By Matt Bridge, Senior Vice President of Strategy and Solutions, AGS Health
LinkedIn: Matt Bridge
LinkedIn: AGS Health
Efficient patient access operations are paramount for healthcare provider organizations to thrive in today’s tumultuous financial landscape. Inefficiencies created by outdated, time-consuming, and cost-intensive patient access and financial clearance operations create delays in the patient’s journey from initial contact to care access—which in turn contribute to revenue leakage that chip away at the bottom line and put an organization’s financial stability at greater risk.
Streamlining the patient access process not only eliminates those delays, but it helps ensure patients’ financial security and timely access to necessary medical services. However, many provider organizations are struggling to improve patient access operations, thanks to chronic staffing shortages, rising patient volumes, and more complex prior authorization requirements. As a result, they are falling short of core financial clearance benchmarks.
The solution is to implement a synchronized financial clearance methodology centered around a well-designed and efficiently operated patient access team and modernized processes. Doing so accelerates revenues by decreasing payment delays due to front-end errors, as well as a reduction in rescheduled appointments and improved patient satisfaction.
The engine that drives this patient access overhaul are new technologies and innovative solutions that streamline operations by engaging people, processes, and technology through collaboration and communication—an approach that also aids in greater revenue capture by proactively addressing patient eligibility and coverage issues before they become denials.
Patient Access Best Practices
Healthcare organizations can effectively enhance patient access processes and improve revenue through a combination of services, technology, and best practices. The first step is to establish a clear patient access strategy to ensure all processes are aligned with the organization’s goals and objectives. This includes establishing key performance indicators (KPIs) and metrics to measure the success of the operation. Team members’ roles and responsibilities should also be defined to drive accountability and ownership.
Invest in the technologies that play an important role in optimizing patient access operations, e.g., electronic health record (EHR) systems, patient portals, and other digital tools that can streamline processes and improve patient satisfaction. Additionally, automating routine tasks such as online appointment scheduling, insurance verification, and prior authorization can reduce wait times, improve efficiency, and reduce errors – all of which contribute to an improved overall patient experience.
Other best practices to optimize patient access operations include:
- Standardize patient access procedures. Doing so ensures consistency across the organization, increases productivity, and creates a consistent patient experience. Standardized workflows should outline each step of the process and the expectations for each team member involved. Future process changes or optimizations are more easily adopted when the processes and underlying training are already standardized.
- Foster a patient-centric culture. A patient-centric culture improves patient satisfaction and loyalty. Staff should be trained to focus on the patient’s needs and provide a positive experience throughout the process. Patient feedback should be solicited regularly to identify areas for improvement and address any issues promptly.
- Proper training on the technology and other tools used in the process. This is essential for the success of patient access operations. Staff should receive ongoing education on changes in regulations and compliance requirements as well as policies related to insurance coverage.
- Establish metrics to track patient access performance. These include appointment wait time, insurance verification rate, prior authorization turnaround time, and patient satisfaction. Measuring and monitoring performance against goals is critical to identifying areas for improvement and optimizing the patient access process. KPIs should be defined, and metrics tracked regularly against benchmarks to identify trends and patterns. Performance should be reviewed regularly to ensure that the operation is meeting its goals.
Effective patient access operations require a clear strategy, technology investments, process standardization, proper staff training and education, measuring and monitoring performance, and establishing a patient-centric culture. Following these best practices, healthcare organizations can optimize their patient access operations, increase revenue, reduce costs and denials, and improve the overall patient experience.
Best Practices in Practice
An excellent example of the impact these best practices can have on patient access operations is the use of a configurable “intelligent authorization” tool to streamline and expedite financial clearance processes.
By automating eligibility and benefits determination, prior authorization, and costs estimation processes, these tools achieve improvements including:
- 70% – 85% faster eligibility and benefit determination
- 85% – 90% improvement in authorization determination time
- 65% – 80% less time on authorization initiation
- 75% – 85% shorter authorization follow-up times
- Up to 80% faster price estimation
Automating prior authorization processes allowed a national network of physician-owned radiology practices and diagnostic imaging centers to double its daily staff production and reduced the percentage of exams requiring manual intervention to just 5-10% of all scheduled exams. It also enabled authorizations to be worked further in advance from the date of service, improving from an average of 3 days out to 9 days out.
The process improvements from automating patient access and financial clearance processes allow for more timely access to care, eliminate unexpected schedule gaps, and generate significant operational efficiencies. They also reduce denials and improve overall patient satisfaction.
Optimized Patient Access
The powerful combination of automation tools and proven best practices is a powerful strategy for enhancing efficiencies, streamlining workflows, and creating the foundation for optimized patient access operations. The resulting synchronized financial clearance methodology eliminates many front-end errors that create delays and drag down revenues.