These challenges in access' future
These challenges in access' future
Resource management is key
Doing "more with less" is a major challenge for patient access leaders, both now and in the coming years. Lauree M. Miller, director of patient access at Catholic Health Initiatives in Lincoln, NE, expects this challenge to grow when healthcare reform initiatives are implemented in 2014, due to decreased hospital revenue.
"We expect all payers to be at the Medicare rate, which is not very high," Miller says. "Patient access needs to 'think out of the box' to be successful in keeping the doors of the hospital open." Here are other changes in store for patient access:
Processes for checking medical necessity will become more stringent, as payers require more documentation to approve services.
"We are already seeing authorizations and precertifications becoming tighter," says Tracy Abdalla, hospital access services supervisor at University of California Davis Medical Center Hospital. "We have to get approval for high-dollar radiology procedures in advance, or it's an automatic denial."
There is the potential for delays in services, adds Miller. "Physicians won't be able to order anything they want to have done any longer," she says. "We need to make sure we have our ducks in a row before we see the patient."
Due to this development, communication with clinical areas about the revenue cycle has become much more important for patient access. "If we try to do point-of-service collections in the ED, nursing staff could care less unless we communicate the value to our financial bottom line," Miller says.
Auditing for accuracy will target claims denials.
"We've been auditing registrations for 10 years. We had to pause and say, 'Are we auditing the things that really matter?' says Miller. "We need to put our resources in the right places."
For example, registrars are expected to use the U.S. Postal Service abbreviations for street addresses, but spelling out the addresses wouldn't result in a denied claim, she explains, whereas identifying the wrong payer would.
Management of staffing resources will become increasingly important.
"It takes more resources to register a patient than in the past, but our reimbursement is going down," says Miller. "We will need to look closely at how that equation looks, going forward."
Catholic Health Initiatives' four Nebraska hospitals are beginning to regionalize the work of patient access with centralized scheduling. "We can be more productive and more efficient with a regional team, instead of having four teams in each hospital," explains Miller.
New systems will be needed so patient information can be accessed by other facilities.
"We already have an electronic health record in place. We are now working on getting to an enterprise master patient index," reports Miller. The goal, she explains, is to have patient medical records accessible to health care teams in other cities.
"Standardizing our upfront processes is critical, in order for those interfaces to happen, so they have access to those records," she says.
However, Miller says that she doesn't believe patient access will ever go truly paperless. "You can have registration kiosks, but you still have to have somebody face to face," she says. "The people part will always be there."
Doing "more with less" is a major challenge for patient access leaders, both now and in the coming years. Lauree M. Miller, director of patient access at Catholic Health Initiatives in Lincoln, NE, expects this challenge to grow when healthcare reform initiatives are implemented in 2014, due to decreased hospital revenue.Subscribe Now for Access
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