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The problem with a five-year projection on the state of health care access management, says Jack Duffy, FHFMA, is that the industry may have gone through "five or six complete changes of technology and knowledge" by that time. "We used to think about progress in five-year bites," adds Duffy, director and founder of Integrated Revenue Management in Carlsbad, CA, and Hospital Access Management’s consulting editor. "Now we talk about progress in five-day bites."
One prediction Duffy makes with relative certainty, he says, is that 100% of patient information will be accessed through the Internet and that information will be maintained by the individual patient or beneficiary on his or her personal web site. Other access futurists who shared their thoughts with HAM see a major impact from the Health Insurance Portability and Accountability Act (HIPAA) of 1996, smaller admitting departments, clinical advances driving changes in access strategies, and more employees working from home, among other predictions.
In contrast to the great lengths that health care providers historically have gone to define and redefine every patient encounter, Duffy suggests, providers of the future will get a one-time use key for the patient’s information when a service is needed. "It will be like a hotel room where you get a plastic key that’s reprogrammed every time a room is used."
The master person indexes that health care organizations are struggling to perfect will go away, Duffy predicts, as consumers become adept at maintaining their own web-based information. In the meantime, he says, there likely will be some "transitory technology," such as a resurgence of the community health information networks (CHINs) that the federal government funded in the late ’80s and early ’90s.
These CHINS — which faded from sight after the funding ended — might be reincarnated to serve as nonproprietary repositories of key pieces of data for an entire community, Duffy says. They would hold not only demographic information, but data on drug interactions and patients’ histories and physicals, he adds. "While building out the access to the Internet, we could use this community network as a place holder."
In the access department of the future, he says, most of the "heavy work" — the gathering of the initial data set — will be moved to a call center and will be done prior to service. And there’s a better-than-even chance, Duffy adds, that the call center will not be in the United States.
Commercial call centers for other industries, he says, have moved to Ireland, then to India, in search of large English-speaking populations and access to lots of labor. "It’s happening right now and it will continue to happen." Although as far as he knows, that hasn’t happened yet with health care call centers, Duffy adds, it is just a matter of time. There are more than 100 companies in India doing medical transcription and/or coding, he points out.
There will continue to be patients who access the health care system without being scheduled and will need to be validated, Duffy notes, but the process will be "100% electronic. Databases will be accessed electronically, not by telephone." As a result, the access department itself will be "concierge-oriented," focusing on customer service and serving — through the emergency department — as a backup to the main procedures, he says.
The biggest factor in future health care access management will be the effects of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, contends Debra Hubers, interim CEO of Del Mar, CA-based MedCambio, a health care payment network that aims to provide point-of-service claims adjudication for its provider clients.
Although HIPAA is the source of much angst and argument within the health care industry because of the expense of implementation, the standardization it calls for is "15 years overdue," Hubers says. "Health care is one of the last industries to adopt standardization within data exchange. We’ve been debating this way too long with ANSI [American National Standards Institute in Washington, DC], and it’s time to come up with an agreement on the standard exchange of [electronic] data."
The same issue was handled a long time ago in the financial industry, she points out, which is why the average financial transaction for a merchant is about eight seconds. "The only reason they can do that is because they have standards related to security and the exchange of confidential information."
HIPAA is crucial to that happening in health care, Hubers notes, because it provides the rules for the infrastructure that must be created. "It neutralizes the parties," she says. "CHINs didn’t work because too many people wanted to maintain their position in the market. HIPAA is universal; it’s a mandate by the government. Some things are appropriate for the government to mandate, and standards for the movement of data are one thing the government has done well. The highest number of electronic submission of claims happens in the Medicare and Medicaid arenas."
Accompanying the changes prompted by HIPAA, Hubers suggests, will be a more efficient admitting department. "The people in admissions will be related more to patient care instead of administration and chasing paper," she adds. "There will be better community relations. With obligations known at the time of service, the whole process will be more efficient."
The data collection and processing side of health care will become less labor-intensive, agrees Peter A. Kraus, CHAM, business analyst for patient accounts services at Emory University Hospital in Atlanta, but says the confidentiality and privacy rules of HIPAA could slow progress in that area to some extent. "Eventually, we’ll find HIPAA-approved ways to obtain demographic, financial, and clinical patient data," he adds. "Maybe it will be on a chip-laden health care card or reside somewhere out in cyberspace. We can’t discount the potential influence of web-based technology on the role access departments play in the health care scheme."
With less billing and collection work necessary, he notes, "I’d like to think that customer-service-oriented programs will fill the void. Patients certainly appreciate hotel-like amenities, and there’s plenty of work to be done to integrate the continuum-of-care model. But if cost-containment programs run rampant, service could become quite basic. It’s hard to say what health care customers will tolerate when faced with affordability decisions."
Access management is likely to move beyond the realm of health care — perhaps to the airline and hotel industries — to find innovative methods to aid in securing patient demographic, financial, insurance, and medical information, notes John Woerly, RHIA, MSA, CHAM, an Indianapolis-based manager with Cap Gemini Ernst & Young.
Although computer systems will support the bulk of those needs, Woerly points out, "we cannot underestimate the importance of people’ and process’ to enhance the outcome of technology." "The blending of people, process, and technology," he emphasizes, "will ensure data integrity while promoting a seamless customer experience. All three must be in balance to be successful."
Like Duffy, Woerly predicts that traditional, stand-alone patient access departments will become a thing of the past. "Enterprisewide patient access models will emerge, utilizing customer relationship management/call center infrastructures to serve all populations."
Many of the innovations in access management that occur in the next five or 10 years will be in response to changes occurring on the clinical side of health care, points out Barbara Wegner, CHAM, regional director of access services for Providence Health System in Portland, OR.
Because the field of nursing, for example, is not attracting young people in large-enough numbers, Wegner says, there is a shortage of nurses that likely will become even more of an issue in the future. Access personnel may have to determine what they can do to help fill the void, she suggests.
"Nursing isn’t 100% clinical," Wegner notes. "There are a number of duties and functions — utilization review, giving out managed care letters, making sure patients understand their rights and responsibilities, as with advance directives — that aren’t actually clinical." Those tasks may have to be looked at, she adds, with an eye on having access share the load.
The same situation exists with health care technicians, Wegner says. "I’m not sure how that shortage might impact us, but there may be things they do, like entering orders, that access [can help with] as people come to the table and start reengineering."
Advances in medical technology, she predicts, will reduce the number of people needing hospitalization and make their stays shorter. Innovations like bloodless surgery "might remove the need for acute care," Wegner suggests. Those changes will impact how many people need to be registered and how they will be seen, she adds, with more outpatient visits and home visits in place of inpatient care.
"In the very near future," Wegner says, "people are going to be able to use an inhalant for insulin, instead of injecting it. That will change the number of people who are hospitalized for diabetes. In the area of orthopedics, there will be a substance in a tube that can be injected into the bone when people break an ankle. It will strengthen the bone right there so people can walk out of the emergency department."
Access departments will need to re-engineer their processes to fit these changes in technology, she notes. "We live in a world of change; so every day, we have to look at what we’re doing and be prepared to make changes."
The one thing that will continue to be paramount, Wegner emphasizes, is that access representatives do a high-quality registration the first time, so hospitals and health care systems can get maximum reimbursement without rework needed on the back end. "That won’t change, but a lot of other things will, she says. "We’ll continue to change our processes, but that will remain our No. 1 objective."