Put physician orders at your fingertips

An incomplete order at the time of registration is a significant cause of frustration for patients, registrars, and physicians.

"It causes wait or hold times for the clinical staff as well as for our patients," says Sharon E. Bright, patient access manager at The University of Tennessee Medical Center (UTMC) in Knoxville.

UTMC’s patient access leaders set goals to reduce the rework involving physician orders and to have all orders available prior to the patient’s appointment. The department implemented a web-based application (Trace, developed by the Knoxville, TN-based White Stone Group) so that fax and electronic orders can be received in a single location.

When orders are missing a diagnosis or ICD-9 code or are non-compliant, staff members immediately fax the physician’s office to alert them. "Prior to using this system, we had several departments involved in receiving and processing our physician orders," says Bright.

No more lost orders

Previously, when patients cancelled and rescheduled their appointments, the original orders often would be lost.

"Through this system, we now retain the original order," says Bright. "This is a really big plus for satisfaction with the physician’s offices, because they don’t have to refax the patient’s orders."

Staff can search for orders by the patient’s medical record number, patient name, date of birth, or account number, and locate them quickly and easily.

"Not only have we eliminated the faxing black hole,’ but we have complete, ready-to-go orders for all of our patients—as well as satisfied physicians and clinical departments," says Bright.

24 hours notice

Harold Mueller, director of patient access and development at Barnes-Jewish Hospital in St. Louis, MO, says most problems with incomplete orders are prevented by preregistering patients 24 hours in advance.

At that time, staff members verify the patient’s insurance, obtain an authorization if one is required, and verify that the order is complete. "If all that is done properly, things are pretty seamless," Mueller says. "Everything hinges on the work we do on the front end."

The last thing patient access staff want to do is tell a patient who has driven a long distance, "Your service is not covered by your insurance plan," or "There is a problem with the physician’s order," he says.

If an order is incorrect, staff members have a day to resolve it with the physician’s office, and sometimes enlist patients as allies in this process. Most often, says Mueller, the problem is that the physician’s office has given incorrect insurance information for the patient. "We aren’t a Kaiser-type model, with a closed panel of physicians," he says. "The physicians who schedule services here number in the thousands, so it does get more complicated."

Physicians’ offices frequently give insurance information that is outdated, incomplete, or incorrect, such as a patient having different plan under a certain carrier. In some cases, patients had Blue Cross/Blue Shield coverage, but for a different state. "Any of that leads to some serious issues on our end. People think registration is easy, but it’s not," says Mueller.

To avoid problems, patient access managers spend a lot of time educating staff on all the various permutations of plans. "We have a small training staff that works with our over 125 registration team members," says Mueller. "This includes employees on our campus and at our satellite outpatient facilities."

Each employee goes through about 25 hours in annual training specific to the payer marketplace.

"Because of all the different products within a certain plan, it gets very complicated," he says. "It’s not instructions for one card they need to know; it’s instructions for 300 cards."

SOURCE

• For more information on ensuring complete physician orders, contact:
• Harold Mueller, Director, Patient Access and Development, Barnes-Jewish Hospital, St. Louis, MO. Phone: (314) 362-2326. Email: hpm9411@bjc.org.