Combining registration, scheduling pays dividends
Combining registration, scheduling pays dividends
Productivity increased without new staff
By combining outpatient scheduling and registration departments, the Rehabilitation Institute of Chicago (RIC) has increased productivity, reduced waiting times, and ensured treatments will be covered by insurers - all without increasing staff. The new outpatient access department is staffed by cross-trained scheduler/registrars who set appointments, screen for benefits, and precertify and preregister patients.
The new system was needed to meet patient and hospital needs in a changing health care environment, says Kate Brennan, RN, BSN, director of admitting and case management.
Until the past few years, RIC operated as a freestanding rehab hospital. Through a series of mergers and alliances, it now provides services in several locations at multiple levels of care. At the same time, the Chicago market has shifted from fee-for-service to heavy managed care. "With all the HMO products we deal with today, patients need to know what is expected of them prior to coming in," Brennan says.
At the time of the change, RIC was in the midst of a major re-engineering project, says Chris Frommelt, RN, BSN, MBA, project specialist. "We knew that access was an issue on the outpatient side. The executive team determined that it was an appropriate re-engineering effort to focus on."
Here are some components of the new system:
1. Patients call one number for an appointment. Before the new system was implemented, patients had to call each site to schedule an appointment and often had to make multiple phone calls before being scheduled. Now patients don't have to know what program or location they're looking for. By calling a central number, they have access to any RIC service at any location.
RIC's orthotics and prosthetics program and the assistive technology program, which once did its own scheduling, have been added to the outpatient access department. All of RIC's outpatient sites are connected by computer.
2. Preliminary information is collected when appointments are scheduled. In the past, schedulers took only a small amount of information, such as phone number and home address, when booking an appointment. When patients came in, the admission staff had to collect demographics and other data. When several patients at once had to be logged into the system for the first time, the lines for admissions were long, Brennan says. Additional staff were assigned to the registration desk in case more than one new patient came in at a time, leading to long periods of downtime for personnel, she adds.
Now, all of the preliminary information is taken over the phone before patients come in for treatment, and all they have to do when they arrive is sign the forms.
3. Insurance benefits are confirmed ahead of time. In the past, financial issues were not addressed when appointments were scheduled. Instead, patients were likely to come in for an appointment lacking information required by their HMOs. Under the new system, schedulers take insurance and other information from patients when they schedule appointments. They tell patients what their HMOs require to approve treatment, such as a physician referral form.
The staff then call to make sure the benefits are in order and let patients know of any problems, such as lapsed benefits. If there are problems, such as a patient being out of network or needing a physician referral form, someone from RIC contacts them before their appointment.
"This is a benefit to the hospital because we have decreased our bad debt, and to the patient because if they meet the requirements of their managed care contract, they don't have to pay out of pocket," Brennan adds. (For more about the financial benefits of the new plan, see story, p. 106.)
Before the new system was implemented, long waits in the lobby prompted some patients to go directly to the treatment area, rather than stand in line and then arrive late for their appointments. Sometimes, staff helped patients bypass the system because a long wait would throw off the therapy schedule for the rest of the day.
"The new system decreases the amount for time for the patient and increases the efficiency and education of the consumer," Brennan says.
Before the change, RIC had one intake coordinator, several registrars, and several schedulers. Now, two intake coordinators take on the complex problems and financial clearance duties and coordinate treatment for people coming from out of state and out of the country.
Staff have been cross-trained to do both scheduling and registration, and the two departments have been merged. The cross-training was done so staff could rotate between the scheduling and registration areas as needed.
To cross-train employees to work both registration and scheduling, the management team created a list of job duties and competencies. For example, during the registration process, an indicator on the computer screen tells the registrars any special tasks they need to perform, such as making sure the patient has a physician referral form. One competency is that the scheduler knows how to look up where the indicator is going to appear.
Staff perform the competency checklist in RIC's test hospital, a dummy computerized hospital system.
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