‘Super user,’ QA monitoring cut errors at Ohio hospital

Customer service cards big hit with patients

Error rates are being slashed and more complete registration data collected through an aggressive training and quality assurance (QA) program at The Ohio State University Medical Center in Columbus.

Following implementation of the training and QA program, the error rate for emergency department (ED) registrations was reduced to 8%, says Patricia McLean, MA, senior manager of patient access services. And registrars went from obtaining the referring physician’s name only 30% to 40% of the time to a capture rate of 70% to 80%, McLean says. Some categories have reached 100%, such as date of birth, next of kin information, and address, she adds.

Meanwhile, the patient financial services customer service department — instituted two years ago — receives as many as 100 calls a day, McLean says.

Putting the customer first

The QA program also has spawned the dis-tribution of customer service cards in the ED, a practice that’s receiving high marks from patients, McLean says.

When patients come to the ED without an insurance card and their insurance information can’t be substantiated, they are given a customer service card, similar to a business card, and asked to call that department with the information. The card contains the name of the department and a toll-free number.

"Patients love it," McLean says. "They do call in, and it’s preventing people from receiving self-pay letters. A lot of the calls we’ve gotten have been about physician billing, which doesn’t come under our department, so now we have a combined card that has the physician billing number as well."

Hired five years ago to develop a QA program, McLean added the condition that a formal training process for new employees be part of the mix. She outlined specific requirements — 80 hours of training, with a combination of computer application and on-the-job instruction. During the on-the-job segment, she remains with the registrar, observing and evaluating. The training is documented each step of the way, she explains, with a sign-off sheet for each part, such as a segment on the ED process or on computer application. The sheet is signed either by the trainees or their manager.

‘Everybody hears the same song’

Ongoing training takes place in huge sessions each quarter on Saturday mornings, where registrars hear about new insurance information, major recurring data errors, and any hot topics or new programs that will affect them, such as a new hospice program at the hospital or changes in how workers’ compensation cases are handled, McLean says. She also gives individual error reports to the employee’s supervisor.

"We have [the session] early enough on Saturday that we can cover [work areas] with a couple of supervisors," she adds. "Everybody’s there, so everybody hears the same song."

In what until recently was a one-woman show, McLean monitors ongoing data quality by going through admitting face sheets and plugging the information into a database. She uses Microsoft Access, a relational database, to do queries by type of admission, registrar, and date, among other things. Implementation of a new patient management system will, she hopes, allow her to receive face sheet information electronically, she says.

Until recently, McLean had no vehicle for collecting outpatient data. As of a few months ago, she began receiving it through a report compiled electronically each evening from that day’s outpatient activity. As with the inpatient data, for the time being she still must enter it into the database to obtain a QA report.

The QA monitoring process "tremendously improved" in January with the hiring of a new employee, McLean says. This data control technician, known in layperson’s terms as a "super user," acts as a trouble-shooter at registration sites with high error rates and reinforces education, primarily regarding insurance information, she adds.

The additional help is particularly timely because of the new responsibilities of McLean’s boss, Joe Denney, CHAM, the director of access management, who now also holds the position of director of patient financial services, McLean points out.

Improving outpatient services

Although Denney has responsibility for the entire medical center’s accounts receivables and oversees all inpatient admissions, he has direct managerial responsibility for only 25% of outpatient registrations, McLean says.

"But he now has a vested interest in making sure any registration, anywhere, is done correctly for his accounts receivable. The problem is the data [from many of the outlying registration areas] are awful," she explains. Registrars in outlying areas "don’t have training, and there is no organized QA."

Although her department has no managerial power over these outlying registrars, McLean says, having the super user "allows us to act as ambassadors of goodwill. We can compile statistics and offer training and education to them, keep them updated on insurance changes."

In the past, such registrars could be using inactive insurance codes for months, because there was no method for updating their infor-mation, she says, adding, "They welcome the help."