EXECUTIVE SUMMARY
Patient access departments often lack good data to demonstrate successes and justify the need for resources. Patient access can use AccessKeys, new key performance indicators (KPIs) developed by the National Association of Healthcare Access Management, to do the following:
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Determine if the department falls into “good,” “better,” or “best” categories.
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Demonstrate how additional FTEs will affect KPIs.
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Boost morale by spotlighting successes.
Too often, patient access leaders lack good metrics to show how well, or poorly, the department is doing. This situation puts patient access at a big disadvantage.
“We tend to not have as good data as the back end. Because of that, we don’t always tell our story as well as we should,” says Yvonne Chase, MBA, CHAM, manager of revenue cycle at Mayo Clinic’s Phoenix and Jacksonville, FL, sites. Chase is president of the National Association of Healthcare Access Management (NAHAM).
Without valid key performance indicators (KPIs), patient access struggles to justify the need for resources. “Data must become a top priority to validate what staff you need and why you need it,” says Chase. “You can’t go to senior leadership and say ‘We need FTEs,’ just because volumes have increased.”
The current state of peer-to-peer comparison in patient access is “all over the map,” says Pete Kraus, CHAM, CPAR, FHAM, business analyst for revenue cycle management at Emory University Hospital in Atlanta. Some departments use MAP (Measure, Apply, Perform) Keys, which are revenue cycle benchmarks, from the Healthcare Financial Management Association (HFMA). Some patient access leaders query their peers at other organizations informally. “Others rely on consultants, who may or may not have an underlying business motive,” says Kraus. “Still others feel pretty helpless in finding a source they can trust.”
In January 2015, NAHAM introduced its AccessKeys: 23 KPIs that track how the front end is performing in point-of-service collections, private-pay conversions, process failures, productivity, and quality. (See related stories on AccessKeys and HFMA MAP Keys in this issue. To learn more about AccessKeys, which are free to NAHAM members, go to www.naham.org/AccessKeys.)
Good data allows patient access departments to call attention to their successes, such as having a wait time of two minutes when the industry standard is five minutes. “These indicators give people the opportunity to make a case for what they need to be one of the best patient access departments in the industry,” says Chase.
Hold staff accountable
At Texas Health Harris Methodist Hospital Southwest Fort Worth, employees in patient access services always have “a mindset of improvement and advancement. If we do not know how we fare, if we have no expectation or goal, we will fail our organization and our community,” says Laura Rasor, director of patient access services.
The department uses a Patient Access Indicator Report, developed internally, with more than 65 indicators. These are displayed in green if the goal is met and red if the goal is not being met.
“Communication boards are required in all departments of the hospital. This is where I post our reports,” says Rasor. Patient access and revenue cycle leaders used the HFMA MAP Keys for guidance to develop the targets.
“Patient satisfaction is an effort that is hot on everyone’s plate. But the Indicator Report also encompasses the basics of patient access, to include collections and quality of work,” says Rasor.
The department uses surveys only from Boston-based Press Ganey to compare itself against its peers. “It is helpful to see how we fare in comparison to facilities that are similar in size. We certainly learn from each other’s wins and opportunities,” says Rasor.
Each month, patient access leaders pull 10 random accounts for each employee to score them on accuracy. Staff members start with a 3.00 score. Specific points are assigned to each component of the registration, such as appropriate documentation and correct insurance code and policy number. If a component isn’t met, points are deducted.
“Our system also has an automated quality assurance tool that alerts representatives of possible errors,” says Rasor. “Managers monitor that tool to confirm our staff are utilizing it and making the necessary corrections in accounts.”
Like many patient access departments, the one at Emory University Hospital is expected to meet various annual goals, such as dollars collected prior to admission and patient satisfaction scores. However, the ability to gauge how those numbers compare to other patient access departments has been a continual challenge.
How the department’s goals compare to industry standards “is conjecture at best,” says Kraus. “Until now, no one has provided a pathway to evaluate where a department is, what it will take to move it to where it wants to be, and compare progress with peers.”
Because patient access departments differ from other areas of the hospital, unique KPIs are needed that take those differences into account. “Access expectations are different from those of other departments,” Kraus explains. “Patient accounts, in particular, sometimes seems to work at odds with patient access.”
Fast registration times conflict with the need to collect complete, accurate information, for example. Likewise, short wait times make it difficult to provide caring, personal attention to all patients. Similarly, high pre-admission cash collection rates might be at odds with the goal of superior patient satisfaction scores.
“But we need to stop thinking that upfront collections automatically will compromise the scores,” says Kraus. “I am convinced that these goals can be reconciled successfully.”
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Yvonne Chase, MBA, CHAM, Manager, Revenue Cycle, Mayo Clinic, Phoenix, AZ. Phone: (480) 342-4472. Fax: (480) 342-3633. Email: [email protected].
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Pete Kraus, CHAM, CPAR, FHAM, Business Analyst, Revenue Cycle Management, Emory University Hospital, Atlanta. Phone: (404) 712-4399. Fax: (404) 712-1316. Email: [email protected].
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Laura Rasor, Patient Access Services, Texas Health Harris Methodist Hospital Southwest Fort Worth. Phone: (817) 433-6600. Email: [email protected].
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Sandra J. Wolfskill, FHFMA, Director, Healthcare Finance Policy, Healthcare Finance Management Association, Westchester, IL. Phone: (708) 531-9600. Fax: (708) 531-0032. Email: [email protected].
