Before revenue cycle leadership proceeded with its detailed front-end modernization project at Ann & Robert H. Lurie Children’s Hospital of Chicago, they had to run it by some very important people — the hospital’s family advisory board.
While it was time to take a fresh look at registration, admissions, and check-in, the group had to ensure that registration processes were not holding up patient care.
“We really wanted to ensure we were meeting our patients’ needs,” says Marcus C. Ingram, director of financial clearance.
“We hadn’t enhanced the workflows in many years,” adds Jason Muldrow, senior director of information management. Because of this, the department could not take full advantage of the available features in the registration system. Front-end processes needed to be more patient-friendly.
“We wanted to be sure solutions were fixing actual challenges from the perspective of our families, and not just an issue we assumed existed,” Ingram explains.
Finally, revenue cycle leaders brought their patient-friendly ideas to the hospital’s family advisory board. This group includes parents of children with extensive inpatient and outpatient experiences at the hospital. “Much of the feedback reinforced what we had been hearing from our families for a while,” Muldrow reports.
A faster, less cumbersome process was at top of the list of fixes. “What was surprising was the feedback related to the physical space and layout,” Ingram says, noting that some families found it challenging to engage in lengthy discussions at the point of registration with multiple siblings in tow. “In the pediatric space, you have to consider the family and not just the patient.”
These busy parents asked for more self-service options. They wanted the ability to complete registration forms via personal devices. “But they were clear they did not want this to replace the ability to work with a representative to complete these functions,” Ingram adds. To get the balancing act just right, Muldrow says leaders “were careful to implement workflows that meet our revenue cycle needs but were very patient- and family-friendly.” The department made a few changes, including:
• Front-end processes were optimized to work with the patient portal. “We simplified our payer structure in Epic to make it patient-friendly on MyChart,” Muldrow explains. Families just need to select their insurance, and the hospital’s real-time eligibility vendor identifies and verifies the coverage.
• Registrars reverify demographic information much less often. Families were asked to verify addresses and phone numbers repeatedly, even if they presented for multiple appointments in a given week. “Sometimes, our staff would ask to verify this information every visit, even if it wasn’t recommended by the system,” Muldrow recalls.
Staff were instructed to verify only if the system tells them to. “This exception-based registration is faster and more family-friendly,” Muldrow says.
Time frames to reverify all registration were expanded. Patients were asked to complete this tedious task every nine months, but the time frame is now 18 months, which helps reduce frustration. Previously, access to registration functionality was limited to centralized registration. Thus, unregistered patients arriving for appointments were directed to a registration phone connecting them to this team. Patients did not understand why employees at check-in could not update basic registration information. “The registration phone call process was a major point of dissatisfaction for families,” Ingram says.
The point-of-service teams at appointment check-in were cross-trained to engage in registration conversations with families and update information as needed in the electronic medical record. “This allowed us to eliminate the registration phone call,” Ingram reports.
The central registration team now handles preregistrations for new patients or existing patients who have not been seen within the last 18 months.
• Families can update their own registration data via the patient portal or check-in kiosks. This hastens registration since the data is entered before the visit. “The point-of-service rep doesn’t need to get the information from the family,” Muldrow notes. “They can just complete the check-in.”
• At check-out, when follow-up visits are scheduled, registrars verify data or collect document signatures for items that will expire on or before the next scheduled visit. This means less hassle and a streamlined registration process for families at the next visit. “The thought was if we have the family in front of us now, let’s collect and verify as much data as possible for the next known visit,” Muldrow explains.
To patients and families, every registration is a personal encounter. “One of the simplest things a registrar can do is greet with a smile, eye contact, and a warm welcome,” says Admitting Services Director Jose Celio.
Scripting is meant only as a guideline. Registrars are not supposed to recite it word for word.
“We leave it up to them to personalize it. Patients and families don’t want to feel like they are talking to a robot,” Celio says.
Patient Registration Account Liaison Victoria Rainey often observes that coming off as approachable and friendly can make a big difference to worried parents. Admitting staff smile warmly at patients or parents and use a pleasant tone of voice on the phone. When parents ask about wait times, registrars do more than just tell them how long it will be. “They find the charge nurse or room nurse to ease the parent’s worries,” says Rainey. Also, Rainey notes that some of the biggest satisfiers are as simple as directing patients to the nearest coffee shop.