Presentation on theme: "Michelle Fox, MBA, MHA, CHAM"— Presentation transcript:
1 Manage Your Message: Improve Patient Experience with Better Communication Michelle Fox, MBA, MHA, CHAMDirector, Revenue Operations/Patient AccessHealth First, Inc.
2 Located in Brevard County on Space Coast 4 not-for-profit hospitals Health First, Inc.Located in Brevard County on Space Coast4 not-for-profit hospitals920 acute-care bedsOther services:4 outpatient diagnostic centers175+ Health First employed physiciansHealth First Health Plans
3 Learning ObjectivesDefine business processes that ensure streamlined access for patients.Create proper clinical and financial expectations for patients prior to arrival.Review patient communications for clear and accurate messaging.Use records for quality assurance, training and productivity monitoring.
5 HCAHPS Scores & Payment Since 2008: Hospitals requesting full payment for treatment to inpatients covered by Medicare & Medicaid required to report patient perception of care data using HCAHPSBeginning in Oct 2012: Under Value-Based Purchasing, CMS may withhold up to 2-3% of reimbursements based on HCAHPS scores and other quality measuresHospitals cover the differenceCenters for Medicare & Medicaid Services, 42 CFR Parts 422 and 480; Medicare Programs; Hospital Inpatient Value-Based Purchasing Program
6 So…What is Patient Experience? “The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”
7 How is it Formed?“Comprised of every impression and encounter a patient (or family member) has with your health system. “Whether it's making a phone call for additional information, scheduling an appointment, or whether your website is easy to navigate, every interaction impacts patient perception.”
8 More of a Priority in the Last Year The Patient Experience2010 Survey of Senior Healthcare Leaders:What priority is the patient experience to your organization?Top 5 PriorityBusiness Imperative that Drives Referrals, Volume and Revenue as Much as Clinical QualityMore of a Priority in the Last Year93%80%72%Factors Motivating Patient ExperienceHCAHPS and other measurement tools that emphasize patients’ perception of careMany are struggling to improve HCAHPS scores and finding ways to get better fasterAmong these efforts:Employee training with increased focus on patient experience: 82%Revised patient and family communication strategies: 51%*Source: August 2010 HealthLeaders Media online survey of senior healthcare leaders
9 A Positive Patient Experience ProfitabilityAdherencePatient OutcomesLoyaltyEmployee SatisfactionQuality of CarePersonal Referrals
10 A Negative Patient Experience Malpractice ClaimsNo-ShowsHospitalizationsMortality RatesProvider-Switching
11 Patient Experience & Profits According to Press Ganey, patient satisfaction and profits are positively correlated, and hospitals can increase profits by 2-5% by improving patient satisfaction.
12 Perception of Care3 of 4 patients rate hospital quality based on perception of care rather than objective measures.Source: Professional Research Consultants, National Consumer Perception Study, 2006.
14 Source: Patient’s Voice, Healthcare Management Toolkit, 2011. Patient ComplaintsRecent study of 1,216 patient complaints from two Boston hospitals:19% identified unprofessional conduct17% reported poor provider-patient communicationSource: Patient’s Voice, Healthcare Management Toolkit, 2011.
15 10 Most Common Patient Complaints Difficulty scheduling an appointmentLong wait timesRude or uncaring staffLack of coordination of carePoor/ineffective treatmentUncomfortable or unclean environmentBilling problemsUnprofessional conductPoor patient-provider communicationUnreturned calls
16 HCAHPS & Communication The strongest predictor of overall HCAHPS scores is how patients rate provider communication skills.Source: Bavis and Fulton, Press Ganey Whitepaper, 2008.
17 HCAHPS & Communication More than 50% of patients say that good communication is the #1 reason they chose a hospital or clinic.>50%Source: Katzenbach Partners, Healthcare Consumer Survey (results based on phone interviews with 1,000+ patients)
18 What This Means for Patient Access Ease of Scheduling an appointmentEase of Registration processWaiting time in RegistrationStaff was friendly and courteous
19 Ensuring Effective Communication A positive patient experience is often tied to the patient receiving clear, accurate and thorough communication before, during and after his/her stay.NegativeUnscriptedUnclear ExpectationsMissing Info.Rapid Fire InstructionsNo Time for QuestionsConfusionNo Recording for QANo Training OpportunitiesPositiveScriptedClear expectationsThorough & Accurate Info.Slow, Clear InstructionsTime for QuestionsUnderstandingRecorded for QATraining Opportunities
20 Patient Access Touch Points Physician scriptsConsents and authorizationsInsurance benefits verificationPrior authorizationNotification of admissionPatient out of pocket estimateFinancial Counseling/Medicaid EligibilityIdentify payer sources
21 Communication Challenges We Faced Too much paperNo proof of communication when disputedNo way to monitor communication for QANo central storage for recordsInefficiency, rework
22 The Impact? Inefficiency Lost faxes Busy Lines Hold Time Duplication ComplaintsCost-bleedingDenialsMissed Revenue
23 Electronic Revenue Record (ERR) Our Solution: An EMR for Patient AccessElectronic Revenue Record (ERR)Technology-based solution that documents all communication (voice, fax, and electronic) on the business side of patient care (with patients, payers, physicians and between providers).Records archived in a central repository and automatically indexed to the patient account for processing, routing and retrieval.
25 File Cabinet Computer Scanner Printer CD-ROM Tape Recorder DVD Memory Face-to-FaceConversationssWebPagesFileCabinetInboundFaxesComputerMessagesVoiceScannerPrinterCD-ROMPhoneCallsTapeRecorderOutboundFaxesDVDA system that allowed us to digitize and place in a central repository all communications to eliminate subjectivity both internally and externallyDocumentsElectronicMemoryPaper DocumentsNote Pad
26 File Cabinet Computer Scanner Printer CD-ROM Tape Recorder DVD Memory DocumentsElectronicInboundFaxesScannerWebPagesOutboundFaxessPrinterCD-ROMPaper DocumentsPhoneCallsTapeRecorderFace-to-FaceConversationsMessagesVoiceDVDMemoryNote Pad
33 Voice CaptureAuthorizations, certifications, referralsPhysician callsVerbal orders from on-call physiciansScheduling callsPricing hotline/estimatesPatient calls on nurse help-lineCalls in Emergency DepartmentCustomer service calls
34 Fax CaptureDischarge planning & notificationAppointment requests for outpatient clinicsOutside patient medical recordsReferring patient for service
35 Electronic CaptureVerification of benefits and eligibilityPrior authorizationAppealsReferrals
36 How ERR Supports Patient Experience SchedulingPrecertification/Preregistration ProcessPayment Estimates/POS Collections
37 Scheduling efficiency Scheduling…Right Place, Right TimeScheduling efficiencyRoute all scheduling to one fax numberIndex records by department (Surgery, GI Lab, Cardiology, etc.)Record-sharingRetrieve all records pertaining to patientReduce phone calls between departmentsOff-site accessMonitor productivity remotely (pending scripts, calls)Communicate with telecommuters
38 Scheduling ResultsCentralized records to reduce calls, faxes and s; filing and duplicationIncreased call volume by 20 calls/daySaved $60,000/year by eliminating 2 temporary positionsSaved $7,200 on paper and toner supplies
39 Clear, Accurate Communication Communicate with patient in the method they prefer.Capture communication, whatever the form (fax, online, phone, face-to-face).Capture faxed estimateCapture order and route to clinical areaRecord phone callsDocument online communication
40 Clear, Accurate Communication Call recordingFace-to-face communicationQA reviewsTraining for schedulersQuality measures, competency reviews*Bonus: Behavior modification for physicians & clinical staff
42 Registration: Patient Expectations Information regarding healthcare benefitsPrior auth and/or precert completed prior to serviceKnowledge of costs and out-of-pocket expectationsServices are covered by insurance company
43 Role of the Patient Access Representative Address verificationCompliance: MSP, ABN, etcObtain AuthorizationSignatures -Consents etc.Estimate out-of-pocketCollect $$Post $$Alternate payment sourcesCollect InformationVerify E&BService with a Smile
44 Registration ProcessAssure patient has received financial clearance.Set expectations for what patient will encounter on the clinical side.Remove worry; set minds at ease.Remove mystery from registration process so patients aren’t surprised with copays and deductibles.Good for organization and the patient
45 Payment Estimates/POS Collections With growing patient obligations and self-pay populations, POS cash collections are increasingly critical to overall revenue cycle performance.For each dollar of patient obligation that is not collected at the POS, only 25 cents on average is collected at the back end.Source:
46 Payment Estimates/POS Collections Prepare patient’s out-of-pocket estimate when encounters are scheduled.Record all communication to assure staff follow all protocols and communication is memorialized when needed for future discussions or disputes.Monitor communication to ensure staff communicate clearly, accurately and ask the right questions in the right way.
47 Monitor communication records for quality and customer service Benefits of an ERRMonitor communication records for quality and customer serviceTroubleshoot issues to improve quality assuranceModify behavior in patient, physician and staff interaction
48 Provider Communication 75% of healthcare providers reported asking a third party to clarify a medication order rather than interacting with an intimidating prescriber.Only 39% of healthcare providers feel their organizations effectively deals with intimidating behavior.Source: Institute for Safe Medicine Practices, 2004.
50 ResultsCustomer service improvementPatient satisfactionQuality assuranceEfficiency: no more printing and scanningWorkflow between departmentsStaff support, satisfaction
51 ConclusionsCommunication impacts a patient’s perception of care more than any other area.Technology is available to create an Electronic Revenue Record (ERR) of communication that surrounds the business side of patient care.Capturing and monitoring communication provides valuable insight that can be used to improve patient experience.