What bothers patients most about their registration process? Do they feel they are receiving enough financial information? A semi-annual survey specifically focused on registration offers answers to these questions and many more at Helena, MT-based St. Peter’s Health.

“This is a great opportunity to gauge satisfaction with the schedulers and registrars,” says Devon Murray, executive director of the revenue cycle. Like many hospitals, St. Peter’s Health has tracked satisfaction with organization-wide Press Ganey surveys for many years. However, these do not reveal enough specific information on the registration process. In addition to asking about the patient’s overall preregistration experience, the customized St. Peter’s Health survey asks patients to rate the:

  • degree to which the information given during preregistration was consistent with the information received during check-in;
  • preregistration representatives’ knowledge about insurance coverage;
  • preregistration representatives’ ability to explain estimated financial responsibilities;
  • degree to which they were presented with sufficient information on payment options and/or financial assistance.

Because the survey covers preregistration, estimates, and billing, it gives an overall view of the entire revenue cycle. Patient access staff did not realize how their jobs affect what happens later in the process. “It helps us identify what impact our front-end processes have on patient satisfaction with billing and follow-up,” Murray says. The main thing registration staff learned is that patients expect more information from patient access — and not just about registration. “We have found that many of our patients are craving more transparency from patient access,” Murray notes.

For patients, registration is only the first step. “They want to know what they can expect from the whole experience, including clinical and billing,” Murray says. These functions are outside the realm of patient access. Thus, staff did not know how to answer patient concerns. Patient access often fielded questions about clinical aspects of the visit, which they knew little about. This has changed by directing registrars to work alongside clinicians. “We have worked to integrate our registrars and schedulers in clinics with clinical staff,” Murray reports.

Likewise, many patient access staff felt out of their comfort zone when patients mentioned money. Training on how to provide estimates and how to answer financial questions was the answer. “Patients want to understand their financial options before they are even seen by the provider,” Murray says. Price estimates still are a central part of preregistration. When patients receive estimates, they often asked more questions than patient access staff could handle. This has changed thanks to training and scripting. “Registrars also have the ability to see estimates that were already created,” Murray adds.

The new survey has revealed a lot of good information on how patients feel about registration. Still, informal, real-time input is just as important. “If we wait for a formal survey to come back, we will miss out on important opportunities to make improvements,” Murray offers.

Patient access employees are told never to hesitate to notify leadership if a patient is unhappy. Staff also are encouraged to give feedback on how the department can improve. “Our staff works with patients every day,” Murray notes. “It is generally obvious to them what we can do to improve.”

Questions about Medicare as Secondary Payer were causing a lot of issues. Many patients complained about the questions. “Patients didn’t understand why we were asking questions that, in their minds, were not relevant,” Murray recalls. The department changed its scripting. Now, registrars explain why they ask the questions of Medicare patients and what people can expect at future visits. “It has improved patient satisfaction significantly,” Murray says.