Payer updates or provider processes often are to blame for inefficiency in patient access. This makes it very tough to measure or improve productivity for anyone.

“Understandardization is both internal and external to the revenue cycle,” says Brett Light, PMP, director of optimization for patient access and financial clearance services at Stanford Health Care in Palo Alto, CA. Here are some examples:

  • Payers vary significantly as to what is and is not covered based on location and provider type, and which facilities are in network;
  • Inconsistent payer requirements result in some patients arriving for scheduled visits without an authorization in place;
  • Providers use different scheduling templates, documentation, and forms;
  • Clinical documentation frequently arrives incomplete or unsigned from physicians’ offices, causing registration delays.

“When we expect our patient access staff to navigate these inconsistencies, we are setting them up for frustration, burnout, stress-related workers comp, and turnover,” Light explains. Most registration areas are far less productive than they could be. “The total cost of this decreased productivity is significant,” Light laments. “But most importantly, it is a key driver for decreased patient satisfaction scores.” Fairly or not, patients frustrated because of delayed care and registration wait times will blame patient access.

To assess productivity, patient access leaders usually rely on work queue reports such as missing registration fields, ancillary order verifications, and observation status notifications. “But it is equally important to look at indicators that patient access cannot control to see the full story on productivity issues,” Light says. Some examples:

  • Plan benefits changes that aren’t current in the registration system;
  • Tests that are medically necessary to complete before the number of days required by payers to give an answer on authorization requests.

“For many patient access leaders, tackling these external challenges can feel overwhelming,” Light notes. He suggests these three approaches:

  1. Start with what you know is your biggest obstacle to productivity. “Expand from there one step at a time, using a gap analysis tool,” Light offers. First, ask registrars to name some obstacles to productivity. Next, identify which of those originated outside the patient access department.
  2. Ask information technology to help you to automate reporting into a dashboard. Light says this makes it far easier to spot problem areas. “Use this tool to sit down with your clinical and payer partners monthly,” he suggests. “Discuss ways to reduce registration issues that are within their control.”
  3. Don’t rule out hiring some outside help. “An experienced consultant can tackle these issues quickly,” Light says. “The ROI will more than justify the investment.”


  • Brett Light, PMP, Director of Optimization, Patient Access and Financial Clearance Services, Stanford Health Care, Palo Alto, CA. Email: