Transformation of Patient Access Processes at Southcoast Hospitals Group
Southcoast Hospitals Group, comprising Charlton Memorial Hospital, St. Luke's Hospital, and Tobey Hospital, embarked on a significant initiative to streamline patient intake processes. This project aimed to centralize scheduling, authorization, and pre-registration, culminating in the creation of an Intake Center. Key steps included restructuring staff, developing career ladders, implementing a competency test, and assuming surgical scheduling responsibilities. Through alliances with periop leadership and surgeons, the project achieved standardized processes and cross-training across multiple sites.
- Hospital Transformation
- Patient Access
- Centralized Scheduling
- Healthcare Initiative
- Surgical Scheduling
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Patient Access Intake Center Transitioning Revenue Cycle Processes to the Front End Kimberly Ryan- Manager of Education Mary Ann Rogers-Project I.T. Specialist 1
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital The Goal To create an Intake Center that will process all ancillary, surgical and inpatient scheduling, authorization, determine patient liability, pre register and collect patient liability. 2
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital First Steps Combined the Centralized Scheduling staff & the Central Authorization Unit staff to one location Realigned leadership to 1 Manager & 2 Team Leaders Developed Career Ladders and combined the job descriptions to create the Patient Access Intake Specialist role 3
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital First Steps (cont.) Involved HR in development of compensation plan Institutued a competency test that would trigger the compensation plan upon successful completion * Test designed to prepare staff for NAHAM ceritifcation exam Began an aggressive cross training plan to expand over 18 months 4
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital New Moves Assumed the Surgical Scheduling for three hospitals and one free standing surgical center Existing periop staff were transferred to the Intake Center Alliances established with Periop Leadership and Surgeons 5
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital New Moves (cont.) Standardized scheduling processes at the four sites Cross trained the schedulers to be able to book at all locations Trained the OR schedulers on insurance criteria * Status C screening * Contracted Insurances * Some Medical Necessity 6
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Appeals Coordinator Identified need to have a position dedicated to review all denials and appeal as quickly as possible AC is able to identify reason for denial and feed this information to the Education Manager Reviews Insurance Newsletters & Bulletins to identify changes in authorization requirements and parses out to appropriate service lines as well as Access staff 7
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Patient Access Project IT Specialist Liason between Patient Access and the Southcoast IT department Handles all dictionary updates Tracks and follows all Meditech issues and tasks Troubleshoots software issues Investigates new technology possibilities 8
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Accuracy & Accountability Implemented Davincian Guardian as our QA tool * customizable * allows staff to correct errors real time * serves as an education tool * includes NEHEN eligibility Individual and department score cards * completed registrations * accuracy rates * frequency of error types 9
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Upfront Collections Collecting at most points of registration Dash Boards assist staff with determining co-pay, deductible & coinsurance: Surgery ED Imaging Therapies are next Track daily collection results on a score card Collected $3.2 million in 2011 * 28% of potential ED & 18% of potential Ancillaries * Staff incentive program 65% 10
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Pre-Registration All scheduled appointments are pre-registered Collection attempt at time of pre-registration Self pay patients reviewed for HSN or other assistance Training staff to estimate payment plans and request initial payment at time of service Patient reports directly to appointment not Admitting 11
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Managed Care Enrollment Enroll Medicaid and Medicare patients into contracted Managed Care Plans Involved most points of registration Patient Financial Services hosts multiple community outreach events Completing Training to Physician Office staff 12
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Physician Practice Buy-In Must work cohesively with MD practices Absorbed high dollar Radiology Imaging authorization process Services 38 offices ( 148 physician s) Provide options on method to access the Intake Center, i.e. phone, fax, electronic Customer Service visits 13
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Education Department Standardized education to all points of registration Provides all initial training - 2 week class * Mandatory annual in-services Computer Access must be approved by Education Maintains duplicate medical record data and recommends corrective action HR approved 14
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital Revenue Cycle Metrics Clean claim rate - 94.6% Days in AR - 32 Administrative write off percentage - .02% Upfront collection - $3.2 million $30 million in documented HSN 15
SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Lukes Hospital | Tobey Hospital National Recognition Southcoast was named a Revenue Cycle Award Winner by the Revenue Cycle Academy . Recognized for: Top Decile performance among all organizations surveyed in net A/R Days (32.0) Bad Debt write off s as a percentage of net revenue (0.2%) 16
