Cooperation, competition equal quality improvement

Access, accounting partnership is key

A relationship of cooperation and mutual respect between access and the billing department is at the heart of a successful quality initiative at Children’s Health Care of Atlanta, says Millie Brown, director of patient access. "Typically, you have the business office looking at access and saying, These are all the things you didn’t do right,’ and access asking, Why can’t they see what we do right?’" she notes.

When she left her position as business office manager to become access director, Brown says, she provided a wake-up call to both sides of that debate. She reminded the business office staff that 80% of the hospital’s bills are paid the first time out. "I said, You guys are looking at those that were denied — everything that was paid has no reason to come to you.’"

With patient access staff, Brown adds, she took the focus off blame by saying, "Of [the bills] that are wrong, here are those you can do something about. I don’t want to say, You got X number of denials.’ I want to say, When putting the Blue Cross Blue Shield numbers in, be careful because . . .’"

"We’re never going to be sensitive over anyone making an error," she says. "That’s the culture we’ve been able to create. I believe that people want to be part of a winning team, and if you can give them the energy and the tools, most people want to do a good job."

Monthly meetings attended by Brown, the departmental trainer, and an access manager or two — along with a similar team from patient accounting — foster the atmosphere of cooperation, she notes. "Sometimes someone from utilization review joins us if we’re discussing a pre-cert issue." At these meetings, Brown says, "We regularly look at the denials, which are tracked by the business office, and sort them out to determine which are based on information generated by access. Then we look at those to spot for trends, so we can implement training around those trends."

The quality initiative Brown spearheaded between January and December 2002 reduced the health system’s annual denials by approximately $20 million.

Competition motivates staff

Key to that success, she explained, was a competition among registrars for gold, silver, and bronze medals, based on registration accuracy. To receive a gold medal, access employees had to have an average accuracy score of 90% or more on the components of the registration that, if not correct, would lead to a denial.

For the year 2002, six registrars got a gold medal. For 2003, 81 of the 100 access employees have earned that honor. "That says something about competition," Brown points out. "They don’t want to look bad in front of their peers." The person with the top quality score and the person with the highest point-of-service cash collection total were given DVD players in recognition of their achievements, she says. Three other awards, based on staff votes, were made to the employees who best represented the spirit of teamwork, "the people who pitch in and help," Brown says. "I ask [access employees], Who’s the person you feel always helps you, the one who is the best representative of what a good worker is?’"

Those recipients — one from each of the health system’s two hospitals and one from a separate business office location — got a day off work and a day at a local spa, she says. Brown points out that each won by a large margin, indicating that it’s very apparent to their colleagues who these team players are.

Recently given responsibility for billing office quality as well, Brown was in the process of designing a plan to foster improvement in that area. One thing she knows for sure is that productivity measures now will be based on the number of claims that resulted in payment, Brown says, not the number of claims worked. "I say not all activity is productivity," she adds. "I don’t want to know how many claims you went through on your queue, but how many you went through that resulted in payment."

For each biller, Brown will be looking at how many of the claims they handled went through after the first time they followed up, how many after the second time, and how many took three or more times, she notes. "We’ll sort those out and go to the specific problem and the specific individual," Brown explains. "Their [quality] scores will relate directly to the score on their evaluations. So if they get an excellent — a rating of 4 — based on their scores, they get a 4 on the evaluation."

As with the access personnel, she "will put out the averages and let them compete with each other. The best $7 I ever spent was on those gold, silver, and bronze medals," Brown adds. 

[Editor’s note: Millie Brown can be reached at (404) 929-7514 or by e-mail at millie.brown@choa.org.]