A comment such as “I already answered that question” once was common at WellSpan Health in York, PA. These days, a comment like that is rare thanks to some recent changes in the preregistration process designed to stop redundant questions.
“It’s one of the things we all need to do better,” says Tracey Shetter, CHAM, manager of the organization’s patient access call centers.
Like most people, Shetter has been frustrated hearing redundant questions at many healthcare appointments. At a recent appointment, the registrar asked for an insurance card, even though it had just been verified at the lab in the same health system. “We have an EMR system for a purpose. Staff need to be actually looking at it,” Shetter says. Redundant questions, a well-known source of dissatisfaction, was a topic at some recent meetings. “It is an objective we are going to start to work on as an organization,” Shetter reports.
At the call center, employees routinely asked for all demographic and insurance information. They did so even if the system indicated someone else collected this information already. Some patients complained, and such redundancies wasted employees’ time. Still, it was not easy to teach staff to stop asking the questions. “It is a cultural change. It’s getting everyone to see that this is the purpose of Epic, and that [repeat questions are] driving our patients crazy,” Shetter says.
Staff could see if the information was verified already; the problem was that staff did not trust the process was handled correctly. “It’s a matter of trusting that whoever clicked the ‘verify’ button really did what they were supposed to do,” Shetter explains.
Also, this problem was not isolated to the call center. Needless questions were asked in radiology, doctors’ offices — anywhere patients presented. Shetter decided to make her department an example of how to change this long-standing practice. She told her staff, “Trust has got to start somewhere, and it’s going to start with us.”
It took multiple discussions over a period, but call center employees changed their ways. Now, they ask for information only when they have to. However, the same was not true of other hospital areas. Some people are preregistered by the patient access call center; such patients assume they will not have to answer more questions.
But when they present for services, registrars at those sites repeat questions anyway, according to Shetter. Confused patients complained they had given all the information over the phone already.
To prevent this, Shetter reached out to leaders. She encouraged them to educate registrars on how to tell if the patient had been registered already. If that is the case, and the patient already has an account number, there is “absolutely no need to ask the same questions over again,” Shetter notes.
All call center interactions are recorded for quality assurance. “The big thing is making sure our personalities on the telephone are what they should be. It’s all in your voice,” Shetter explains.
In addition to a friendly tone of voice and other criteria, QA specialists listen for redundant questions. If they are repeating questions, employees are coached not to do so in the future. On the other hand, staff are responsible for making sure information is up to date, including emergency contacts. Now, once somebody hits the “verify” button, it is valid for 60 days. There are three possible scenarios:
• It is more than 60 days since the patient last presented. This means a full preregistration is needed, but staff do not just fire away with a long list of questions. They start with a matter-of-fact explanation: “I see it’s been longer than 60 days since we last verified your information, so I will need to go through that again.”
With this kind of intro, says Shetter, “people answer far more willingly. The conversation goes more smoothly.”
• The call center does not need to contact the patient at all since all the information was verified sometime in the past 60 days. If the patient was seen at a doctor’s office recently and insurance was verified there, staff just complete the registration from the work queue. “We then don’t even need to call the patient,” Shetter adds.
• A full preregistration is not needed, but some information is missing. Usually, it is answers to the Medicare Secondary Payer questions that are missing. Staff begin the conversation by explaining that Medicare requires them to carry out this step every time for all Medicare patients.
Other times, the patient is coming for a diagnostic test that could be accident-related. This would not apply for services such as mammograms that clearly are unrelated to accidents. The question does need to be answered for most other tests, such as CT scans.
“If it turns out the test is being done due to an accident, it changes what insurance should be billed,” Shetter explains. For this reason, staff really need the information before the claim is sent out.
Ideally, the question is covered at the point of scheduling, but it does not always happen. “We reminded the schedulers to ask this question. If the answer is ‘no,’ we won’t have to call the patient,” Shetter says.
If this piece of information is missing, call center staff need to contact the patient. They explain, “I see that you recently verified your information at another WellSpan location. I just have a few questions related to this visit.”
Now that call center staff have stopped asking redundant questions, productivity has spiked. This is due to decreased call volume. “We are seeing an average of 1,500 fewer calls each month,” Shetter reports. Calls are answered in less than 30 seconds, on average.
Patient satisfaction is better because people can talk to someone immediately. “Nobody likes to sit on hold,” Shetter observes. “We are only calling the people that we really need to talk to.”
Shetter says the next challenge is to teach other registration areas to stop asking questions mindlessly. More patients are registering online now through the health system’s patient portal. Too often, when these patients arrive for an appointment, all the same questions are asked again. “Staff are so much in the habit of asking all the questions,” Shetter says. “They are just trying to do their job well. It was always something you just did.”