In health care’s transition from volume to value, patient access serves as a critical quality indicator because it encompasses goals related to both volume and clinical outcomes. Finance leaders can play a collaborative role in offering objective evidence for restructuring revenue cycle and care processes to improve care in both fee-for-service and value-based systems. And they can provide the executive leadership to oversee this effort.
The essential element for financial leaders in this collaboration is to set the direction of change with the right degree of flexibility. They should have a strong voice for leadership in clearly communicating across the enterprise how access will be measured and why.
Future-Proof Patient Access
Improving patient access at the physician level, whether at a large health system or a small practice, is an effective way to increase revenue and improve quality and patient engagement. Even under value-based care models, seeing more patients per day and delivering more services will increase revenue and bolster a competitive advantage for organizations. According to a 2014 study, patients (i.e., healthcare consumers) look for the same things in a provider that they want in any other consumer experience.
a Many would switch providers for a better experience, including the following:
- A quickly scheduled appointment (61 percent)
- An appointment at a convenient location (52 percent)
- Better customer service (51 percent)
Improving patient access also helps organizations deliver care in a more timely fashion. Patients with chronic conditions—responsible for 86 percent of the $2.9 trillion spent on health care annually—would not need to wait as long for check-ups, testing, and other cost-effective preventive services if effective patient access policies and procedures were established. b
It takes more than simply adding appointment slots or recruiting more providers to ease patient access. Indeed, a comprehensive patient access strategy also is likely to have a significant impact on revenue cycle, scheduling, and clinical workflows. By assessing scheduling procedures and governance across the enterprise, a provider can identify potential changes that could be highly beneficial.
Redesigned clinical triage process. Triaging patients should start with the patient’s first contact with the organization. With the proper process and staffing, organizations can fully understand the patient’s health needs and find an appropriate appointment with an available physician or clinical support staff member.
Faster insurance benefits eligibility confirmation. Some long waits for appointments, tests, and procedures are due to delays in health plan approvals of patients’ eligibility. These types of waits often are unnecessary because authorization or denial is usually highly predictable based on historical revenue cycle data. Finance leaders can offer insight into trends such as how often certain high-demand tests and procedures are approved or denied by which health plans. Such analyses, combined with technology that can rapidly obtain eligibility confirmation, can provide a basis for new policies that enable faster, easier access.
Greater scheduling oversight and transparency. Some physicians are understandably protective of their schedules, but concerns over schedule autonomy also can impede expanding patient access. Staff who schedule appointments need to have greater transparency into all schedules enterprisewide, as well as tools to communicate with care teams so appointments can be adjusted to allow flexibility and promote physician productivity.
To accommodate these efforts, a centralized and integrated patient access center may off-load administrative burdens from outpatient clinics or community practices while improving physician capacity and patient access across the enterprise.
Earning Physician Buy-in
One of the main challenges in improving patient access is maximizing physician capacity. Many physicians believe their schedules are already overbooked; however, an analysis of scheduling and billing data sometimes can reveal areas for improvement in efficiency.
For example, some physicians set aside blocks of time as contingencies for other appointments that might run longer than scheduled. When that extra time is not necessary, the physician is left waiting for the next patient to arrive. A closer exploration of physician schedules also may uncover large blocks of time in which specific tasks are not categorized, which could be modified to accommodate more patient care time. Physicians also may choose to delegate some care to other clinicians, such as physician assistants and nurse practitioners, giving the practice the opportunity to see a greater number of patients overall.
When presented with historic scheduling and revenue cycle data, both physicians and clinical support staff can better understand their actual capacities versus their perceptions. The following metrics can provide a persuasive means of achieving this objective.
Third available appointment wait time. Measuring the average number of days between the appointment request and the third available appointment can provide an accurate picture of how long a typical patient waits for a visit. c The first available appointment is not a good indicator of patient access due to numerous variables, such as predetermined arrangements physicians have with certain types of patients, and the next available appointment often can reflect a chance occurrence, such as a recent cancellation. For this reason, the third possible time available for an appointment when a patient calls to schedule one is regarded as a more reliable metric for a practice’s actual patient appointment wait time times. Third available appointment wait time for new patients may be even longer than for existing patients, which can indicate additional patient acquisition challenges for the organization.
Physician capacity. Historic data such as how many patients are seen per day, work relative-value units, or other metrics an organization chooses can indicate how close a physician is to reaching his or her capacity. Patient type and complexity should be considered to present a fair comparison.
Patient satisfaction concerning appointment wait times. Patients rarely complain to providers about how long they were required to wait for an appointment, but they typically remember when asked in post-visit surveys, especially when they were dissatisfied due to a long wait time.
Financial leaders have access to enterprisewide billing, eligibility confirmation, and other financial metrics to help drive the patient access conversation. These objective data can help physicians and other providers visualize how different practices, facilities, specialties, or even individual physicians are performing.
Clinical, financial, and administrative leaders should meet regularly to discuss the data and progress on improvement strategies. Such transparent discussions also are crucial to obtaining buy-in among both employed and affiliated physicians. To build trust and promote adoption, administrative leaders should candidly explain the financial pressures the organization faces. Physicians should be educated about the challenges presented by the shift to value-based payment and cost management, and how care performance and productivity are likely to affect the organization’s sustainability.
Communicating, Compromising, and Creating Incentives
Transparency, especially with financial data, is essential throughout the process to expand patient access. Once the data are presented—along with information about the organization’s financial pressures and patient demand—it is important that financial and administrative leaders listen to provider concerns about schedule control and be willing to negotiate compromises. One compromise, for example, might be to establish ethical, risk-based financial incentives for meeting targets, depending on employment structure and health plan requirements. Some of the financial incentives can be tied to patient satisfaction results for the patient’s perception of access to the office/appointment availability and the patient’s willingness to refer the physician or physicoan office to others.
Revised compensation plans should be structured to reward improved patient access in addition to other value-based goals.
For example, one health system recently implemented a compensation structure that has three flexible components: productivity, quality/value, and citizenship. Citizenship is a unique metric that includes attending internal organizational meetings and events in the community where potential patients have an opportunity to meet physicians and learn about the organization. Over time, the percentage of payment tied to each component will change to mirror organizational goals.
Assuming an organization can afford such an incentive plan and it is approved by the compensation committee, the most feasible implementation strategy usually is to start with a small amount of risk and gradually increase it along with performance demands. The organization also should carefully define quality and access targets for providers, and explain how and why definitions and/or percentages change over time.
Once again, data transparency is essential so physicians can monitor their performance. Financial leaders should collaborate with IT or health information management (HIM) leaders to ensure physicians have easy access to dashboards or other reports that they can review at a glance.
Establishing a Centralized Patient Access Center
Financial leaders can help further alleviate scheduling, registration, and authorization tasks from outpatient clinics and affiliated practices by serving as administrative champions for centralized patient access centers. These centers are major investments but can bring significant increases in revenue, patient engagement, and patient acquisition.
Creating a successful patient access center typically includes the following five steps.
Select a physician champion. Centralizing schedules and removing some autonomy from clinic offices requires a physician champion in a leadership position who can accelerate buy-in among other physicians. This physician champion will serve on a committee comprising stakeholders across the organization, who will manage the project. Throughout the process, the administrative and clinical leaders’ messages should be aligned and consistent when communicated to all stakeholders.
Determine goals. Once leadership is selected and the committee is assembled, specific goals for the patient access center should be established. The committee should decide how goal achievement will be measured, as well as action steps for nonperformance.
Align systems. For a patient access center to reach its full potential, the flow of clinical and financial data between it and the hospitals and physician practices must be seamless. Collaboration with IT, HIM, revenue cycle, and numerous other departments is necessary to ensure clinicians and staff have the information they need to effectively, efficiently, and safely triage patients and resolve their concerns.
Set attainable goals. The temptation to set overly ambitious patient-access expansion goals is enormous. Given the multimillion-dollar investment typically associated with creating an integrated and centralized patient access center, the pressure is high to maximize ROI. Attempts to do too much too soon can lead to push-back from clinical staff and may result in scheduling errors, which can frustrate patients. Instead, starting with just one additional appointment a month per eligible provider can make a major difference in patient access, revenue, and patient satisfaction.
Measure and communicate progress. Leaders should communicate progress to all stakeholders so that they understand the initiative’s impact on enterprisewide patient access, satisfaction, and revenue. These updates should include comparisons of defined measures with a baseline to note success and continue improvement opportunities.
Filling Care and Financial Gaps
Improving patient access is an enterprisewide concern. Simply put, delivering care to more patients per day will have a positive impact on financial and clinical performance, regardless of future industry or regulatory changes.
Finance leaders can offer a unique and reliable perspective by delivering meaningful data that demonstrate the importance of patient access. These data can show how access varies across the enterprise and forecast how small changes could deliver significant returns in both revenue and patient satisfaction.
Finance leaders can promote even more positive change by advocating for a centralized patient access center. The finance leader should begin the initiative by reaching out to clinical leaders to form a partnership and achieve physician buy-in. The finance leader also should work with IT, HIM, and other departmental leaders to enable systemic integrations.
To change mindsets, the finance leader should help set goals, seek open and honest feedback, collaborate on designing processes, and ultimately share data to communicate progress. Such an effort, undertaken deliberately, has the potential to produce revenue gains that can more than pay for the patient access center, while delivering even longer-lasting ROI in the form of improved care quality and patient engagement.
Rik Baier, CMPE, is president and CEO, Presence Medical Group, Chicago, and former executive consultant for Culbert Healthcare Solutions, Woburn, Mass.
a. Collier, M., and Basham, L.M., “Patient Loyalty: It’s up for grabs,” Accenture.
b. “At a Glance 2016,” National Center for Chronic Disease Prevention and Health Promotion, 2016.
c. “Third Next Available Appointment,” Institute for Healthcare Improvement.