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From the Consultant’s Corner 8/7/19

Patient Access Centralization – Far More Complicated Than Anticipated
By Nancy Gagliano, MD

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Nancy Gagliano, MD is CMO at Culbert Healthcare Solutions in Woburn, MA.

Over the last decade, healthcare organizations have implemented centralized access centers with the promise of a panacea to improve patient satisfaction, access, volume, revenue, and all that ails ambulatory operations. Numerous articles have espoused the value of this approach. Unfortunately, organizations are struggling with numerous challenges, having underestimated the complexity involved in running a successful patient access center.

The wide variety of challenges are not easily covered in one article. This article will summarize and highlight common opportunities. Over the next few months, I’ll dive deeper into these challenges, highlighting considerations and recommended solutions. Topics will include:

  • Scheduling templates and governance.
  • Technology and telephony.
  • Staffing and service level agreements.
  • Establishing a patient access center approach.
  • Self-service – where the future lies.

“Centralized Patient Access” does not have one clear definition. In some organizations, it defines the approach to registration and insurance verification. In other organizations, it includes scheduling and referral management. In some, it also includes pre-authorizations and nurse triage. Without a clear short- and long-term vision, organizations struggle with whether this is a finance or an operations unit. When the initial foundation and governance is not clear or aligned, it leads to broader challenges as a centralized approach is expanded. In some organizations, we have seen two central access groups – one for financial-related activities and the other for patient clinical activities, creating unclear accountability. Other organizations have one center but are challenged because of matrixed responsibilities and structure.

Scheduling: A common scenario includes scheduling staff centralized into pods of expertise responsible for registering and scheduling patients. Patients, in theory, will be evenly distributed to all available providers, filling any open slots, and providing access quickly to patients, resulting in increased patient satisfaction and overall volume. While organizations are aware this works best when schedule templates are simplified with clearly documented protocols, the hard work of obtaining provider buy-in and changing their schedule templates is often not completed due to provider resistance. Without simplified schedules, the patient access center often makes errors as well as ends up with unused slots in schedules. Without easy access to talk to providers, schedulers cannot fill unused slots for “different” patient types. It is often best for central access centers to start with more general specialties, such as primary care, and then add complexity associated with specialties as the foundation for success is established.

Governance: An opportunity often underappreciated is the need for a governance model that has accountability for both the performance of the central access unit and dependent clinical operations components. For a centralized unit to be successful, a collaborative dyad between the practices and the central unit is required. An organizational approach to scheduling templates, visit times, provider availability, and bump rules needs to be defined and managed. Practices, in turn, need to be assured of appropriate staffing, training, and performance of the centralized unit. Working together through joint governance creates the collaborative approach necessary for the foundation of success.

Technology and Telephony: There are numerous third-party vendors available to support effective call center operations. Many organizations leverage telephony and provider matching systems already in place. However, for efficiency and quality, additional systems can be extremely helpful. I have seen organizations have too many systems, too few systems, poorly leveraged systems, as well as a  lack of internal expertise to maximize the use of technology.

Staffing: Appropriate staffing for call centers is quite complex. Turnover is often as high as 30% – higher than ambulatory practices. Replacement staff tend to lack training, experience, or exposure to the clinical setting, and are therefore less efficient and prone to errors. Given high turnover, most centralized call centers are short staffed, particularly on Mondays and Tuesdays, in addition to most mornings, which see peak call volumes. Appropriate staffing is also dependent on which specialties are included in the access center. The more specialized the departments are, the more complex access support is, requiring a higher level of staff skill.

Us/Them Mentality: When practices have their staffing cut to support a central unit, it commonly sets up tension between the two. Practices may want all calls to be handled centrally and are often slow to respond to calls from the call center in need of support and clarification. Practices may undermine the central unit by providing patients with a “back number” to the practices. Or practices will avoid scheduling any patients, such as follow-up when leaving their visit, and refer all scheduling events to the call center. In turn, call centers voice frustration on calls they receive that may not technically be their responsibility, such as medication refill requests or complaints that the practice hasn’t returned the patient’s calls. The antagonism is typically not anticipated or realized until the center is underperforming and improving relationships is difficult.

Patient Satisfaction: While patient satisfaction and consumerism are often a core rationale for centralized patient access centers, underperforming central access may worsen patient satisfaction. Poor response times, handle times, errors, and lack of expertise may lead to dissatisfied patients who find back channels to the practices to get their problems solved. Subsequently, providers and practice leadership, vent their frustrations to organizational leadership.

Referring Providers: An effective patient access center is designed to efficiently handle referrals to minimize leakage and reduce the work by outside practices to schedule their patients. Unfortunately, many call systems are still working through faxed referrals, resulting in only about half of the requests ending in actual patient visits. To complicate matters, most organizations do not have an efficient tracking process to inform referring providers of complete or incomplete referrals.

Cascade of Challenges: The result of an ineffective patient access approach is a cascade of challenges. The central patient access center is challenged in meeting call demand and is fraught with scheduling errors. The practice staff spend time cleaning up schedules, rebooking patients, and dealing with frustrated patients. Because practice administrative staff numbers have been transferred to the central unit, the time spent in “clean-up” precludes practice staff from supporting in-office patient flow and other patient needs. Subsequently, providers are less efficient, frustrated with the central unit, and often request being removed from the central until. The overall result is frustrated patients, providers, practice staff, and access staff without significantly increasing access, productivity, or reducing costs.

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If operating a superb patient access center isn’t challenging enough, most organizations initially set up their centers for phone-based interactions with patients. Now access centers are transitioning to multi-channel communications, because patients want the ability to communicate by phone, text, email, and chat. The next goal for organizations is to support patient and referring provider self-service. However, without setting the above foundations, self-service will only be a vision for the future rather than a near-term reality.

In summary, operationalizing a patient access center is extremely challenging and many organizations are looking for ways to improve performance, patient satisfaction, and provider engagement. While there are no quick fixes, organizations should assess their vision, governance, provider scheduling approach, technology, and staffing. Stay tuned for deeper dives into these topics.


Contacts

Jenn, Mr. H, Lorre

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News 8/5/19

August 5, 2019 News No Comments

Top News

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Ambulatory health IT reseller and consulting company DAS Health acquires the WRT collection of companies, which includes WRT Specialties, Easy PC Solutions, EasyMed Billing, and Systech Solutions. It’s the company’s fifth acquisition in the last year.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.

Check out the recording of last week’s webinar from Mercy Technology Services titled “Modern Imaging Technology for the Enterprise: Improve Imaging Cost, Speed, Capacity and Care Quality.” Mr. H called it “among the best ever.”


Acquisitions, Funding, Business, and Stock

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Imaging center and software company RadNet uses assets from newly acquired Nulogix to launch a division focused on developing, acquiring, and investing in AI technologies that better enable image interpretation and radiology business processes.


Announcements and Implementations

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DirectTrust announces that more than 1 billion messages have been sent and received using its secure messaging system since it began tracking transmissions in 2014. The milestone follows last week’s news that the nonprofit is developing a standard for secure instant healthcare messaging.

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Workit Health, an addiction care company that offers its programs and services through telemedicine, will open a brick-and-mortar clinic in Kern County, CA. It received grant funding last month from the Center at Sierra Health Foundation to expand its services in California, and start pilot projects with emergency departments in certain counties.

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Choices Counseling Center (OR) selects EnSoftek’s behavioral health-focused DrCloudEHR.


Government and Politics

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Ohio Governor Mike DeWine announces that the state’s PDMP has reached record utilization levels, recently surpassing 1 million daily queries on two separate occasions. In 2016, Ohio became the first state to offer direct integration of its PDMP into EHRs and pharmacy dispensing systems free of charge.


Telemedicine

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Baton Rouge, LA-based startup Relief Telemed raises $150,000 in a family-and-friends seed-funding round. Co-founder and CEO Vishal Vasanji is also the co-founder of Patient Plus Urgent Care. CMO Ronald Andrews, MD is the owner of Pediatric & Internal Medicine Associates in Baton Route. Vasanji says the company just signed its first payer, and that eight clinics in and around the city are using the company’s software. He added that practices will eventually be able to buy a white-label version of the technology.


Sponsor Updates

  • Nordic will exhibit at the CORE Conference August 5-7 in Salt Lake City.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

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News 7/31/19

July 31, 2019 News No Comments

Top News

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This JAMA editorial highlights the fine line pediatricians must walk when engaging in portal messaging with parents. The physician authors point out that in one large group practice, the average pediatrician responds to 10 portal messages a day – none of which are eligible for reimbursement and all of which likely add to administrative burden and burnout. Additional challenges include managing patient expectations when it comes to response times, and taking the right tone so responses aren’t misconstrued. The authors recommend that physicians:

  • Develop standards and establish expectations for what constitutes a reasonable period between a parent’s message and a physician’s reply.
  • Create guidelines for parents about what types of concerns are appropriate for a message as opposed to a telephone, video, or office appointment, and how quickly parents should expect a response.
  • In a group practice setting, develop templates to enhance the consistency of written instructions.
  • Create electronic in-basket coverage structures and cohesive expectations for how thoroughly covering clinicians should address issues.
  • Train other clinicians to be part of a team that addresses portal messages from parents.

HIStalk Practice Musings

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Pure literary torture: The Booker Prize includes Lucy Ellman’s “Ducks, Newburyport” in its list of finalists. The book is actually a single sentence that runs over 1,000 pages. Just typing that reminds me of the pain I felt trying to get through “Moll Flanders” in high school. Chapters, not to mention full stops, were created for a reason!


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.


Announcements and Implementations

BetterPT incorporates patient engagement and telemedicine tools from BlueJay Mobile Health into its patient app, which features provider search and appointment scheduling capabilities.


People

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Patient check-in company Clearwave names Mike Lamb (SimplyWell) CEO.

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Shailendra Sharma (Nuance) joins Precision Point Specialty Analytics as president.


Other

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They’re coming for you, Claire’s: Rowan launches at-home ear-piercing services in New York and Connecticut, cutting out the mall middleman and ensuring the blood-drawing rite-of-passage is done by a licensed nurse. The company’s real bread and butter will come from its subscription service, which offers monthly boxes of earrings and tween-friendly trinkets. Founder Louisa Schneider says RNs will be key to the company’s success: “We found that nurses were very interested in an opportunity to earn another stream of income that did not involve things like end-of-life care or home care. This is typically a fun experience for them. It’s a celebration.”

This article about medical students serving on the Little League World Series medical team reminds me how much I’ve enjoyed reading about Dr. Jayne’s adventures at the World Scouting Jamboree. I’d love to hear from any readers that may have served in similar capacities at large gatherings like these. Any Olympic or Paralympic clinicians out there? Email me with your anecdotes.


Sponsor Updates

  • AdvancedMD will exhibit at APA2019 August 8-11 in Chicago.
  • Culbert Healthcare Solutions will exhibit at West Coast CORE August 7-9 in Salt Lake City.
  • LightSpeed Technology Group achieves SOC 1 and SOC 2 Type 2 attestation.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 7/29/19

July 29, 2019 News No Comments

Top News

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Women’s health and fertility care company Kindbody brings it pop-up mobile clinics to San Francisco and opens a clinic within Carbon Health’s primary and urgent care practice while its stand-alone clinic is being prepared for opening later this year.

Kindbody also has a presence in New York City, and will eventually expand its brick-and-mortar operation to Los Angeles. It has raised nearly $22 million since launching last August. Its proprietary KindEMR was likely built off the IVFqc cloud- based EHR and billing software it acquired from Althea Science around the same time.


HIStalk Practice Musings

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“The Overstory” by Richard Powers was recommended to me this morning. Wikipedia describes it as the story of “nine Americans whose unique life experiences with trees bring them together to address the destruction of forests.” If you like your descriptions a little more high brow, the Library Journal adds that it’s a “a deep meditation on the irreparable psychic damage that manifests in our unmitigated separation from nature.” Make of that what you will.

Powers supposedly wrote the book after seeing giant redwoods for the first time, which makes me wonder: Do you have a favorite book inspired by nature? “Cold Sassy Tree” by Olive Ann Burns is the only book in my library that comes close. Email me with your favorites and I’ll be sure to share.


Webinars

July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Denver-based virtual scribe vendor Skywriter MD will open a second office in College Station, TX by the end of next year. CEO Tracy Rue expects to hire 200 employees to staff the new location, largely drawing from the area’s medical students at Blinn College and Texas A&M.

Beacon Orthopaedics and Sports Medicine in Ohio partners with private equity firm Revelstoke Capital Partners to launch a national managed services organization.

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CNBC reports that membership-based primary care company One Medical’s valuation has increased to $2 billion. The company, which also offers an employer service line, has raised $400 million since opening in 2007. Headquartered in San Francisco, it now has 72 clinics in seven states, and has partnered with health systems in several markets. The company has developed its own EHR and patient app, and offers online appointment scheduling and video consults.


Announcements and Implementations

BetterPT adds interoperability functionality from Kno2 to its inbound patient management software, giving physical therapists and physician referrers a more seamless way to share patient data.

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Simple Interact announces GA of digital informed consent forms that automatically upload to the EHR.

MyOutcomes develops an open source version of its behavioral health measures software.


Government and Politics

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HHS awards $42 million to 49 Health Center Controlled Networks, which in turn will funnel that funding to 1,182 FQHCs to assist them in adding or upgrading health IT. OCHIN, the largest HCCN in the US, will use its $8 million to help facilities within its network improve care coordination; reduce provider burden; and increase connectivity to state immunizations registries, prescription drug monitoring programs, and HIEs.


Telemedicine

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Henry Schein Medical introduces an updated version of its MedPod MobileDoc telemedicine equipment. New features include integration with Uber Health, giving physicians the ability to book their patients rides to and from appointments, or more acute care settings.

Physicians in Florida cry foul over licensing and registration fees associated with the state’s new telemedicine laws. Out-of-state physicians who want to virtually care for Florida patients don’t have to pay any registration fees, while in-state MDs must pay a $350 application fee and initial $355 licensing fee. Governor Ron DeSantis vetoed legislation that would have required out-of-state physicians to at least pay a $150 registration fee, saying they would have undercut efforts to curb healthcare spending. 

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Rite Aid will use software from InTouch Health to launch kiosk-based telemedicine services at a handful of RediClinics within its retail pharmacies.

Ohio Governor Mike DeWine passes legislation requiring payers to reimburse providers for telemedicine visits.


Other

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Park DuValle Community Health Center (KY) pays hackers $70,000 to unlock medical records that have been held ransom since June 7. Its appointment scheduling system has also been affected, and so patients are being seen on only a walk-in basis. The health center has been the victim of ransomware attacks twice since April. It did not pay the requested ransom after the first attack, instead electing to rebuild its records from backups. CEO Elizabeth Ann Hagan-Grigsby says the center has spent about $1 million on recovery efforts over the last three months.


Sponsor Updates

  • EClinicalWorks will exhibit at the CHCAMS 32nd Annual Conference July 30-August 2 in Biloxi, MS.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 7/24/19

July 24, 2019 News No Comments

Top News

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Mental health telemedicine and analytics company Telemynd announces plans for an $8 million IPO. Based in Mission Viejo, California, the vendor was spun off earlier this summer from parent company Mynd Analytics before it was sold to Emmaus Life Sciences.


HIStalk Practice Musings

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Check out the Advisory Board team’s suggested summer reading list. It’s full of suggestions for a wide range of interests. As a huge Star Wars fan, I will definitely check out(!) “The Princess Diarist” by Carrie Fisher.

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The folks at Hyland have also started a blog series about their favorite business, technology, leadership, and professional development titles.

Does your practice or company share reading recommendations? Email me with your lists and I’ll share them in an upcoming post. Happy reading!


Webinars

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Announcements and Implementations

NextGen adds OptimizeRx’s point-of-care digital prescription savings software to its Enterprise EHR.

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HealtheConnections combines its New York-based HIE data with information from state and national healthcare databases to develop the MyData platform, which includes community health dashboards, quality measures, and data discovery capabilities.

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Modernizing Medicine announces GA of bundled EHR, practice management, and business services software.

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ESimplify develops Practice Analytics for family medicine providers and internal medicine groups.

CVS Health will work with social services software vendor Unite Us to develop a portal that Aetna Medicaid patients in Florida, Kentucky, and Louisiana can use to find and connect with local resources. The project is part of the $100 million Building Healthier Communities initiative, through which CVS and Aetna are working to improve community-based health and wellness over the next five years. CVS acquired Aetna late last year for $70 billion.


Other

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Kaiser Health News covers the work University of Chicago Medicine PCP Wei Lee, MD is doing to help providers develop better “computer-side” manner. Lee and her colleagues have developed a curriculum to help physicians use EHRs in a way that makes patients feel included, including an ABC mnemonic for patients: Ask To See The Screen. Become Involved. Call For Attention.

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So sweet: Medical student Odolphe Augustin proposes to his girlfriend on stage after receiving his white coat at Touro College’s special ceremony. She said yes!


Sponsor Updates

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

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