to scan the patient’s insurance and identification and have the patient sign the consent form.
If the indicator is “Stop,” then the patient needs to complete a full registration. “This may be due to the preregistration process being incomplete, or the patient may have to make a payment,” says Peters.
At Children’s Healthcare of Atlanta at Egleston, patient access recently switched to bedside registration at the hospital’s 30-room day surgery department. Improving patient satisfaction was the biggest motivating factor for this change, says patient access manager Michelle H. Crumbley, CHAM.
“Our waiting room is not very large. During our busiest days, folding chairs are brought out, and we have families waiting out by the elevator,” she explains.
With limited space, there wasn’t enough privacy during the registration process.
“Patients are now brought directly back to their assigned room,” says Crumbley. “Patient access comes to them.” This process is used:
- Upon arrival, patients are greeted by a registration coordinator and are signed in.
- The Day Surgery team provides a list of the day’s room assignments to the greeter.
- A patient care assistant brings the patients back to a room. “Once in a room, they can now be more comfortable. The child can even lay down or watch TV,” says Crumbley.
Registrars use a wheeled computer to register the patient, collect out-of-pocket costs, and obtain signed consent forms.
- An electronic status board lets physicians and nurses know the patient is in a room. “Registration turns a light on above the door, once they are finished” to alert clinical staff members that they can now come into the room to begin treatment, says Crumbley.
“We’ve seen many benefits from this process,” says Crumbley. “We have brought together patient access and nursing.”
When registration was done in the waiting room, patient access and clinical staff members had no contact with one another. “But our impact on each other was huge,” says Crumbley. “We now share in a common goal, and our teamwork shows.”
Physicians now can see their patients between surgery cases, since the patient is already in a treatment room. “Before, patients might have been sitting out in the waiting area waiting for registration,” says Crumbley.
Family members are much less anxious and more comfortable being in a private room. “They are more willing to pay their copay in a private, relaxed environment,” she says. “And patient access staff feel more a part of the clinical team caring for the patient.”
Customer service scores, registration wait times, surgery first start times, and turnaround times are all being measured. Because the process just started in January 2015, little data is available.
“But even without these numbers, the success is evident by walking out into the waiting room,” says Crumbley. “There are no more folding chairs and no long waits.”
- Michelle H. Crumbley, CHAM, Manager Patient Access, Children’s Healthcare of Atlanta at Egleston. Email: Michelle.Crumbley@choa.org.
- Becky J. Peters, System Director, Patient Access, Sutter Shared Services Center, Roseville, CA. Phone: (916) 297-9004.