Using proven principles you can quickly measure what the activities in Access Management are costing – including the rework in other departments caused by inefficiencies in the Registration processes. This article examines how to assess and plan for improvements in Access Management. The ROI, both financially and in customer relations, can be staggering.
Background
Healthcare delivery and financing aren’t getting any easier. Managed care requirements, the BBA, compliance, and outpatient prospective payment are all adding layers of complexity to the administrative burdens of healthcare providers. No longer is this only an administrative or bookkeeping exercise either. Now payors require that business office personnel also be clinicians who can discern whether or not a service is medically necessary and thus reimbursable. Some legal knowledge is also handy as personnel must sort through complex program compliance issues or deal with an account involving subrogation.
In order to continue to get paid and maintain cash flow, providers have set up further levels of specialization. The result has meant more handoffs, more delays, eroding financial positions, and a much more frustrated set of customers.
What can we do about this? So much of it seems beyond our control. When you factor in the maze of new technologies, it starts to get a bit overwhelming.
The ABC’s of Access Management
We have to start with the patient. At the hub of the patient experience is what is now commonly called Access Management, formerly referred to as Admitting or Registration. This group has the job of collecting enough information to satisfy the clinicians treating the patient, meeting the requirements of Joint Commission and other authoritative bodies, and getting the ball rolling on collecting and settling the account. In other words, the Access Management area has numerous customers in addition to the patient or family member sitting across from them.
Without the benefit of relevant information, providers have attempted to staff Access Management based on past history – namely, if patient and physician complaints aren’t too high, there is probably enough staff. However, staffing in Access Management has not kept up with the increased demands and complexity of the process, and thus other areas are suffering. Clinicians and medical records personnel deal with incomplete or incorrect information. Claims information is incomplete and left to back office to sort through. And all of these things make for a much more unhappy set of customers (both physicians and patients) as they continually have to live with the repercussions of inaccurate and incomplete information.
As the chart above shows, Access Management is the hub of the patient experience and kicks off several processes in the hospital setting: medical record documentation, patient flow, revenue capture, and billing and collections. In each of these areas, we are dealing with an inordinate amount of rework as information that should have been collected and verified in Access Management is corrected or added in other areas. This does not go unnoticed by patients and physicians as these situations erode their confidence in the hospital’s ability to get things right.
Access Management is the area that has the first chance to create the “emotional contract” with the patient that the hospital must have if it is going to be successful. It is here that the tone is set for the patient on the issues with respect to their hospitalization. And it is here that the provider has the chance to begin working on the patient’s behalf to get all the information correct so that the clinical outcomes are appropriate and the account is settled in a timely manner. All of this must happen in an environment that minimizes the likelihood of any of this occurring outside the realm of the complex legal requirements established by state and federal officials.
So why do we let unresolved issues out of the Access Management area? In a manufacturing environment, if there are problems on the front-end design or in the manufacturing process itself, huge problems ripple downstream in terms of recalls, warranty related expenses, lawsuits, and customers that abandon the company’s products. World-class manufacturers dealt with these issues with their TQM and Six Sigma programs during the 80’s and 90’s. Providers, however, are letting the issues in their manufacturing process (Access Management) create huge and costly problems for them in downstream processes.
The first step in understanding the overall implications of this is to analyze how much these non-value-added tasks of reworking are costing the hospital. The way to tackle this is using a discipline that manufacturing adopted in the 80’s and 90’s – activity based costing. In a relatively short period of time, the activities in Access Management and related areas can be identified and costed. The costing is done against relevant workload measures. Thus you can learn what each significant activity is costing in terms of the work that is being produced. Each activity is also identified as value or non-value-added, further identifying issues in the process.
Today, hospitals are looking for a silver bullet answer to their Access Management and Business Office problems. It is hoped that a new Internet technology or outsourcing partner can provide the missing piece of a complicated puzzle. However, it is hard to imagine planning for these types of changes without first going through the analysis of the activities that are consuming the resources of the hospital. That is exactly what activity based costing does. With the information on the cost of the activities, providers are armed with the information needed to make staffing, technology, and partnering decisions. The goal of each of these decisions is to lower the overall cost per workload measure and improve the quality of the process, including the downstream activities.
Getting Started
Every provider must take a proactive role in dealing with this trend. The next few years will prove pivotal in adapting to the new age of the empowered customers, Internet technologies, and more demanding payment plans. The first steps in this journey are assessment and planning.
The assessment is not a management engineering set of time studies aimed at micro costing every second of work. The information needed for this plan is collected in a few days by talking to the people performing the work. Estimates are gathered based on workers’ views about how they spend their time. This information is combined with available workload measures and general ledger cost information, and activity based reports are produced.
From there, it is an exercise in planning. Activity based information is used to look at areas where work can be restructured so errors and rework can be eliminated. New technologies that target problematic activities can be selected and implemented. Outside companies that can perform complex activities more economically can be evaluated.
Conclusion
Few doubt the clout that the consumer will have in the emerging healthcare environment. The customer’s experience with providers will play a much more important role in the future with regard to growing and sustaining market share. Thus, improvement efforts have to begin where we begin the customer relationship – in Access Management.
Activity based costing is a proven tool for analysis that can be applied easily to the Access Management area. It provides information that is essential to the critical decisions that must be made if the provider expects to provide excellent customer service in the coming years. Also, activity based costing and management tools can be applied in many other ways throughout the providers’ operations. TQM and budgeting programs benefit nicely from this type of analysis.
Manufacturing learned this a long time ago — you have to understand the activities that are occurring if you hope to make sustainable improvements in your operations. Providers rarely have the ability anymore to significantly grow the top line. It will be critical that these types of analysis begin to occur in the provider setting if they hope to lower cost and improve quality. And what better place to start than at the hub of the patient experience.
Contact: Lance Lott llott@infoad.com Tom Dugger tdugger@infoad.com
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