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.