Does ‘C suite’ undervalue access? Don’t be shy about your successes!

Reinforce the importance of patient access

“What information do you need that you are not getting today, in order to be successful in your job?”

Amber Reeff, director of patient access systems at Virginia Mason Medical Center in Seattle, routinely asks hospital leaders this question. “It’s amazing how many people will grab onto that rope when you throw it to them,” she says. “Sometimes people don’t see the connection right away. They see patient access as another entity, when in fact, we are an extension of the care team.”

One thing Reeff learned was that senior leaders wanted more data on the barriers to care that patients experienced. “They wanted to know how many patients aren’t able to get through our door, and why,” she says. To answer this question, Reeff surveyed a group of schedulers, and asked them to identify the top three barriers to getting a patient scheduled, and shared her findings with senior leaders.

“It is critical to communicate the health of our front door to all senior leaders, and any barriers or challenges that may exist,” says Reeff. “If you can’t get patients through your front door, you are not going to be viable.”

Hospital leaders often don’t realize the sheer volume of information collected by admitting staff, and don’t need to know all the details of what patient access does, says Reeff, but they do need to trust the information they are receiving.

“It is our responsibility as patient access leaders to ensure senior leaders have the most current information to guide them in making an informed business decision,” she says. “There is so much hidden treasure in these areas, and it doesn’t require expensive technology or a complex process of data gathering. It lies in the staff who are manning your front door.”

Patient access is often undervalued, but this situation is changing as the complexity of the position continues to evolve, according to Stacy Calvaruso, CHAM, assistant vice president of patient management at Ochsner Health System in New Orleans. “We are now seeing progressive organizations strive for better metrics on front-end performance,” Calvaruso says. “Shine the light on the shift from back-end processing to front-end processing. The analytics will ‘toot the horns’ of top-performing facilities!”

Show KPIs to leaders

With so many different areas of focus in health care today, being able to communicate “well and appropriately” to senior leaders is necessary to reinforce the importance of patient access, emphasizes Courtney M. Higdon, director of Enterprise Patient Access Services at UK HealthCare in Lexington, KY.

“VIPs do have limited time,” says Higdon. “That is why it is important to be able to ‘tell the story’ of patient access for the organization in a few key performance metrics and graphics.”

Calvaruso says these key performance indicators (KPIs) are essential to show leaders how front-end processes affect hospital operations and the revenue cycle:

— average registration time;

— point-of-service collections, compared to the amounts available to collect;

— the number of patients who leave the emergency department without being seen;

— in-house authorizations pending;

— discharged not final billed, related to registration and admitting;

— department productivity;

— patient access-related denials;

— overall quality assurance (QA) scores.

Each facility at Ochsner has its own KPI scorecard. “At the end of the month, we roll this up into a patient access dashboard,” says Calvaruso. “We distribute it to our CFOs, senior leaders, and key operational business partners.”

Hospital leaders especially appreciate the dashboard because it gives them a high-level view that allows them to drill down into any area they have a concern with, she adds. Here are ways in which patient access leaders can attract the attention of senior leaders:

• Create dashboards to track important data, and periodically share those results.

“Produce measurable results in important areas such as point-of-service collections and patient satisfaction,” advises Higdon.

• Keep leaders informed of instances of outstanding individual performance from registrars.

“This allows the employee to be recognized at the highest levels of the organization and the leader to be more closely engaged in the role of the department in the organization,” Higdon says.

• Tie results to revenue cycle KPIs.

For example, if your QA scores are showing 98% accuracy but the claims are being denied, determine how this could be possible. “Are your claim scrubber rules too stringent? Do you not have the correct rules in your front-end QA process?” asks Calvaruso.

By demonstrating that the front end is aware of, and is monitoring, the claim scrubber pass/fail rate as well as the denial rates, you’ll be able to articulate to administrative leaders “the fact that it all really does start at the front end,” Calvaruso says.

• Help executive team members to view the front-end teams as an operational department as opposed to a revenue cycle department.

“Registration is 24/7, which is staffed mostly based on visit volumes and patient flow. Clinical operations staffing models are the same,” Calvaruso explains. By reinforcing that patient access operates in a clinical operations capacity, executive leaders will be able to tie department outcomes to operational performance, she says. One way to do this is to base staffing models on patient flow, instead of using a flat staffing level.

“By tying your KPIs to operational processes, you can paint a better picture of potential opportunities,” adds Calvaruso.

• Make others aware that patient access plays a role in increased volume.

“Many times, the front desk is forgotten when we congratulate certain areas or departments on having such a high volume month,” says Calvaruso. She says it’s the job of patient access leaders to counter this perception.

“If the collaborative relationship is strong enough, everyone realizes that increased volumes are directly related to the patients getting scheduled and registered for those services, which is performed by the front desk,” she says. (See related story on how patient access leaders at Virginia Mason Medical Center interact with hospital leaders, below.)

You should connect with hospital leaders

Patient access leaders at Virginia Mason Medical Center in Seattle “have a seat at so many different tables in the organization,” reports Amber Reeff, director of patient access systems. “This gives us the opportunity to brainstorm with various leaders, both as part of the planning process and ‘in-the-moment’ huddles.”

Here are ways that patient access leaders interact with senior leaders at the organization:

• Senior leaders make rounds throughout the organization, including registration areas, to view production boards.

Kristi Hoagland, manager of revenue stream and admitting, says, “Anyone can come into our workspaces and see our metrics and activities. We use dashboards that are color-coded red, yellow, and green. Things get expedited very fast if there are any concerns.”

• A patient safety alert (PSA) system is used if any issues arise that potentially could compromise care.

The term “patient safety” makes most people think about something that is strictly clinical, says Hoagland, but patient access areas use these to report any issue that needs attention.

“Our safety office assigns a severity level which invokes different levels of leadership, which ensures immediate attention from hospital leaders as appropriate,” says Hoagland. For example, a PSA was filed when a registrar created two visits, which potentially could cause a problem for the care team.

• Patient access is directly involved in identifying possible obstacles to the admissions process.

The hospital’s admissions center uses an “admissions viewer” report, which makes the admission process transparent and accessible to all hospital leaders. It shows exactly where a patient is in the process. “For example, it may be that we are waiting for the ED nurse to call us back with a final report, or that the patient is unstable for transport,” Hoagland says. “In some cases, we need to do an ‘intake huddle’ to address a situation right away.”

• When the hospital is determining whether a particular patient needs to be admitted, patient access staff provide information on the patient’s financial situation.

Patient access staff work with a physician advisor, a utilization review nurse manager, a charity manager and a financial counselor manager to ensure every patient that needs help gets it, says Hoagland. “We are right at the table for every patient coming into the hospital,” she says. “We contribute information to build the entire patient story, which includes clinical, social and financial components, to determine what is the right thing for that patient.”