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Performance Measurement To Improve Patient Access Management

April 1, 2021
April 1, 2021

This blog post excerpts the HealthStream article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective,” by  Mary Beth Rozell, Sr. Director of Revenue Cycle Solutions at HealthStream’s partner nThrive, and Susan Gurzynski-Wells, RHIA , Senior Product Manager, Revenue Cycle, HealthStream.

 

Price transparency and consumerism have a direct impact on today’s hospital Patient Access operation and more changes are coming in 2021 due to new, stringent Federal and State regulations. Considered the hospital’s “front door,” the role of Patient Access has traditionally begun with the initial patient encounter — where staff confirm patient identity, verify insurance status and more.

Healthcare reform has changed the role of Patient Access substantially, focusing revenue cycle leadership more on the expanding role and expertise of its Patient Access staff. Today’s Patient Access expert is tasked with capturing patient information, as well as educating and supporting a range of individuals—patients, hospital personnel, and providers—helping to ensure comprehensive, quality healthcare service delivery and patient satisfaction.

The Growing Role of Patient Access

Healthcare industry challenges, such as a payor mix shift and rising patient debt, have also expanded the role of Patient Access Managers into upfront collections at healthcare organizations across the country. A robust health information technology suite and Patient Access presence assist in securing patient out-of-pocket costs and/or alternative payment solutions, integral to maintaining a healthy bottom line. From the first patient interaction, today’s Patient Access team:

  • Schedules healthcare service appointments
  • Determines patient insurance eligibility
  • Enters required demographic and billing data
  • Collects co-pays and discusses alternative payment solutions

The bar is set high regarding responsibilities required of a Patient Access team. They must operate at maximum performance levels, create a positive patient experience, and protect revenue integrity by ensuring appropriate insurance reimbursement and patient payments for services rendered. 

How can hospitals and healthcare organizations ensure their Patient Access team is executing at a high level? Implementing key performance indicators (KPIs), providing education, and mentoring your Patient Access representatives comprise an impactful first step to achieving patient satisfaction and revenue cycle success. This blog post is the first in a series discussing key strategies for improving patient access success.

Develop and Monitor Key Performance Indicators (KPIs) for Patient Access

To ensure a high level of productivity and accuracy, Patient Access operations should be measured on KPIs to monitor quality, process, financial, and customer service. Healthcare organizations throughout the medical industry have established guidelines on appropriate Patient Access KPIs with examples, including:

1. QUALITY – A best practice benchmark for duplicate medical records is 2% or less says American Health Information Management Association (AHIMA). Duplicate medical records can lead to patient safety issues. Patient Access has the best opportunity to validate patient identification and prevent duplication by reviewing key identifiers.

2. PROCESS - Benchmark for resolving prior authorization and medically necessary services are both key for successful denial prevention. According to the National Associations of Healthcare Access Management (NAHAM) the benchmark is >90%. As part of patient scheduling/intake, the Patient Access team must validate that authorizations are in place and services are medically necessary.

3. FINANCIALS – Benchmark for point-of-service cash as percentage of total cash collected is >2% says the Healthcare Financial Management Association (HFMA). Patient Access staff must be familiar with the various types of up-front cash collection required.

4. PATIENT SATISFACTION – Benchmark for patient wait time is <10 minutes says HFMA. An impactful first encounter is key to preserving loyalty and ensuring that patients return for future services. A patient’s experience, including registration and wait time impacts their decision to become a loyal consumer. Accompanying KPIs with specific department goals leads to positive outcomes, making certain that you set your team up for success.

Future installments in the series will address the importance of patient access training and education. Download the full article, “Two Key Strategies for Improving Patient Access Success in Healthcare: How Continuing Education and KPI Monitoring Can Make Patient Access More Effective.”

Patient Access Education

All staff with patient access responsibilities must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Our training provides Patient Access employees with the necessary training to ensure patients understand their financial obligations and payment options. This information, when communicated properly, increases payment collection and reduces days of AR.