A patient at University of Arkansas for Medical Sciences Hospital calling for an appointment with an ear/nose/throat specialist was told she would have to wait many months. Thanks to a newly implemented approach, she was able to see the specialist 189 days sooner than expected.
“We are starting to roll out the ‘Fast Pass’ option to get long wait times cut down,” says Amy Gross, director of the pre-access business center within the revenue cycle division.
The new system works like this: When an appointment is canceled or becomes available for other reasons, patients who have been marked on the waiting list are offered the open slot. Five patients are contacted simultaneously by email, text, and the patient portal. The first person to respond is booked.
“After the first person accepts the new appointment, then the others are unable to also accept it,” Gross explains. The four other patients stay on the waiting list. If another appointment becomes available, the process starts again. The process has been live for only about a month, but is already receiving high marks. “It is definitely a patient and provider satisfier,” Gross notes. Previously, patients had to call back repeatedly to see if any appointments were available. This was time-consuming for provider’s offices, too. No one was happy. “Patients honestly prefer scheduling appointments through their phones using text messaging technology or MyChart,” Gross offers.
Booking patients sooner also is financially beneficial for the hospital. “Filling an open slot on a provider’s schedule provides us additional revenue,” Gross adds.
No additional full-time employees (FTEs) are possible at this point, even though registration area staff are seeing higher volumes. “We have to maintain our processes in a budget-neutral approach,” Gross says. Since Fast Pass patients are contacted electronically, and the appointment is booked automatically, no manual processes are needed. “We don’t need a staff member to look at the open slot and then reach out to the patient,” Gross says.
The Fast Pass option is just one example of how the department is moving toward self-registration. “We’ve relied on technology to help with some of our staffing issues,” Gross reports. Previously, patients had to register and schedule an appointment over the phone. This was time-consuming for everyone. While people could request an appointment online, they could not actually schedule it. Now, established patients can. “We are trying to automate all of the processes where we normally require FTEs,” Gross says.
Self-scheduling is about expand to new patients, too. Additionally, patients can review and update demographic information on their computer or smartphone, saving time and increasing registration accuracy. “Copay collection will follow soon, another example of how the work of registration is shifting to patients themselves,” Gross notes. This allows registration staff to focus on other departmental priorities. “Whereas a staff member used to ask patients demographic questions, we have registration staff working claims edits instead,” Gross explains.
This is particularly important for the department, because preauthorizations are becoming even more time-consuming. Providing the exact CPT code for the procedure that has been ordered is a particular challenge. “We run into a lot of issues there. We think we’re going to do one procedure, but the providers do a different procedure,” Gross says. This means that patient access authorized the wrong service. Of course, the incorrect CPT code results in a denial.
Ideally, payers would cover a range of services to prevent this from happening. “But that’s not always what’s negotiated in the contract. That’s a huge challenge,” Gross notes. The hope is that registration staff will be able to focus more on obtaining authorizations once e-check-in is implemented fully. “That’s what we are anticipating,” Gross adds.
As in most patient access departments, morale and engagement are ongoing concerns. Leaders alleviated any concern that the Fast Pass option, or other automated processes, would lead to layoffs. “We have communicated with our staff about the trends in healthcare access,” Gross says. Management emphasized that higher-skilled workers are needed to perform claim edits and ensure “clean” bills are sent out.
“We have many ways we appreciate staff and show them their value to the organization,” Gross adds. “Care coins” that can be redeemed for $5 credit at any hospital gift shops or cafeterias is one way of keeping spirits high. Staff receive these coins when someone compliments the care they provided. “We work really hard to help staff focus on the fact that we are here to serve our patients and families,” Gross says.