Patient access has always lacked benchmarking data and key performance indicators focused on the front end of the revenue cycle, but this is changing. Departments are:

  • using registration metrics to set productivity expectations;
  • identifying how many full-time employees are needed in registration areas;
  • determining the hourly cost of a registration.

Patient access saved nearly $3 million in one year at Winston-Salem, NC-based Novant Health. They did it by using two Key Performance Indicators (KPIs) measuring productivity.

“Benchmarking is important in any industry. But in patient access, there has been a lack of standards beyond collections metrics,” says Danielle Andujar, assistant director of onsite patient access at Novant Health.

The patient access department began using the National Association of Healthcare Access Management’s (NAHAM) newly developed AccessKeys in 2016.

Previously, there were no KPIs available specific to patient access.

The KPI data are “invaluable in understanding opportunities for improvement,” Andujar notes.

Armed with data indicating what changes were needed, patient access set to work.

“We are moving forward with operational change to better position ourselves in the current healthcare landscape,” Andujar explains. Here is how the department put its newly discovered data to use:

  • The “average registrations per person per day” metric revealed the number of registrations a team member should complete per hour.

Patient access set a productivity expectation for the team of five registrations per hour. This allowed them to go to the next step: Comparing volume per hour to determine how many full-time employees were needed in each registration area.

“The results were surprising. At some facilities, we were overstaffed,” Andujar recalls. “We adjusted our staffing plans accordingly.”

  • The cost per registration metric determined the hourly cost of registration at each non-emergency registration point.

“This revealed areas that had very high cost,” Andujar says.

The most shocking finding involved decentralized registration points. It became apparent that it was far more expensive to complete a registration in those areas.

The compelling data enabled patient access to persuade facility leaders to consolidate registration points. This was something they’d tried before without success.

“We previously tried to persuade facility leaders to consolidate due to the challenges in staffing multiple areas, and were unable to,” Andujar notes. “The data [were] instrumental.”

Patient access proposed consolidating some registration points. They also suggested changes in hours of operation at other registration areas if the volume did not support remaining open. Radiology and general admitting were consolidated. This change resulted in significant cost savings. “Due to the desire to have a boutique-like mammography area, we have not consolidated the mammography registration point at this time,” Andujar says. However, hours were changed at several facilities. “The majority close an hour or two earlier, based on volume,” Andujar adds.

  • Collection expectations were categorized by facility, based on geographic and socioeconomic factors.

The collection goal for a facility with higher elective services was set to “best,” (2% of net revenue). In contrast, the goal for an urban trauma facility was set at “good” (1% of net revenue).

Previously, all facilities set the same goals. “2017 was the first time we varied goals by facility,” Andujar says.

“We have gone even further in varying these goals in 2018.”

Setting clear, attainable expectations for each facility allowed for the capture of significant additional revenue.

“We were able to increase our average monthly upfront collections 21% over the prior year,” Andujar reports.

Historically, revenue cycle-related KPIs focused mainly on the “back end,” also referred to as billing and collections. “Only in the past 10 years has the focus really begun to shift to the front end,” says Michelle Fox, DBA, MHA, CHAM, director of revenue operations/patient access at Health First in Rockledge, FL.

The new focus on sending bills quickly and accurately to receive appropriate reimbursement for services called for new KPIs focused on the front end of the revenue cycle.

“It is vital to a healthcare organization’s bottom line that the patient access department be able to measure and benchmark its performance,” Fox underscores.

Hospitals have always closely tracked the “clean” claim rate, A/R days, denials as a percentage of net revenue, charity dollars, and total cash collections. Until recently, though, the role of patient access in these important revenue cycle metrics has been largely overlooked.

“KPIs gave our department the data it needed to make strategic operational decisions,” Fox says.

NAHAM’s AccessKeys focus solely on front-end functions of the revenue cycle. These include demographic information obtained from a patient, verification of insurance eligibility and benefits, and upfront collection of patients’ financial responsibility.

“These are all critical steps to aid in the process of sending a clean bill out in a timely manner — and, ultimately, improving cash flow,” Fox says.

The AccessKeys allow a hospital to benchmark against their peers in the areas of collections, conversions, patient experience, critical processes, productivity, and accuracy. Based on the KPIs, Health First’s patient access staff were reorganized based on their individual strengths. The goal was to increase both upfront collections and productivity. “We used to have all pre-registration staff creating accounts, verifying benefits and authorizations, creating estimates, and calling patients to collect,” Fox explains.

The pre-registration team was split into two groups. “Account creators” are responsible for creating the account, verifying benefits and authorizations, and creating estimates. “Account collectors” are responsible for calling patients with financial responsibilities and asking for payment. “We have four collectors that are collecting, on average, about $525,000 a month over the phone,” Fox says. Point-of-service collections as a percentage of net revenue is one of the KPIs that is monitored every day. “Best practice is 2%, and we are there,” Fox reports. “Now, our goal is to maintain at least 2% on a monthly basis.” During one month, the metric hit 2.8%. “This was a direct result of process improvements put in place,” Fox says.

Most importantly, registrars are required to run estimates to be run for all patients. This initiative is called “100% Estimates, 100% Ask.” This means all patients receive an estimate, and all patients with a financial responsibility are asked to pay.

“Front-end staff not only collect the set copay amount. They also know what coinsurance and deductibles are remaining,” Fox says. Staff speak with confidence about patients’ benefits and financial responsibility. Patients can tell staff are well-versed in the matter, making them more likely to pay. “It really was a win-win for everyone,” Fox adds. “It has worked wonders for us.”


  • Danielle Andujar, MBA, CHAM, Assistant Director, Onsite Patient Access, Novant Health, Winston-Salem, NC. Phone: (704) 384-3077. Email: dfisher@novanthealth.org.
  • Michelle Fox, DBA, MHA, CHAM, Director, Revenue Operations/Patient Access, Health First, Rockledge, FL. Phone: (321) 434-6017. Email: Michelle.fox@health-first.org.