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Practice Management

Streamline your front-end processes

Opportunities abound for improvement when a hospital looks at building a super-effi cient patient access production system.

By Julie Waddell T

Julie Waddell is vice president, revenue cycle solutions strategy, MedAssets. For more information on MedAssets solutions:

he healthcare industry has consistently been stable, responding well to changes in the eco- nomic climate over the years. But in the last year, the outlook for the healthcare sector has shifted from stable to negative as a result of many different factors: increased bad debt exposure, softening volumes, restricted pricing growth opportunities and increasing charity care. Several sweeping trends with far-reaching implications for years to come are affecting the industry. Healthcare organizations face identity fraud and theft, resulting in the need for identity verifi cation and validation in the schedul- ing, pre-registration and registration processes. In addition, hospitals are managing new fi nancial risks such as fi nancial securitization and alternative payment sources. These new concerns, combined with staff shortages, industry- wide escalating costs and increased patient liability, leave hospitals scrambling to stay ahead.

In order to thrive under these conditions, hospitals must look carefully at their front-end processes for ar-

eas of possible improvement. By addressing, analyzing and improving front-end issues, hospitals can reduce the cost of collection, avoid denials, expedite payment and eliminate rework.

In late 2007, OhioHealth, a network of non-profi t, faith-based hospitals and healthcare organizations serving patients in central Ohio, realized the need to streamline its front-end processes. With 108,000 total admissions, 325,000 emergency visits and more than 1.5 million out- patient visits, OhioHealth had a patient cash goal of $60 million. Anything that could be done to improve patient access would increase patient satisfaction and ultimately improve the bottom line as well. To begin, a front-end analysis was performed. Offi cials gathered data from all areas related to the business offi ce, including failed claims, denials, physician satisfaction sur- veys and cash amounts. With data in hand, OhioHealth

24 April 2011

then determined its overall vulnerabilities so that plans could be put in place to address and eliminate them. Finally, offi cials used clean claims data to identify shortfalls. An ongoing theme throughout the entire process of gathering data and determining areas for improvement was accountability. Offi cials adopted an acronym, “GOFAR,” which stood for “gotta own functional areas of responsibil- ity.” Staff members were encouraged to apply the GOFAR concept to three key ideas: go beyond daily tasks and think about functional processes that could benefi t the entire health system; adopt accountability as a personal value; and build accountability as a departmental value. “We clearly outlined the traits of an accountable em- ployee,” says Pam Carlisle, OhioHealth’s corporate direc- tor of patient access services. “We expected employees to take initiative, proactively make reports, relentlessly pursue results, overcome obstacles and meet deadlines. At the same time, we trained managers to identify issues they could control, while teaching them how to infl uence or strategize around those issues they could not directly control. Managers also received training in coaching oth- ers so we could give everyone the tools they needed for success.”

All activities related to patient access were identifi ed and grouped into three key areas: pre-encounter, encounter and post-encounter. The pre-encounter segment included the following actions: • Customer and referral services, • Patient assessment, • Resource scheduling, • Pre-registration, • Patient and family education, • Clinical and fi nancial prerequisites, • Payor authorizations, • Benefi t verifi cation, • Pre-encounter communications, • Proration, and • Financial clearance.

While OhioHealth already had a high pre-registration rate, offi cials found other points in the pre-encounter area


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