Executive Summary
There is increasing need to integrate systems used by patient access departments within organizations, and also within hospitals in the same health system, to prevent rework, incorrect information, and inefficient processes.
• At Western Connecticut Health Network, a small group of enthusiastic patient access employees were trained six months before the “go-live” date of the newly integrated system.
• Registrars can work at multiple hospitals if they share the same system.
• Patient access leaders at Kern Medical Center found a low-cost way to put surgery scheduling in the same module as preoperative testing.
It’s one of the biggest time-wasters in patient access: Employees are constantly switching back and forth between many different systems, just to do their jobs.
“For the last decade, we have talked about clinical system integration and meaningful use requirements. But we have neglected a focus on revenue cycle integration,” says Katherine H. Murphy, CHAM, vice president of revenue cycle consulting in the Oakbrook Terrace, IL, office of Experian/Passport Health, a provider of technology for hospitals and healthcare providers.
When patient access systems aren’t integrated, information is outdated and sometimes incorrect. “Disparate and missing information across the enterprise is the monster you have to wrap your arms around when patient access is working with a lack of integration,” says Murphy.
Manual entry of the same information over and over causes dissatisfied patients and increased claims denials. “With the advent of patient engagement buzz, meeting consumer expectations, and a decrease in reimbursement, integration is certainly a key to success,” says Murphy.
In October 2014, two hospitals in the Western Connecticut Health Network integrated their systems, including those used by patient access areas.
“Prior to that, we were on all different platforms for every single system,” says Judith Nicolosi, CHAM, director of patient access for the health system, which includes Danbury Hospital, New Milford Hospital, and Norwalk Hospital.
Six months before the integration went live, Nicolosi identified five patient access employees — about a third of her staff — who were most enthusiastic about switching to the new system. “They became the experts. They had an intricate level of understanding on how the systems worked,” she says. “That piece was so important.” These employees then trained their patient access colleagues, so they were comfortable working on the new system well before the go-live date.
The third hospital in the health system still isn’t integrated. Patient access employees also still need to use multiple applications within the two hospitals that are integrated.
Still, the change made patient access processes much more efficient. “It’s one sign-on when we go into any application,” says Nicolosi. “Now we all talk the same language.” Previously, patient access staff at the two hospitals used different terminology for insurance codes.
Staffing is more flexible, because registrars can easily switch back and forth between hospitals. “We can have a staff member work at the other hospital if they’re in a staffing crisis, because they already know the system,” says Nicolosi. “We were not able to do that before.”
Patient access leaders at Bakersfield, CA-based Kern Medical Center had a frustrating problem: Surgery scheduling was not done in the same module as preoperative testing.
“We had to find a way to gather all the schedules for every single visit and create a flow to ensure that all tasks were completed,” says Susan Labow, interim executive director of revenue cycle. Labow also is vice president of Receivables Optimization Inc., a Long Beach, CA-based consulting firm specializing in revenue cycle improvements.
Pre-registering, verifying insurance, obtaining authorizations, and collecting patient liability needed to occur prior to the patient’s arrival. Also, patient access needed to notify clinical areas if a patient was scheduled for surgery but wasn’t scheduled for preoperative testing. “We needed to find a solution without a big price tag,” says Labow.
One obstacle was that patient access used three systems for the electronic medical record (EMR), registration, and scheduling. Patient access manager Helen Cullen says, “There was no way to get the three platforms to talk to each other. Our EMR is somewhat archaic, adding to the confusion.”
When a physician entered an order into the system, the referral department couldn’t see it if it was first opened by someone else, such as a nurse in the provider’s office. “Because of this system limitation, if somebody other than the referral department opened the notification, there was no way for the referral department to even know it exists,” says Cullen.
The biggest issue involved patients scheduled for surgery. In some cases, the patients already had appointments at clinics for preoperative testing. “It was so frustrating, because we couldn’t see that,” says Cullen. The patient would show up on the surgery schedule, which meant patient access needed to obtain an authorization. However, patient access had no way of knowing if the patient was scheduled for their preoperative testing.
Cullen took a night class at a community college to expand her knowledge of the department’s Microsoft Access Database program. Working with the hospital’s information systems department, Cullen found a way to make the orders accessible to patient access. They’re now moved directly into a table that she created. “I was very surprised that something so simple worked. Why didn’t we think of this before?” says Cullen.
When patient access employees submit an authorization, a spreadsheet opens up. “That form is the face of what’s really going on behind the scenes,” says Cullen. Staff easily can view all of the authorization requests they need to follow up on.
“What is really nice is we don’t have to be dependent on other departments for information. We just have it,” says Cullen.
Previously, Kern’s patient access staff couldn’t see the patient’s insurance information without going into a separate registration system.
“We had the patient’s last payer information pulled into the Access database, as a starting point,” says Cullen. “At least we know what insurance company to verify eligibility for.” This system greatly reduced denials for claims billed to the wrong payer or for a patient who no longer had that coverage.
The most recent information now comes up, and “99% of the time it’s correct. We just validate it and submit. It’s a lot quicker,” says Cullen. “It’s one less step for us to take.”
Staff members now can sort authorizations by insurance payer, which allows them to consolidate calls and spend less time on the phone. “Previously, staff would call payers for one patient at a time,” says Cullen.
Data is fed from the EMR, registration, and scheduling systems into the Access Database table used by patient access, and it is continually updated. “Staff submit the request for authorization to the payer using one form. Once it’s submitted, they use a follow-up form,” says Cullen. If the authorization is obtained, it goes off their view and doesn’t pop up again.
“Physician offices can see that the authorization is obtained and that surgery is OK to schedule,” says Cullen. “Before, the other departments had no way of knowing it was approved.”
SOURCES
• Helen Cullen, Patient Access Manager, Kern Medical Center, Bakersfield, CA. Phone: (661) 326-2303. Email: cullenh@kernmedctr.com.
• Susan Labow, Interim Executive Director, Revenue Cycle, Kern Medical Center, Bakersfield, CA. Email: labows1@kernmedctr.com.
• Katherine H. Murphy, CHAM, Vice President, Revenue Cycle Consulting, Passport Experian Health, Oakbrook Terrace, IL. Email: Katherine.Murphy@passporthealth.com.
• Judith Nicolosi, CHAM, Director, Patient Access, Western Connecticut Health Network, Danbury, CT. Email: Judith.Nicolosi@wchn.org.