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With the demands placed on today’s access managers — from overseeing staff to keeping abreast of the latest dictates from Medicare — there may be little or no time to put into practice sophisticated patient access processes.
"So many times, we return from an educational conference with full intentions of implementing those wonderful programs presented by respected colleagues and consultants," says John Woerly, RHIA, CHAM, an Indianapolis-based manager with Cap Gemini Ernst & Young who worked for many years as a director of access services.
"What I see within the patient access profession is a desire to make positive changes, but an access manager tied up in day-to-day operations may fall behind in new products and/or processes," Woerly adds. "They may not have the time or background to analyze, plan, and implement changes that could have a major impact on their institution."
For access managers disillusioned because they haven’t had the opportunity to put that presenter’s recommendations to the test — and for those who are attempting to come up with their own innovations — Woerly offers some guidelines on how to be your own consultant:
• Concentrate on the BIG.
Investigate processes with the biggest dollar savings for the institution, or the process that, if corrected, would generate the largest improvement in customer satisfaction.
Keep in mind, Woerly advises, that you won’t have time to do it all, so start with the activities that produce the biggest results. "You don’t want to preregister a lab test when you can better utilize the available time on an MRI [magnetic resonance imaging] account, which has a higher dollar impact upon the institution if not preregistered and precertified," he says. "As you further refine your process, you can build upon your success and add."
After selecting the process to improve, Woerly suggests, break the process into steps. "In developing a prearrival process, for example, it is important to establish work priorities — to decide what time frame you have to complete the work, how to communicate scheduling updates to the staff, and a hundred other steps. "Within the simple step of preregistering," he adds, "you have to look at the time of the patient’s arrival, testing to be performed, whether the patient has a current file within the computer system, etc."
As he works with clients at health care organizations across the country, Woerly says he often comes across these barriers to an optimally functioning access department.
• Lack of system and process integration.
When necessary databases either don’t exist or aren’t being used to automate the process, he points out, that shows a lack of integration. Ask yourself, Woerly suggests, "What tools do staff have to do their job?" Addressing this problem might mean, for example, creating an access database of third-party payers with their contact information and benefit requirements, he says. "Simple, manual processes also may not be integrated. . . . Examples are process gaps, multiple hand-offs, and duplication of effort."
• Absence of process, or fragmented alignment of the process.
"This is a barrier to realizing excellent customer service, as well as to ensuring financial and data integrity," Woerly says. "An example of fragmented alignment may be registration functions at multiple locations that are inconsistently performed. They also may have multiple reporting channels, which only adds to the inconsistency in performance."
Having multiple locations and multiple reporting channels may be completely justified and fine, if there is consistency in approach, he adds, "but many times there’s not."
There also may be processes that no one wants to own, that have the wrong owners — they’re disinterested or unknowledgeable, for example — or for which ownership is unclear, Woerly points out, citing as an example the processing of outpatient/observation patients.
"I was in a meeting with clients where we talked about third-party payer denials," he says. "One outstanding area of denials was patients classified as Outpatient Observation.’ Someone said, We’ve talked about this for five years and no one wants to own it.’"
The issue was large and encompassed multiple departments and participants, he notes, but someone needed to take ownership and sponsor the process redesign.
• Inconsistent and inadequate training and feedback.
"There may be a lot of word-of-mouth training, on-the-job training," Woerly notes. "New employees may learn under the worst or best registrar." If training is not organized and the new associate gets a negative first impression, he or she may become disheartened with the new position, he adds. These conditions may contribute to high turnover, as well as poor work habits and job performance, Woerly says.
• Technology does not fully support people and processes.
This may be because there are multiple, nonintegrated or noninterfaced systems, he says. "An employee may enter data, and then hand [the information] to another person, who enters them into another system." This kind of inefficiency may occur, Woerly points out, because "value-added enablers are not in place." Those enablers, he adds, might include an access database, or an on-line Medicare Secondary Payer or Advance Beneficiary Notice process.
Processes may become so complex — multiple steps, large volumes, etc. — that automation is required to effectively and efficiently perform the task, Woerly suggests. "In a multihospital system, prearrival activities — resource scheduling, preregistration, benefit verification, precertification, authorization, and patient financial education — may require automated work queues vs. shuffling paper’ from one associate to the next," he adds.
An automated work queue, Woerly explains, balances workloads based on pre-established priorities. "You get to the point where you have to go paperless," he says. "You can’t do large-volume scheduling and preregistration successfully by shuffling paper."
At one organization where Woerly served as director of access services, he points out, studies showed that time spent shuffling paper accounted for an entire full-time equivalent (FTE) of the 25 FTEs within preregistration.
That paper shuffling, Woerly explains, involved getting copies of new schedules, getting the add-ons to the schedule, and "putting this piece of paper over here and waiting for someone to call back." If the patient or payer didn’t call back within the same workday, which is common, the workload continued to accumulate, he says. "The next day, the em-ployee may forget yesterday’s paper is there, because other demands are coming in.
"When the employee is off for a day, the workload has to be redistributed and yesterday’s work’ passed out to others," Woerly adds. "With more than 800 patients a day being preregistered, think of the opportunities to lose a sheet in the paper shuffle."
It’s easy to view your own department’s operations day in and day out and not see the improvements that could be made, Woerly notes. When acting as your own consultant, he suggests, it may be helpful to do what he did when embarking upon a new job as access director, a position he has held at several different health care organizations.
"Make a list of what is working and what is not working and what you need to do," Woerly says. "Think, What can I do to help the place?’ Try to see things through the eyes of a new employee, or even a new patient.