EXECUTIVE SUMMARY
Outdated, inaccurate information causes patients to be matched with the wrong provider, a dissatisfier for patients and providers. Revenue cycle leaders can address this by:
- coordinating with clinical leaders to create referral and scheduling templates;
- using diagnosis codes to steer a patient to the correct physician or location;
- factoring in patient location preference.
Patient access representatives don’t really know if they’re relying on accurate data to refer or schedule patients. This means some patients are matched with the wrong providers — a big dissatisfier for all concerned.
“This is one of the fundamental challenges patient access departments face across the industry,” says Travis Moore, senior vice president of market solutions at Kyruus, a Boston-based provider of patient access solutions.
Patient access staff often end up validating information manually as they try to refer or schedule patients.
“They make decisions based on the data they have in front of them, spread across multiple databases, in thick binders, or on Post-its, and update information where they find discrepancies,” Moore explains.
This inefficient process causes misdirected referrals.
“Patient-provider mismatches can lead to an increase in patient leakage out of the health system, not to mention a poor patient experience,” Moore says.
However, patient access representatives are limited in what they can do. The true “owners” of provider information are elsewhere — medical staff offices, managed care offices, practice management systems, and providers.
“If the necessary provider information can be verified by these sources before it gets into the hands of patient access representatives, it increases the likelihood of appropriate patient-provider matches at the point of scheduling, and ultimately improves the patient’s experience,” Moore says.
Patient access call centers typically don’t have clinically trained staff booking appointments. When patients ask to see someone who treats a certain condition, the best provider match often isn’t apparent based on available data.
“For example, if someone is seeking help for knee pain, is the health system’s top orthopedic surgeon the best provider for that patient, or is a practice’s nurse practitioner the best choice as the first step toward diagnosis and treatment?” Moore asks.
It might even be that another type of provider is a better fit, such as a sports medicine expert.
“That’s not easily determined due to the limited data available to patient access representatives,” Moore notes.
Sometimes, patients wait weeks or months for an appointment, only to later find that the provider wasn’t the best match. Both the patient and provider are unhappy.
“This can lead to friction or distrust between provider organizations and patient access centers,” Moore observes.
Accurate Data Ensured
Andrew Ray, director of professional revenue cycle at Stanford (CA) Children’s Health, sees three main sources for data inaccuracy issues:
- Referral data related to the patient’s condition;
- Referral data related to the services, physician, or location where the patient is expected to be seen;
- Patient demographic and insurance information that drives the referral, scheduling, and authorization workflows used to verify insurance coverage.
“We have rolled out an enterprise-wide approach by building referral and scheduling templates, in close coordination with the physician and clinic leadership, to improve this,” Ray reports.
When processing referrals, scheduling, and authorizations, patient access staff is led through comprehensive questionnaires.
“This ensures we have complete and accurate data from the referring provider, the patient, and the insurance to complete this process,” Ray says. Diagnosis codes are used to steer a patient to the correct physician or location.
“We also have expanded our geographic footprint significantly over the past five years, throughout the Bay Area,” Ray notes.
The process weighs patient location preference, when there are two or more options, along with availability and physician preference.
“This enhances the experience for our patients and our referring providers,” Ray says.
SOURCE
- Andrew Ray, Director, Professional Revenue Cycle, Stanford (CA) Children’s Health. Phone: (650) 723-9810. Email: [email protected].
‘One of the fundamental challenges’ for patient access.
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