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By Lola Butcher
When the four acute care hospitals in the Crozer-Keystone Health System operated their own patient access departments, consistency was hard to find.
"The patient would show up, stop in our registration area, and go through a process so we could revalidate the demographic information," says Richard Madison, vice president of revenue cycle operations, Crozer-Keystone, Upland, Pa. "It was an underutilization of the staff that we had, it was an inconsistent approach to preregistering patients, and it was a disservice to the patient."
In 2009, Crozer-Keystone developed an off-site pre-encounter unit called the Patient Services Center that centralized registration activities for the health system's four hospitals. The pre-encounter unit-which comprises 24 employees who were patient access staff members at Crozer-Keystone's hospitals-handles preregistration, insurance eligibility and benefit verification, payer authorizations, and preservice collections for all scheduled diagnostic testing and surgery patients.
"There's nothing small about this," says Madison. "This was a cultural transformation that the organization never experienced before."
Preregistration and financial clearance now occurs at least five days-and sometimes as far out as three weeks-before the patient arrives for a procedure. Payer authorization or preregistration snafus no longer cause last-minute cancellations, which has improved patient flow and patient satisfaction, according to Madison.
Other results include:
"The patient experience has improved by removing the mystery out of how our registration process works," he says. "We developed a brochure that is provided to our patients that details what they can expect after services are arranged. Patients are now informed about their financial responsibilities prior to obtaining service. This way, they are not taken by surprise when asked for their copayments or deductibles."
Shortly after moving to the Patient Services Center, patient access staff embarked on an extensive training program that covered basic patient access skills and knowledge.
"We had a lot of naysayers with 30 years of experience who thought, 'I know how to do this,'" says Madison. "We brought them back to the rudimentary processes of the registration system and elementary-level insurance coverage."
A comparison of pre-test and post-test scores showed how valuable the training was: An audit conducted 90 days after "go live" found more than 50 percent of patient access staff had 100 percent error-free work, and no representative fell below 85 percent.
Madison also developed a set of principles to guide the patient access redesign process and a set of operating characteristics so staff knew what was expected.
"Whenever we tended to stray from those principles or characteristics, we would go back to those documents and say, 'It doesn't fit this characteristic or this principle. We need to get back on course,'" says Madison.
The patient access guiding principles include:
The operating characteristics include:
Since the Patient Services Center opened, Madison says the unit has received fewer complaints from patients about preregistration and scheduling services and has realized a reduction in cancelled services.
"That means patients are aware of when they should expect to come in," he says. "Whether they come to Springfield Hospital or Crozer-Chester Medical Center, patients should experience the same preregistration process and be informed of any issues related to their registration."
That also means pre-encounter staff are doing their jobs well. Madison says the organization's emphasis on goal-setting, high expectations, and performance measurement has increased staff productivity and satisfaction.
For example, Patient Services Center leaders posted each representative's performance indicators-data-quality scores, number of cases they worked on, and their point-of-service collections-publicly and invited top health system leaders to visit the unit to witness the employees' productivity.
"The staff loved it," says Madison. "They have a sense of accomplishment rather than just the never-ending spinning of the wheel that they were experiencing at the hospitals."
One tactic that proved successful for Crozer-Keystone: Implementing an intensive communication campaign so that health system employees, physician offices, and patients understand the new centralized system. In the months before and immediately after the transition, Crozer-Keystone placed an article in its systemwide journal that is distributed with employee paychecks. The article explained how the change would improve service to patients and help the health system operate more efficiently.
Members of Madison's staff met in person with administrative staff from the top 30 physician offices that feed into the health system. "We gave them the brochure that we developed for patients that says, 'Here's the Patient Services Center, and this is what you should expect and anticipate when scheduling the service,'" says Madison.
Madison shares three additional lessons learned from Crozer-Keystone's transition to centralized registration.
While the process of converting to a centralized registration system is challenging, Madison expects to see the model adopted with increasing frequency as more hospitals consolidate and health systems seek ways to increase the efficiency of their administrative operations. "As systems grow and more hospitals attach themselves to one another, I think it's going to become more common," he says.
Lola Butcher is a freelance writer and editor based in Missouri.
Interviewed for this article:
Richard Madison is vice president of revenue cycle operations, Crozer-Keystone Health System, Upland, Pa., and a member of HFMA's Metropolitan Philadelphia Chapter (email@example.com).
Publication Date: Wednesday, January 11, 2012
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