Patient satisfaction surveys probably include at least a few questions about registration. The problem is patients really do not make a distinction between registration and the clinical service for which they have arrived. “Often, the terminology of the questions leads to answers about other areas,” says Heidi Kennedy, director of patient access at North Mississippi Health Services in Tupelo. Previously, the patient satisfaction survey asked people to rate how satisfied they were with “wait time in registration.” Of course, patients did not realize staff were asking them to consider only the time they spent waiting to register. They rated their satisfaction based on the overall time they spent waiting to be seen, including post-registration.
If a patient was registered immediately, but then waited an hour to be seen because a clinician was backed up, that person would probably rate satisfaction with “wait time in registration area” as low. To obtain better data, the patient access department reworded the question to “wait time to register.” It turned out to be an important distinction. “What we have found is when wait time increases, patient satisfaction scores decrease, and vice versa,” Kennedy reports.
Preregistration has greatly improved satisfaction because things go much smoother on the day of service. “Patients are better prepared. They know how much they owe, when applicable,” Kennedy observes. “It decreases wait time and enhances the ease of registration.”
Kennedy says two other specific metrics are helpful in telling the “patient experience” story. Respondents are asked to rate “helpfulness of the registration person” and “ease of the registration process.” Patient experience with registration is notoriously hard to measure. “It gets so muddled across the scope of interactions that patients have,” says Debi Lasswell, director of revenue cycle transformation at Bluetree Network.
Lasswell recommends creating a list of “quick hit” metrics to tell the story of how patients are treated. These could include scheduling lag time, appointment cycle time, cancelations or reschedules initiated by the hospital, patient estimate accuracy rate, the percentage of patient estimates provided, and accounts sent to bad debt. “These are all good things to report out on, to monitor at a high level what’s going on with the patient experience,” Lasswell offers.
No patient comes to the hospital just to be registered, after all. They come for a test, procedure, or surgery. Therefore, when asked about wait times in registration, patients do not separate the chunk of time they spent waiting to be registered. They will look at the total time they spent in the registration waiting area.
“Regardless of whether the patient is waiting or being registered, it is all time that is keeping them from the service they actually came to receive,” says Sue Plank, LCSW, CHAM, director of patient access at Goshen (IN) Health.
The department calls this time spent waiting the “patient experience time.” There are three metrics the department uses to assess it: The actual number of patients who waited more than 10 minutes, the time it takes to register, and the percentage of accounts that are preregistered by the day before service.
Amanda Gordon, senior director for patient access and customer service at Portland, OR-based Legacy Health, says frequent use of the MyHealth patient portal is a good sign that patients are engaged. More than half of payments are now made through this portal. “There’s a lot more automation than we’ve had in the past,” Gordon reports.
Before, patients had to call customer service to set up a payment plan. Now, patients can set that up online, including adding new balances to existing payment plans. Other sources of patient experience data come from community members who offer feedback. “Sometimes, the trap you fall into is that you know the business so well, but it doesn’t necessarily make sense to the patient,” Gordon shares.
Assumptions are challenged based on what the community members report. One incorrect perception was that older patients were not inclined to want to use automation. “This is something that was not supported by community members’ input,” Gordon says. Based on the feedback, the department is making a strong effort to engage patients before service whenever possible. “We start to have the conversation about the procedure they’re going to have. We provide estimates,” Gordon says.
Patient access staff are expected to fully understand the revenue cycle. “In the past, we gathered a few pieces of demographic information, and sent the patient on their way,” Gordon recalls.
Today, patients expect staff to help with complex questions about financial assistance, price estimates, and enrolling in Medicaid. Secret shoppers are another method used to keep an eye on patient interactions. “It’s not punitive; it’s purely to educate,” Gordon says.
Observers look for whether staff explain why the patient might receive an additional bill from an outside party. “Otherwise, patients may feel they are getting fraudulently billed,” Gordon explains. All these efforts work in tandem to send an important message to patients — the hospital wants to continue to be their provider. “All of these things that we do are really helpful to build a relationship,” Gordon adds.