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Michelle Fox, MBA, MHA, CHAM

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Presentation on theme: "Michelle Fox, MBA, MHA, CHAM"— Presentation transcript:

1 Manage Your Message: Improve Patient Experience with Better Communication
Michelle Fox, MBA, MHA, CHAM Director, Revenue Operations/Patient Access Health First, Inc.

2 Located in Brevard County on Space Coast 4 not-for-profit hospitals
Health First, Inc. Located in Brevard County on Space Coast 4 not-for-profit hospitals 920 acute-care beds Other services: 4 outpatient diagnostic centers 175+ Health First employed physicians Health First Health Plans

3 Learning Objectives Define 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.

4 The Patient Experience Imperative

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 HCAHPS Beginning in Oct 2012: Under Value-Based Purchasing, CMS may withhold up to 2-3% of reimbursements based on HCAHPS scores and other quality measures Hospitals cover the difference Centers 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 Experience 2010 Survey of Senior Healthcare Leaders: What priority is the patient experience to your organization? Top 5 Priority Business Imperative that Drives Referrals, Volume and Revenue as Much as Clinical Quality More of a Priority in the Last Year 93% 80% 72% Factors Motivating Patient Experience HCAHPS and other measurement tools that emphasize patients’ perception of care Many are struggling to improve HCAHPS scores and finding ways to get better faster Among 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
Profitability Adherence Patient Outcomes Loyalty Employee Satisfaction Quality of Care Personal Referrals

10 A Negative Patient Experience
Malpractice Claims No-Shows Hospitalizations Mortality Rates Provider-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 Care 3 of 4 patients rate hospital quality based on perception of care rather than objective measures. Source: Professional Research Consultants, National Consumer Perception Study, 2006.

13 Perception & Clinical Satisfaction
Satisfied with Billing Experience Unsatisfied with Billing Experience 93% Satisfied with Clinical 63% Satisfied with Clinical Source: “Study Shows Link between Patient Satisfaction with Billing Experience and Clinical Satisfaction,” Executive Insight, ©2011.

14 Source: Patient’s Voice, Healthcare Management Toolkit, 2011.
Patient Complaints Recent study of 1,216 patient complaints from two Boston hospitals: 19% identified unprofessional conduct 17% reported poor provider-patient communication Source: Patient’s Voice, Healthcare Management Toolkit, 2011.

15 10 Most Common Patient Complaints
Difficulty scheduling an appointment Long wait times Rude or uncaring staff Lack of coordination of care Poor/ineffective treatment Uncomfortable or unclean environment Billing problems Unprofessional conduct Poor patient-provider communication Unreturned 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 appointment Ease of Registration process Waiting time in Registration Staff 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. Negative Unscripted Unclear Expectations Missing Info. Rapid Fire Instructions No Time for Questions Confusion No Recording for QA No Training Opportunities Positive Scripted Clear expectations Thorough & Accurate Info. Slow, Clear Instructions Time for Questions Understanding Recorded for QA Training Opportunities

20 Patient Access Touch Points
Physician scripts Consents and authorizations Insurance benefits verification Prior authorization Notification of admission Patient out of pocket estimate Financial Counseling/Medicaid Eligibility Identify payer sources

21 Communication Challenges We Faced
Too much paper No proof of communication when disputed No way to monitor communication for QA No central storage for records Inefficiency, rework

22 The Impact? Inefficiency Lost faxes Busy Lines Hold Time Duplication
Complaints Cost-bleeding Denials Missed Revenue

23 Electronic Revenue Record (ERR)
Our Solution: An EMR for Patient Access Electronic 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.

24 Objectives Revenue Processes Integrate Centralize Scheduling Requests
Capture Preregistration Data Document Authorization Data

25 File Cabinet Computer Scanner Printer CD-ROM Tape Recorder DVD Memory
Face-to-Face Conversations s Web Pages File Cabinet Inbound Faxes Computer Messages Voice Scanner Printer CD-ROM Phone Calls Tape Recorder Outbound Faxes DVD A system that allowed us to digitize and place in a central repository all communications to eliminate subjectivity both internally and externally Documents Electronic Memory Paper Documents Note Pad

26 File Cabinet Computer Scanner Printer CD-ROM Tape Recorder DVD Memory
Documents Electronic Inbound Faxes Scanner Web Pages Outbound Faxes s Printer CD-ROM Paper Documents Phone Calls Tape Recorder Face-to-Face Conversations Messages Voice DVD Memory Note Pad

27 Tools: Our Capture Methods
Voice Fax Electronic Inbound Calls Outbound Calls Voice Mails Live Conversations Inbound Faxes Outbound Faxes Paper Documents Notifications Web Pages s Images, Documents Electronic Forms

28 Electronic Revenue Record (ERR)
ERR Features Central Record Storage Web Tracking System Index and Archive Date-and-Time Stamp System-Wide Access Retrieval and Routing Electronic Revenue Record (ERR)

29 Electronic Revenue Record (ERR)
Electronic Records Inbound Fax Records Outbound Fax Records Voice Records

30 Voice Records

31 Used to Streamline Workflow
Scheduling …between departments Business Office Eligibility Patient Discharge Authorization Patient Continued Stay Pre- Registration Registration

32 …and for individual activities

33 Voice Capture Authorizations, certifications, referrals Physician calls Verbal orders from on-call physicians Scheduling calls Pricing hotline/estimates Patient calls on nurse help-line Calls in Emergency Department Customer service calls

34 Fax Capture Discharge planning & notification Appointment requests for outpatient clinics Outside patient medical records Referring patient for service

35 Electronic Capture Verification of benefits and eligibility Prior authorization Appeals Referrals

36 How ERR Supports Patient Experience
Scheduling Precertification/Preregistration Process Payment Estimates/POS Collections

37 Scheduling efficiency
Scheduling…Right Place, Right Time Scheduling efficiency Route all scheduling to one fax number Index records by department (Surgery, GI Lab, Cardiology, etc.) Record-sharing Retrieve all records pertaining to patient Reduce phone calls between departments Off-site access Monitor productivity remotely (pending scripts, calls) Communicate with telecommuters

38 Scheduling Results Centralized records to reduce calls, faxes and s; filing and duplication Increased call volume by 20 calls/day Saved $60,000/year by eliminating 2 temporary positions Saved $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 estimate Capture order and route to clinical area Record phone calls Document online communication

40 Clear, Accurate Communication
Call recording Face-to-face communication QA reviews Training for schedulers Quality measures, competency reviews *Bonus: Behavior modification for physicians & clinical staff

41 Call Monitoring: QA Scorecard

42 Registration: Patient Expectations
Information regarding healthcare benefits Prior auth and/or precert completed prior to service Knowledge of costs and out-of-pocket expectations Services are covered by insurance company

43 Role of the Patient Access Representative
Address verification Compliance: MSP, ABN, etc Obtain Authorization Signatures -Consents etc. Estimate out-of-pocket Collect $$ Post $$ Alternate payment sources Collect Information Verify E&B Service with a Smile

44 Registration Process Assure 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 ERR Monitor communication records for quality and customer service Troubleshoot issues to improve quality assurance Modify 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.

49 Audit Trail Monitor productivity Quality assurance, staff training Customer satisfaction

50 Results Customer service improvement Patient satisfaction Quality assurance Efficiency: no more printing and scanning Workflow between departments Staff support, satisfaction

51 Conclusions Communication 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.

52 Questions?

53 Michelle Fox Director Revenue Operations,Patient Access Health First, Inc. (321)

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