Manage Your Message:
Improve Patient Experience
with Better Communication
Michelle Fox, MBA, MHA, CHAM
Director, Revenue Operations/Patient Access
Health First, Inc.
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
Learning Objectives
1. Define business processes that ensure streamlined
access for patients.
2. Create proper clinical and financial expectations for
patients prior to arrival.
3. Review patient communications for clear and
accurate messaging.
4. Use records for quality assurance, training and
productivity monitoring.
The Patient Experience Imperative
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
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.”
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.”
The Patient Experience
2010 Survey of Senior Healthcare Leaders:
What priority is the patient experience to your organization?
Top 5 Priority
93%
Business Imperative that
Drives Referrals, Volume and More of a Priority
Revenue as Much as Clinical
in the Last Year
Quality
80%
*Source: August 2010 HealthLeaders Media online survey of senior healthcare leaders
72%
A Positive Patient Experience
A Negative Patient Experience
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.
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.
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.
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.
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
HCAHPS & Communication
The strongest predictor of overall HCAHPS
scores is how patients rate provider
communication skills.
Source: Bavis and Fulton, Press Ganey Whitepaper, 2008.
HCAHPS & Communication
More than 50% of
patients say that
good communication
is the #1 reason
they chose a
hospital or clinic.
Source: Katzenbach Partners, 2007. Healthcare Consumer Survey (results based on phone interviews with 1,000+ patients)
What This Means for Patient Access
•Ease of Scheduling an appointment
•Ease of Registration process
•Waiting time in Registration
•Staff was friendly and courteous
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
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
The Impact?
Inefficiency
Busy Lines
Duplication
Lost faxes
Hold Time
Complaints
Denials
Costbleeding
Missed
Revenue
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.
Objectives
Integrate
Revenue
Processes
Centralize
Scheduling
Requests
Capture
Preregistration
Data
Document
Authorization
Data
File
Cabinet
Computer
Scanner
Printer
CD-ROM
Tape
Recorder
DVD
Memory
Note Pad
File
Cabinet
Computer
Scanner
Tape
Recorder
Memory
Face-to-Face
Conversations
Printer
CD-ROM
DVD
Note Pad
Tools: Our Capture Methods
Voice
Fax
Electronic
Inbound Calls
Inbound Faxes
Web Pages
Outbound Calls
Outbound Faxes
Emails
Voice Mails
Paper Documents
Images, Documents
Live Conversations
Notifications
Electronic Forms
Central
Record
Storage
ERR Features
Web
Tracking
System
Retrieval
and Routing
Electronic Revenue Record
(ERR)
SystemWide
Access
Index and
Archive
Date-andTime Stamp
Electronic Revenue
Record (ERR)
Electronic Records
Inbound Fax
Records
Outbound Fax
Records
Voice Records
Voice Records
Used to Streamline Workflow
Scheduling
Business
Office
…between departments
Eligibility
Patient
Patient
Discharge
Authorization
Continued
Stay
PreRegistration
Registration
…and for individual activities
How ERR Supports Patient Experience
• Scheduling
• Precertification/Preregistration Process
• Payment Estimates/POS Collections
Scheduling…Right Place, Right Time
Scheduling
efficiency
Record-sharing
Off-site access
• Route all scheduling to one fax number
• Index records by department (Surgery, GI Lab,
Cardiology, etc.)
• Retrieve all records pertaining to patient
• Reduce phone calls between departments
• Monitor productivity remotely
(pending scripts, calls)
• Communicate with telecommuters
Scheduling Results
Centralized records to reduce calls,
faxes and emails; 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
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
Call Monitoring: QA Scorecard
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
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.
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
Results
•
•
•
•
•
•
Customer service improvement
Patient satisfaction
Quality assurance
Efficiency: no more printing and scanning
Workflow between departments
Staff support, satisfaction
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.
Questions?
Michelle Fox
Director Revenue Operations,Patient Access
Health First, Inc.
(321) 434-6017
michelle.fox@health-first.org