Is there a way to satisfy both?

The reality of shrinking reimbursements has clearly conflicted with the primary  healthcare mission of creating a satisfactory patient experience. Is there realistically a way to both satisfy the patient and effectively manage the cost of service, and how is this related to the front-end operation of scheduling?

Today, hospitals face the challenge of overworked clinicians who are continually being asked to do more with less. In addition to shrinking reimbursements, hospitals must now be concerned with competition and fiscal management; hospitals must look deeper into what they do and how they do it. To this we add factors like not being reimbursed for services provided, increasing numbers of insurance denials, and more write-offs leading to increased bad debt. However, in challenging situations, there is always opportunity.  How can hospitals capture more revenues and increase efficiency in workflow?  A critical place to start is at the very front-end of the patient encounter. The Integrated Appointment Management System (IAMSystem) created by T4 Healthcare, accomplishes: improved efficiency, increased revenue and a better patient experience by linking your hospital's registration, with T4's scheduling, insurance authorization tracking, and charge entry. This paper discusses the process. 

The Challenges:

(1) Inability to schedule the patient for all services in an easy and timely manner may result in loss of the patient to the competitor.  For example, patients often choose one hospital for their surgery or inpatient stay, but another clinic or hospital for their on-going rehabilitation follow up. (2) Inability to ensure that no unauthorized services are provided causes lost revenue. Insurance denials alone can comprise 10-15% (or more) of bad debt. This occurs when insurance authorization occur after services are performed, or manual tracking of authorized visits, time periods and dollars succumbs to human error. This often leaves hospitals "holding the bag" so to speak because patients do not want to assume responsibility for payment they expected would be covered by the insurance company. (3) Inability to audit for completion of all charges for every event that occurred causes lost revenue. Lost Charges may account for 20% loss in revenues. The confusion that evolves from overworked staff as a result of reductions in numbers of employees may lead to delivered services going unbilled.  (4) Inability to gain real-time access to referral trends per service may result in marketing efforts occurring too late. Hospitals may also lose market share if they do not understand where their business is coming from and proactively manage that process. Without easy access to referral trends and data, they are unable to nurture current referral sources or seek new ones in a timely manner. 

IAMSystem lends control to these issues. 

(1) IAMSystem allows both centralized and/or decentralized scheduling, so operationally each organization has the flexibility to run their business the way most advantageous to their unique needs. For example, a hospital may have ALL departments except Surgery and Rehabilitation use a central scheduling department. This increases the efficiently and productivity of the clinical staff in those departments. Still, some departments may feel they need direct control of their scheduling system, as it changes so rapidly.  But all can be linked to check for  patient and provider conflicts across the enterprise, ensure retention of the patient across the network of services and maximize efficiency in resource utilization!  In this scenario, with one phone call, the patient may be scheduled for her surgical event, and instructions attached to this particular type of surgery pop up to schedule the first Physician follow up on week post op, and the first Physical therapy appointment two weeks post op. Clinical outcomes are improved as this patient will now receive timely follow up care, fiscal out comes are enhanced as the patient is now receiving more needed care within the same organization, and the patient's satisfaction is ensured by receiving instructions and multiple appointments with one phone call.(2) IAMSystem can automate the task of tracking this patient's insurance authorizations, time limits and dollar amounts for on-going Physical Therapy (or any other service), so that denials are avoided. The therapist may see 20 patients in one day!  How will we ensure that no unauthorized services are now delivered? The IAMSystem will visually flag that authorizations are needed based on insurance type, and it will count down and list how many authorized visit are left  as they are used. Further, it will run daily reports of patients whose user-defined thresholds are reached and block the scheduling process if authorizations have expired! Denials due to unauthorized services are eliminated! (3) Now, how can you be sure that all charges for every service and its associated material or equipment is submitted, and done so on time? IAMSystem has a charge ticket hidden behind every scheduled event. Simply click it on and send it off.  Daily audits will notify the designated responsible person of any outstanding charges! You may use this feature for some departments and turn it off for others... (4) IAMSystem will now produce reports on which referral source referred which patients for what services, so proactive outreach and marketing data is available at your finger tips.  Managers concerned with patient volume do not have to wait for IS queries or do hand counting of referral sources, instead, they can spend their time dealing directly with their current and potential referrers!

Results:

The additional revenues gained from the more sound fiscal management of: enhancing customer service, retaining  the patient's business throughout the network, charge capture for every scheduled event,  and reduced denials due to non authorized visits being provided, will allow healthcare providers to further invest in better ways to increase patient satisfaction, and focus more on the primary missions of patient safety and enhanced clinical outcomes.