Electronic Health Reporter

By Chelsea White, consultant, Freed Associates.

Want to rapidly improve your hospital’s brand, reputation and financial prospects? Look no further than patient access (PA), typically the front-line “face” of a healthcare provider and instrumental to an organization’s clinical, financial and reputational success.

While the definition of “patient access” may vary from organization to organization, generally it means the department responsible for handling new patient intake, including registration, insurance verification, billing, admissions, cash collection and more. According to the National Association of Healthcare Access Management (NAHAM), PA representatives handle access for “patients, providers and payors into, through and out of their healthcare experience.”

PA also significantly impacts a healthcare facility’s revenue cycle and finances, due to its role in benefit verification, pre-certification and even financial counseling. NAHAM estimates that about 80 cents of every dollar collected by a healthcare facility is handled by PA representatives. Considering the significant shift in health insurance toward high-deductible health plans, and the likelihood that patients will have an ever-larger portion of their overall bill to pay, the importance of PA has never been greater.

You would think a department and function as critical as PA would be considered a healthcare facility’s crown jewel and receive sufficient resources and internal approval accordingly. Yet too often, some in healthcare view PA as a necessary expense – a transactional, high-cost center often faulted for bad debt, claims denials, administrative delays and sub-optimal patient experiences. While that may be the case in some PA departments, high-performing healthcare providers know differently, and ensure that their PA staff members receive all that they need to succeed. Following are the most common characteristics of high-performing PA departments.

It Starts at the Top

A PA department is only as good as the system it supports, and most of that system is beyond PA’s direct control. For example, if a healthcare system lacks sufficient providers to meet the demand for care, or the right mix of specialists, PA will bear the patient-facing brunt of these issues. Similarly, if a facility doesn’t offer the time availability or convenient location to meet local patients’ needs, PA will suffer.

Operationally, healthcare organizations need to be sure they have in place the right care delivery strategy and resources to meet patient requirements – and allow their PA team to correspondingly perform well. That’s especially important in today’s era of healthcare, with patient experience increasingly affected by factors like access, convenience and cordiality, in addition to patients’ baseline expectations of caregiving competence.

Support from the top for PA is not only strategic and philosophical, but also practical. This includes making sure that PA has the latest technological tools necessary to deliver quality PA workflow. This could mean providing PA staff members with improved visibility tools into ED and inpatient unit availability, allowing for better and more productive PA decision-making. For patients, this might entail offering a high-quality, 24/7 online patient portal, providing information on lab results, discharge summaries and billing and scheduling information. 

Improving PA Performance

Assuming that a healthcare system has done all it can from a strategic and operational standpoint to further PA’s success, what can PA departments specifically do to improve themselves? Consider the following areas for PA improvement:

• Staff – As the single largest PA expense, and the one most likely to affect its operations, proper staffing is critical to a PA’s function and budget. You need to ensure PA staffing levels meet current and future system requirements and patient expectations, and are flexible enough to meet inherent changes in PA demand. For example, one healthcare facility significantly improved its PA staffing based on a new, dynamic staffing model centered on patient registration volumes and several other key data inputs. The result was a system that fulfilled everyday staffing needs and offered robust predictive staffing insights.
• Budget – Rather than considering PA staff scheduling as “fixed” and unchangeable, consider the potential benefits of creating a dedicated PA “float team” to meet PA demand at multiple locations. A healthcare organization saved nearly $100,000 annually in overtime and contracted labor costs, and increased operational efficiency, using such a float team.
• Finances – Find ways for PA to handle previously unconsidered point-of-collection opportunities. For example, PA staff members in one health system assumed all co-payment collection responsibilities for a healthcare system’s several different clinics. The result? A significantly higher co-payment collection rate than previously achieved, and improved cash flow. Consider standardizing review of patients’ prior outstanding balances at check-in and collecting then. Patients often appreciate the chance to pay in-person versus by phone or mail. If needed, patients can be connected with an on-site financial counselor to review options for outstanding balances.
• Development – Do not assume that the skills of PA staff members are static. PA staff skills and expertise should be regularly developed. For example, by training PA staff on improved patient experience standards, including patient registration and front desk workflows, a healthcare provider significantly improved its patient experience, and achieved a happier and more satisfied PA workforce.

Conclusion

Led and managed well, a PA department can be a justifiable source of pride for any healthcare organization – and a distinct competitive differentiator. PA staff members fulfill a unique dual role in healthcare. They address their employer’s functional and operational requirements and ensure that patients receive the care they need and are treated with all due consideration, empathy, dignity and respect. The greater you can ensure your PA staff is up to these tasks, the greater the likelihood of success for your entire healthcare organization.