Centralized scheduling provides many benefits
Executive Summary
A Patient Contact Center At Pittsburgh-based UPMC Handles Scheduling, Discharge Planning, And Collection Of Unpaid Balances For More Than A Dozen Hospitals And 23 Specialties.
• Financial discussions occur at the point of scheduling.
• Providers build in decision rules into the system for scheduling.
• Patients can make appointments any time of day or night.
Back in 2006, revenue cycle leaders at Pittsburgh-based UPMC noted an increase in patient complaints that calls to physician offices weren’t being answered and messages weren’t responded to quickly enough.
"We were getting feedback that people were not always getting through to the service/office clinical area. We wanted to make sure we weren’t losing customers because they were reaching voicemail versus people," says Karen Shaffer-Platt, vice president of patient concierge services/access in UPMC’s Corporate Revenue Cycle.
Patients who called the wrong departments weren’t always referred to the correct department. "We were hearing that UPMC is so big that it is difficult to know who to call," says Shaffer-Platt. "Not all 60,000 employees have a good decision support tool that can lead them to the right appointment or the right place."
More than 10,000 calls a day are now managed at UPMC’s centralized consumer call center, where patient access employees handle primary or secondary scheduling support for more than a dozen hospitals and 23 specialties, in private practice and academic. "We are zealous about it. We are huge proponents of centralized consumer call centers," says Shaffer-Platt. "We had to really grow it up, but it’s turned into one of our most valuable assets and customer satisfiers."
Expanded role of access
Shaffer-Platt says the patient contact center is "taking the real definition of access farther. Access should be the ones who are getting patients to the first service and connecting them to their next service."
Patients can make or cancel appointments 24 hours a day, seven days a week. "We also serve as our doctors’ offices answering service. That saved us a lot of money with an outside vendor," Shaffer-Platt says.
Staff members can book an appointment, page a doctor, or use a protocol to direct patients to appropriate care sites. This system sometimes avoids an unnecessary emergency department visit. Diane Zilko, senior director of the Patient Contact Center, says, "We have e-visits, and the call center can lead patients to immediate service in the comfort of their home."
Shaffer-Platt says "the real issue is access to services. That’s what a contact center is all about."
Billing concerns are addressed
Here are some of the items handled by the call center’s agents:
• They handle billing concerns, such as adding an additional coverage, reviewing the Explanation of Benefits, and supplying itemized copies of bills.
If a patient calls stating that a visit should have been coded as a wellness visit, the agent refers the problem to the coding department.
"We can’t change a CPT code, but we have a coder look at it within eight business hours," Shaffer-Platt says. "Coders are expensive and shouldn’t have to call patients, so we may have to do the outbound call, which we have no problem doing."
• They collect outstanding balances and have financial discussions with patients.
With higher-out-of pocket responsibilities for patients, the best time to have financial discussions with patients is at the point of scheduling, argues Shaffer-Platt. Agents use a price estimator, built into the system, to give accurate quotes for out-of-pocket expenses.
"Why would I put the patient in a work queue for somebody else to do an outbound call on, or worse, wait until the day of service to try to collect?" she asks.
Instead, staff determine the patient’s propensity to pay right at the time of the call. "If I’m a patient, I don’t want somebody trying to figure all this out with a calculator," says Shaffer-Platt. "Nobody is smart enough to know all of that, so the system tees it all up right in front of the contact center agent, based on the insurance plan details."
Find out upfront: Can patient pay?
If the patient is unable to pay for services, "you should know that upfront, not after they have entered into a complex clinical care plan and they are on an OR schedule," says Shaffer-Platt.
In this case, the patient needs a more in-depth discussion of his or her finances, at a convenient time for the patient. "I’d rather talk to mom about her out-of-pocket expense after she puts the kids to sleep, than at the arrival desk the day of surgery," says Shaffer-Platt.
Patients often are relieved to learn they qualify for financial assistance or need-based discounts. Zilko says, "Letting the patient know that will partner with them at the beginning of the care plan eases the mental fatigue from financial worries during an already trying time."
- Karen Shaffer-Platt, VP of Patient Concierge Services/Access, Corporate Revenue Cycle, UPMC, Pittsburgh. Phone: (412) 432-5350. Fax: (412) 488-0040. Email: [email protected].
- Diane Zilko, Senior Director, Patient Contact Center, UPMC, Pittsburgh. Email: [email protected].
