Want dramatic revenue results? Be the ‘go-to’ place for providers

Job security comes with increased revenue

Providers ordering stat CT scans or magnetic resonance imaging scans (MRIs) certainly don’t want their patients to wait hours in the emergency department, to show up for a test only to learn the original order was incorrect, or receive a bill due to a failure to obtain a required authorization. Too often, however, those situations occur.

“One of the challenges we faced was that both patients and referring doctors had a perception that it was difficult to navigate the hospital. People don’t want to be left on hold and transferred multiple times,” says Mike Horton, MHA, manager of radiology and the centralized scheduling department at Hackensack (NJ) University Medical Center.

Horton set up a concierge hotline for physicians with “stat” or emergent cases, and asked more than 100 referring physicians in the community to call him directly instead of the hospital’s Call Center which schedules the routine cases, so he can get their patients in without delay.

“Providing this service has added a more personal touch and service-oriented approach,” says Horton. “It has been a tremendous hit. Physicians are very busy people, and their staff don’t have a lot of time to spend on repeated calls.”

If Horton is off, another manager carries his phone, and if he goes to a meeting, the call bounces to the front desk so staff can handle it.

“I have empowered my staff to do exactly as I would do,” says Horton. “I tell them: ‘If a physician calls for a ‘stat’ exam, do everything possible to accommodate the patient.’” As a result, many patients are seen who previously would have sought care elsewhere.

Horton agrees to get the patient in, on the condition that the provider office does its part to put the authorization in place. If patients call, he makes them aware that their physicians needs to obtain the authorization. This process motivates everyone involved to do their part to be sure the authorization is in place, if and when it is necessary, he explains.

“My philosophy is to make things simple. If a patient has a script and an authorization, why make them wait?” asks Horton. “If I can’t help them today, someone else will.”

Volume is priority

Payers are not approving high-dollar diagnostic tests as frequently as they once were, and some patients are reluctant to obtain a CT scan due to high deductibles or concerns about radiation exposure, notes Horton, adding that he has made increasing volume a top priority.

“Our volume has increased at a time when nationally, volumes are shrinking,” says Horton. “We are seeing significant growth, year over year.” Over the past four years, the number of CT scans performed increased by 30% and the number of MRIs increased by 40%, he reports.

“Doctors and patients often perceive hospitals as big behemoths that are difficult to navigate,” says Horton. “I’m reversing these misconceptions by bringing small business customer service to a large organization.”

Horton likens the system to a customer calling a “big box” store to find out if they have an item in stock, and having the manager answer the phone and give the answer, versus being transferred to numerous individuals.

“The end result is obviously increased volume, but there are other downstream benefits,” he says. “Now that we made it easy for their patient to get a CT scan, offices are more inclined to send patients for other clinical services, such as cardiology or physical therapy.”

Horton says job security is another big motivator for staff to help increase volume.

“Right now, we’re hearing a lot about layoffs in healthcare. The more CT scans we do, the more job security we have,” he says. “Rank-and-file employees often feel they don’t have any say over their employment, but here’s a way they can have direct control.”

Lighten providers’ load

Typically, providers’ office staff schedule appointments with the facilities that they like to deal with, according to Myndall V. Coffman, MBA, director of patient access at Baptist Health Lexington (KY).

“Constant changes in healthcare are very stressful for physicians. If access can lighten up some of the stress and load, not only for physicians, but for their staff as well, loyalty is created,” she says. “We do whatever we can to ensure the physician’s office is not inconvenienced.”

Here are ways patient access can support physicians and increase volume:

• Patient access can educate providers on payer requirements.

“Offering education via hospital newsletters and personal meetings can go a long way in not only developing the relationship, but cleaning up practices on both sides,” says Coffman. “This directly aids the hospital in making sure a good claim gets out the door.”

In “A Survey of America’s Physicians: Practice Patterns and Perspectives,” a 2012 survey conducted by Merritt Hawkins, physicians reported spending more than 22% of their time on non-clinical paperwork.

“Hospitals are feeling many of these same strains. However, we are typically better equipped to handle the requirements placed by regulators and insurance companies,” says Coffman.

• Registrars can obtain and verify necessary authorizations.

Recently, patient access leaders at Mercy Medical Center & St. Elizabeth Hospital in Oshkosh, WI, identified obtaining radiology authorizations as a “bottleneck,” reports Connie Campbell, director of patient access.

“When the office had to obtain the auth, it caused a delay. There is such a learning curve in trying to figure out what is needed,” she explains. They now have a select group of specialists out of their scheduling department who do these, Campbell says. “It helped us, too, as most of the procedures requiring auths are $2,000 to $3,000 in cost,” she says.

Members of Baptist Health Lexington’s patient access staff have taken on the responsibility of helping physicians obtain pre-certifications for procedures, when possible, by contacting the insurance company directly. Coffman expects to see a 10% drop in claims denials as a result of this change.

Ensuring that the order received is a valid, complete, compliant order is “half of the battle, not to mention that precerts and authorizations are being obtained for the right facility and ordered exam,” says Coffman. “Through this partnership, the physician’s load is lightened, accuracy increases, and denials decrease.”

• Registrars can fax over an order with all of the patient information needed to schedule a procedure.

“Patient access staff take care of everything, including calling the patient to work the appointment into their schedule,” says Coffman. “In addition, we are working with some physicians to feed back procedure results directly into the patient’s electronic medical record.”

Sources

For more information on increasing volume in patient access areas, contact;

Connie Campbell, Director of Patient Access, Mercy Medical Center and St. Elizabeth Hospital, Oshkosh, WI. Phone: (920) 223-1874. Email: ccampbel@affinityhealth.org.

Myndall V. Coffman, MBA, Director, Patient Access, Baptist Health Lexington (KY). Phone: (859) 260-2162. Fax: (859) 260-6935. Email: myndall.coffman@BHSI.com.

Mike Horton, MHA, Hackensack (NJ) University Medical Center. Phone: (551) 996-4032. Email: mhorton@hackensack@umc.org.