NAHAM speaks out on the ‘access’ debate
NAHAM speaks out on the access’ debate
[Editor’s note: Joe Denney is a veteran access professional, past president of the National Association of Healthcare Access Management (NAHAM) and chairman of NAHAM’s communications/publications committee.]
By Joe Denney, CHAM
Director, Department of Access and Revenue Cycle Management
The Ohio State University Health System
Columbus
On behalf of NAHAM, I would like to offer some background and additional thoughts relative to the recent flurry of discussion about the name "access" vs. "admitting" or "registration." I vividly recall the many, many hours of debate among the NAHAM leadership and others that took place during several strategic planning sessions/retreats before the issue of changing the name to access was presented to the general membership for a vote. Actually, I was president of the association when the vote was taken, although it was my predecessor Judy Balas, among others, who led the cause in support of changing the name.
I think it is important to be very clear about using the term "access." There was never intent to physically replace admitting/registration with access services. I am not aware of any institution that hangs a sign or waves a banner directing patients to access services. The physical locations of admitting and registration continue to exist and probably always will. And there also never was intent to confuse our patients with the term access services. They will continue to know that place where health care institution employees interview them to collect information and have forms signed as admitting or registration.
The term access services began to take shape in the late 1980s and ’90s as the umbrella that encompasses what we in the business are all about. Early discussions included all of the various functions our membership at the time represented. Even back to the time NAHAM was born, members had varying responsibilities. Some were combined admitting and business office managers, some had responsibility for patient information, telephone switchboard, central transportation, etc. Some just dealt with the inpatient piece while others included outpatient registration.
It is important to remember that it also was about this time, in the late 1980s, when a significant portion of our traditional inpatient business began to migrate to the outpatient arena. This, combined with, or actually as an effect of, a significant increase in regulatory requirements, resulted in our membership becoming even more diverse in its responsibilities. Beside the original various functions we performed, new programs managed by the soon-to-be access manager began to pop up all around us.
Centralized scheduling, pre-certification programs, and transfer centers, to name a few, became necessary in many institutions to help manage this new way of delivering health care. Expertise on a variety of subjects, including the Emergency Medical Treatment and Active Labor Act and Medicare Secondary Payer, for example, also became necessary for the successful access manager to understand and employ. In essence, the traditional role of admitting or registration manager has grown by leaps and bounds.
Even more relevant
Although the association name change took place more than 10 years ago, it is the opinion of the current NAHAM leadership that "access" is even more relevant today than it was when the name was changed. Given recent introductions of ambulatory payment classifications, the Health Insurance Portability and Accountability Act, etc., the access manager’s role continues to evolve.
Many institutions are developing call centers to accommodate tiered approaches to scheduling in order to optimize customer (physician) satisfaction, but also to ensure that everything possible has taken place on the front end to secure collection of payment on the back end, and actually, to go one step further, to collect those patient copays up front. It just makes sense to encompass all of these functions we perform under the access umbrella.
Finally, I have read all of the comments many have voiced on this subject in the past few issues of Hospital Access Management. The opinions are as diverse as are the functions of the folks who shared them.
While not every institution embraces the concept, the traditional admitting and registration services continue to fit well under the access umbrella. Perhaps it has been the larger or maybe the academic institutions that have stepped up to the access plate more readily or in larger numbers. But I also know of smaller, community-based hospitals and some very large health systems that have accepted and use the access services model.
I represent The Ohio State University Health System, where patient access services have thrived for more 10 years now. The larger department to which I report is called access and revenue cycle management. Access — with all of the services and functions performed under this umbrella — is an integral part of today’s revenue cycle management.
And, just as a final tidbit, I notice that a number of Hospital Access Management editorial advisory board members represent institutions that have embraced the term "access services."
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