Nailing the Perfect Patient Access Process!

10 Keys to "Perfecting" Access Management
Hans P. Morefield, SVP, Strategic Partnerships, SCI Solutions

Advanced Access Management is defined as a solution that automates all areas of the healthcare enterprise relative to scheduling, registration, patient finance, guest relations and other like services. This article discusses criteria to be considered in transforming front-end scheduling, pre-registration and administrative services so you can realize the associated value on the back-end. The following pages outline strategies to help you perfect your overall Access Management process and create the ideal solution that will result in significant benefits to your organization.

The Perfect 10!
10 Keys to "Perfecting" Patient Access:

1. Smart, Flexible Scheduling Functionality
2. Powerful Pre-registration Capabilities
3. Online Order/Referral Processing
4. Expert Clinical Rules Engine
5. Self-scheduling (for Patients and Providers)
6. Accelerated Revenue Cycle (starting at Scheduling)
7. Smooth, Efficient Workflow (Worklist)
8. Automated Appointment Reminders
9. Easy Access to Appointment Data (Schedule Viewer/Patient Itineraries)
10. Advanced Arrival Functionality

1. Smart, Flexible Scheduling Functionality

The ideal Access Management solution should start with scheduling—which must be both smart and flexible. It must be able to capture every detail that defines how an appointment will be scheduled, including: resources, resource quotas, provider preferences, privileges, clinical rules, patient condition, patient preferences, travel time, clinical prerequisites, availability, etc. Additionally, the scheduling solution must provide a powerful rules engine that is both user-friendly as well as adaptive to applying these detailed rules where applicable.

Ideal scheduling solutions are robust enough to serve a wide range of scheduling environments, including primary and specialty clinic visits, hospital diagnostic services (department-specific), Rehabilitation services, Oncology services (including infusion therapy), Surgical services and even meeting rooms.

2. Powerful Pre-registration Capabilities

In the ideal Patient Access process, patients pre-register before they arrive for their visit (test, therapy or procedure). This enables a faster check-in process and the ability to identify and avoid potential claim denial issues in advance of the visit. Ideally, pre-registration is done directly in the scheduling application—during the scheduling call or even by empowering patients to pre-register themselves via the web.

3. Online Order/Referral Processing

The ideal Online Order process will solve the problems of lost, illegible or incomplete orders by providing a front-end for MD offices to enter online orders for outpatient tests (scheduled and unscheduled tests) as well as referrals to other physicians. Orders and referrals are always complete, with ICD9 codes and electronic signature. And Medical Necessity is checked before the order leaves the physician’s office.

In this scenario, the order is available to schedulers who schedule more accurately as a result. The order is also available to the front-desk staff, providers and medical records. And beyond that, the originating office can view the status of the order and the appointment through an order “dashboard.”

If all offices are not onboard to immediately adopt an online tool for entering orders, an integrated fax server solution can complement the online orders dashboard—allowing for nearly 100% orders/referrals to be captured in the database. This enables ease of indexing and every order is easily retrievable throughout your enterprise.

Are your outpatients arriving without their orders? Are orders illegible or incomplete? At nearly all hospitals, the answers are “yes” and “yes” and the result is that the front-desk staff must call the physician’s office to get a copy of the order faxed, the patient has to wait, the appointment slot may go unused, the waiting room is filling up and the physician’s office/clinic is cursing the need to drop everything to fax another order to the hospital.

4. Expert Clinical Rules Engine

The ideal scheduling solution incorporates advanced, clinical rules to support all models of scheduling (decentralized, centralized, hybrid, etc.). Centralized scheduling is difficult, even if just done on a limited scope. Whether in a hospital or clinic setting, the rules that define how appointments are scheduled are complex. Diagnostic tests require screening questions and specific orders and offsets when scheduling multiple tests. In specialty clinics, physicians see only certain patients, based on considerations such as diagnosis, patient age, previous history and the like. Rehab and Oncology require recurring scheduling, where patients need to be scheduled for an entire treatment plan encompassing potentially many resources over weeks. The ideal scheduling solution enables accurate, centralized scheduling because its rules engine guides and prompts schedulers with all the rules they previously had to know.

In the ideal scheduling environment, users are guided through the entire scheduling process. A clinical rules engine is vital to the success of 21st Century healthcare scheduling. Schedulers in a centralized call center depend on a rules engine to guide them through scheduling hundreds of different appointment types for hundreds or even a few thousand resources (personnel, places, equipment).

In an ideal scenario, a new scheduler quickly becomes an “expert” scheduler empowered with the “expert rules”—after just a few weeks of orientation on the system.

5. Self-Scheduling for Patients and Providers

The ideal self-scheduling environment also accommodates real, live appointment booking. Not submitting a request and waiting for a call back. Would you go online to www.usairways.com to submit a request for a call center agent to call you back to book a flight? Probably not. You’d call the 800 number and expect to book the travel arrangements you want. The same is true of referring physician offices and patients—they don’t want more steps to get an appointment booked, they want an easy way to “book” their appointments.

While both airline customers and patients want the same kind of service, healthcare scheduling is much more complex. Self-scheduling only works if there is no possibility of an untrained scheduler making an error.

The ideal Patient Access process includes self-scheduling portals for both patients and providers. Patients can schedule and/or request appointments (facilities determine what patients can and cannot do with respect to online scheduling). Even if a facility is uncomfortable with patients booking appointments, the self-scheduling portal lets patients reschedule or cancel their appointments as well as simply view their upcoming appointments, prep instructions, directions to the location and links to relevant content and forms. Referring MD offices in the community use a similar provider portal to schedule into the hospital instead of calling for appointments. Users of a provider portal may schedule tests, visits, therapies and procedures and view previously booked appointments. They can also print an itinerary with prep instructions and directions to the location to hand to their patients.

6. Accelerated Revenue Cycle Starting at Scheduling

Scheduling is the ideal point to start the revenue cycle. What better time to check whether the diagnosis provided by the referring physician office passes Medical Necessity requirements than while the staff member is on the phone? What better time to identify that an authorization is required or that the preferred provider is out-of-network? When the revenue cycle is started at Scheduling, the result is a smoother registration process and fewer denials, write-offs and claims re-work.

The ideal scheduling solution supports an automated, smart revenue cycle process because at its core are two key elements:

1) A powerful, flexible rules engine that triggers both financial and clinical rules

2) An insurance master file that identifies payers and ties the payers to the plans they offer

The ideal “revenue cycle smart” scheduling system stores the history of all the insurances ever captured by a provider for a patient, making it easy for the scheduler to identify/enter the patient’s insurance during scheduling, and then run rules based on the coverage.

7. Smooth, Efficient Workflow (Worklist)

In the perfect Patient Access process, nothing slips through the cracks. While ideally the revenue cycle process starts at Scheduling, the reality is that not every process/requirement can be completed during the scheduling call or online scheduling interaction. The referring office may not have the authorization details for the test yet. The patient may need to speak with a financial counselor.

This is where an online Worklist capability saves the day. Instead of depending on the schedulers to take notes for pre-registration, the scheduling system automatically puts To-Do items on a user’s or a group’s Worklist. These items explain what needs to be done, define the due date and the escalation process if not done and provide tools to complete many of the processes.

8. Automated Appointment Reminders

No-shows are expensive. The effort spent scheduling and pre-registering the patient is wasted, the appointment slot will likely go unused (which reduces productivity/utilization) and, over time, the healthcare provider will compensate with double/over-booking, which results in patient and staff dissatisfaction.

So the ideal scheduling solution provides multiple options for reminding patients of their upcoming appointments (i.e., via voice, letter and/or email according the patient’s preferences). Appointment reminders are set up based on the type of procedure. This flexibility lets the facility use automated
reminders as a customer service tool while improving efficiency. For hospitals that wish to print and send their own Appointment Letter Reminders, the ideal system offers the hospital the ability to receive reminder information nightly.

9. Easy Access to Appointment Data (Schedule Viewer/Patient Itineraries)

The ideal scheduling solution provides view-only capability in the form of a simple schedule viewer. This consists of a web page where authorized users can view booked appointments, either by resource (location, department, clinic, group, provider, etc.) and/or by patient. For example, providers log on and see their schedules for the day, week, etc., but perhaps not those of other providers. A clinic manager can view all of their clinic’s appointments and those of other clinics, but perhaps not Radiology’s. A staffer at the information desk uses the schedule viewer to look up a patient by name or identifier and ascertain the location of an appointment in order to direct them appropriately. The schedule viewer is set up to be available via the web, so providers and employees can view their schedules from their home or office.

Additionally, in the ideal situation providers and other resources can integrate the schedule view with Microsoft Outlook, so their patient appointments are visible along with other appointments and allow for synchronization with handheld/smartphone devices such as a Palm or Blackberry.

10. Advanced Arrival Functionality

A key benefit for the patient arrival experience is that the patient has previously pre-registered. If that’s the case, then the patient simply checks in, possibly signs some forms or scans his or her insurance card and then is directed to the clinic/department. It’s a quick process that eliminates long waits and the stress of having to register at the height of the patient’s anxiety.

When a patient arrives, ideal functionality lets staff pull up the appointment and immediately review what remains to be done so nothing is overlooked before check-in. (i.e., patient sign ABN, collect co-pay, obtain referral form, etc.).

The facility defines its own patient/appointment statuses, such as Arrived, Waiting, In Room, Out of Room, Departed, etc. The ideal scheduling solution supports a wide-variety of integration options for the arrival process, including the ability to interface with a kiosk.

Conclusion:

In your quest to “Nail the Perfect Patient Access Process,” using this criteria will help you define your objectives and evaluate the technologies that will build the ideal solution for your organization. Look for solutions that are robust, integrate with the legacy systems and are supported by experts who are experienced in the entire Access Management process—from the front door to the back office—and have a proven track record of exceeding the goals of their customers!

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customer quote:

“In only four short years, SCI has impacted our facility by streamlining the scheduling process, increasing revenue and strengthening patient, physician and staff satisfaction.”

Addy R., Director of Patient Scheduling                          Torrance Memorial Medical Center

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