Latest / Becker’s Healthcare Podcast / Rethinking Patient Intake to Drive Revenue and Improve the Patient Experience

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Rethinking Patient Intake to Drive Revenue and Improve the Patient Experience · Becker’s Healthcare Podcast

• 0:00
  - Well, hello, everyone. This is Erica Spicer Mason
• 0:02
  - with Becker's Healthcare.
• 0:04
  - Thank you so much for tuning in to
• 0:05
  - the Becker's Healthcare podcast series.
• 0:08
  - Today, we're going to talk about rethinking patient
• 0:10
  - intake and strategies for greater revenue realization.
• 0:14
  - And joining me for this discussion is Victor
• 0:17
  - Zamora,
• 0:18
  - the executive vice president of customer care at
• 0:21
  - MedMetrix.
• 0:22
  - Victor, welcome to the podcast. Thanks so much
• 0:24
  - for being here today.
• 0:26
  - Thank you, Erica. I'm, excited to be here.
• 0:29
  - I'm excited to discuss this topic today. It
• 0:31
  - certainly is an important one.
• 0:33
  - I've been with MedMetrix for three years.
• 0:37
  - Prior to MedMetrix, over the course of the
• 0:39
  - last twenty eight years, I've spent my career
• 0:42
  - managing revenue cycle operations,
• 0:45
  - managing revenue cycle transformation,
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  - initiatives at a variety of
• 0:50
  - hospital based health care organizations
• 0:52
  - as well as physician led organizations throughout The
• 0:55
  - United States.
• 0:56
  - So I'm happy to share and opine,
• 0:59
  - on the, on the topic today.
• 1:02
  - Yeah. Thank you so much, Victor. And we
• 1:05
  - are fresh off of our, health IT and
• 1:07
  - revenue cycle conference. So this topic is certainly
• 1:10
  - top of mind for me, and I know
• 1:11
  - our listeners as well.
• 1:13
  - And I wanted to start by talking a
• 1:15
  - little bit about where... What we're hearing in
• 1:17
  - the innovation conversation when it relates to the
• 1:20
  - revenue cycle.
• 1:22
  - So much of that conversation tends to focus
• 1:24
  - on those back end processes,
• 1:26
  - like coding,
• 1:28
  - denials, collections.
• 1:29
  - I'm curious where patient intake sits in that
• 1:32
  - picture, and what does the front end determine
• 1:35
  - about how the rest of the cycle plays
• 1:37
  - out? You know, great question. The front end,
• 1:39
  - the patient access or the patient intake process
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  - is probably
• 1:44
  - the most critical
• 1:45
  - of every segment of the revenue cycle operation.
• 1:49
  - Most folks will undermine the level of priority,
• 1:52
  - it should require.
• 1:54
  - But what most folks, should understand
• 1:57
  - is
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  - on the back end, an insurance claim,
• 2:01
  - has about 80 fields. More than half of
• 2:04
  - those fields
• 2:05
  - are actually captured
• 2:07
  - by the team members in the patient intake
• 2:09
  - process or the patient access department.
• 2:12
  - And it has a variety of scenarios,
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  - whether they are engaging with a patient in
• 2:17
  - the emergency room
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  - or on an inpatient floor or whether they
• 2:21
  - have the opportunity to engage with a patient
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  - in advance
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  - of having some elective service.
• 2:28
  - The criticality of how accurate
• 2:30
  - each of those data elements are being captured
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  - and timely,
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  - is ultimately going to result in how quickly,
• 2:37
  - and accurately,
• 2:39
  - a health care organization is gonna get paid
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  - for the services,
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  - that they've rendered.
• 2:44
  - Yeah.
• 2:45
  - Appreciate the overview, Victor.
• 2:47
  - I know another essential consideration here is
• 2:51
  - segmentation.
• 2:52
  - So can you say a little bit about
• 2:54
  - how the approach that you've just described,
• 2:57
  - how that differs from how most organizations
• 3:00
  - segment patients today, and and what tends to
• 3:02
  - change downstream when they get that part right?
• 3:05
  - Yeah. Ultimately,
• 3:06
  - fundamentally,
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  - the process
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  - is the same,
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  - but it varies
• 3:12
  - depending on the timing at which
• 3:15
  - a health care organization
• 3:16
  - has to engage with a patient. And so
• 3:18
  - that segmentation
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  - really gets driven
• 3:22
  - and supported by existing technology enabled workflow or
• 3:27
  - data integration,
• 3:29
  - levels at an organization. I find that oftentimes
• 3:31
  - at an organization,
• 3:33
  - the process
• 3:34
  - is relatively manual, and they haven't benefited
• 3:37
  - from some technology enabled workflow and prioritization
• 3:41
  - of the work.
• 3:42
  - When we talk about segmentation
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  - and how innovation or technology and data integration
• 3:47
  - can help,
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  - we need to address
• 3:50
  - the variety of scenarios that occur
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  - for elective procedures.
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  - As an example,
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  - if patients are scheduled for a diagnostic service,
• 3:59
  - two
• 4:00
  - of the areas of engagement will typically occur
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  - at the time of scheduling for a patient
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  - or at the time of preregistration.
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  - Sometimes those happen during the same event.
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  - And so that's the opportunity,
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  - that an organization has to both leverage existing
• 4:16
  - technology,
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  - but also reinforce
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  - education and the importance of the data being
• 4:21
  - gathered by the team members who are engaging
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  - with those patients.
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  - Ultimately,
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  - gathering all of the accurate patient demographic information,
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  - insurance
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  - information,
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  - who the actual subscriber is,
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  - the types of service,
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  - making sure that the services, if they require
• 4:41
  - authorization,
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  - are actually being captured appropriately, and that authorization
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  - is actually being procured and secured
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  - from the insurance carrier to ensure
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  - that they are securing reimbursement
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  - before those services are even being rendered.
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  - In addition to that, you can leverage technology
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  - to
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  - improve the patient experience,
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  - informing a patient and validating not just their
• 5:07
  - insurance coverage electronically,
• 5:09
  - leveraging technology,
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  - but also validating
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  - what potential out of pocket expense
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  - that patient is going to have as a
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  - result.
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  - And offering a pre collection
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  - process,
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  - through payment acceptance capabilities that they may have,
• 5:24
  - at their fingertips immediately,
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  - online,
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  - or over the phone, or setting up payment
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  - plans if patients cannot. And so the fact
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  - that you're informing the patient of their coverage
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  - benefits, but also their out of pocket expense
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  - ultimately leads to even better patient experience
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  - because you avoid
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  - the shock factor. In today's day and age,
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  - we live in a world of high deductible
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  - health insurance plans.
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  - And you don't want patients to experience a
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  - sticker shock effect,
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  - when they're receiving a large 2,000 or $3,000
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  - deductible bill.
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  - They should be well informed of those potential
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  - liabilities beforehand.
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  - You have other scenarios
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  - where you don't have the opportunity to engage
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  - with a patient
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  - in advance,
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  - of their services, as an example, in the
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  - emergency room.
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  - And you can't even have financial or or
• 6:17
  - or financial discussions with a patient,
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  - until that patient has been stabilized and triaged.
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  - And so what
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  - innovation or technology,
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  - the organization has at hand to validate insurance
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  - coverage real time,
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  - identify what the patient's liability is beforehand, and
• 6:36
  - having those conversations,
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  - informative conversations with the patient beforehand, again, will
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  - help ensure that you are securing reimbursement for
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  - those services, but also improve the patient experience
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  - by communicating what their coverage benefits and potential
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  - liabilities are. Technology is at the forefront of
• 6:53
  - that. The ability to validate the insurance coverage,
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  - validate the patient's demographic information,
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  - validate whether or not authorizations
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  - and coverage benefits that are required
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  - that meet clinical
• 7:07
  - and payer reimbursement policies
• 7:09
  - and informing the patient of their liabilities,
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  - all,
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  - can be properly supported if the right technology
• 7:15
  - is in place and well integrated.
• 7:17
  - Yeah. Victor, I was just going to say
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  - it sounds like there are a lot of
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  - opportunities
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  - for organizations to proactively address many of these
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  - intake steps,
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  - to get ahead on not just revenue cycle
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  - challenges, challenges that could come up down the
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  - line, but also to improve the patient experience,
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  - which is such an important piece of this
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  - that I appreciate that you touched on.
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  - And I know you mentioned how technology can
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  - factor in here.
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  - But for this segmentation approach to really pay
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  - off, I imagine the data captured intake has
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  - to be clean and flow seamlessly into the
• 7:51
  - billing and revenue cycle system.
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  - So can you say a little bit more
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  - about how integration between those systems can factor
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  - into an organization's success?
• 8:00
  - Absolutely.
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  - Typically,
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  - most
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  - health care organizations will have a standard patient
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  - management system, whether it's Epic or Cerner or
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  - some other patient management system. And those systems,
• 8:12
  - if not well integrated
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  - to process
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  - what we refer to as real time eligibility,
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  - to verify a patient's insurance,
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  - coverage benefits.
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  - And not well integrated
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  - for the appropriate selection of the insurance plan
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  - can oftentimes
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  - lead to
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  - rework on the back end. So as an
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  - example,
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  - if they've selected the wrong insurance plan and
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  - have not interpreted the real time eligibility
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  - transaction,
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  - correctly,
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  - that if left to manual interpretation
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  - could lead
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  - to a denial on the back end having
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  - to rework the account,
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  - update the information, and then resubmit a claim.
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  - Integration is key because there are opportunities,
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  - available today
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  - where you can integrate
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  - real time eligibility,
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  - with your patient management systems
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  - in different solutions that will auto select
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  - the correct insurance plan based off of that
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  - real time eligibility.
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  - There is still some interpretation required,
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  - but we find that the insurance information and
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  - the subscriber information that comes directly from that
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  - real time eligibility.
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  - When integrated very well and auto select capabilities
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  - are leveraged,
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  - that can lead to a significant
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  - efficiency downstream. You get paid the first time.
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  - Trying to get to a first time payment
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  - rate of somewhere around 70%
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  - would be ideal.
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  - And, typically, it is the information and the
• 9:41
  - accuracy that's collected on the front end intake
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  - process that will drive that that benefit and
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  - that efficiency.
• 9:47
  - Mhmm. Yeah. So when we're talking about some
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  - of these capabilities
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  - here,
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  - whether that's integration
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  - or real time
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  - capabilities.
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  - Saying this is one thing, but I know
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  - implementing
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  - it is something completely different. And leaders consistently
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  - name change management as a very challenging part
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  - of introducing and scaling new technology and processes.
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  - So
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  - as you've worked alongside clients
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  - through those moments, what have you found actually
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  - determines whether these initiatives can really stick?
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  - I would say the framework at which they
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  - drive,
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  - any of the initiatives. Right? If they have
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  - a
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  - well developed
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  - framework for not just
• 10:32
  - identifying
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  - the opportunity
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  - and
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  - identifying what solution,
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  - whether it's technology or process improvement initiatives,
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  - or both,
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  - If they have a well developed project management
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  - plan that,
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  - leverages
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  - and assigns,
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  - not just,
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  - tasks to owners, but gets and gains executive
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  - sponsorship from the organization
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  - so that folks know it's a priority,
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  - in addition to frequency
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  - of managing progress,
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  - to each of those initiatives,
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  - and understanding that it's a priority to the
• 11:10
  - organization and that folks,
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  - are held accountable,
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  - to driving,
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  - their respective piece of the initiative or the
• 11:19
  - rollout of technology,
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  - that will typically drive,
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  - progress,
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  - for any initiative, whether you're rolling out technology
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  - or any other process improvement initiative.
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  - Unless you drive accountability in a well structured
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  - project plan,
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  - framework,
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  - folks will typically lose sight of,
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  - of the prioritization.
• 11:41
  - Yeah. It... It's a really good point, Victor.
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  - And I know things like initiative fatigue, competing
• 11:48
  - priorities, that unclear ownership,
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  - resistance to change.
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  - I know these are forces that many leaders
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  - have said to us at Becker's and also
• 11:57
  - I've heard here on the podcast, they tend
• 11:58
  - to they tend to crop up very often.
• 12:01
  - Which of those
• 12:03
  - kind of recurring barriers do you think tends
• 12:05
  - to do the most damage? Is it that
• 12:07
  - accountability piece,
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  - or is it something else? And how have
• 12:10
  - you seen organizations get past it?
• 12:12
  - You know, they're all challenges. I would say
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  - the most detrimental
• 12:16
  - is unclear ownership.
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  - When
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  - no one has clearly communicated
• 12:22
  - who owns
• 12:23
  - each individual or the prioritization
• 12:25
  - of of of the project, whether it's process
• 12:28
  - improvement initiative or the rollout of technology.
• 12:31
  - It is the lack of communication of ownership,
• 12:34
  - not just as an executive sponsor of the
• 12:36
  - project or the initiative,
• 12:39
  - but to each
• 12:40
  - of the owners for each of the respective
• 12:42
  - segments of the project plan. When there is
• 12:45
  - no ownership
• 12:46
  - individuals,
• 12:47
  - you you will see that that progress will
• 12:49
  - will
• 12:50
  - will flail. They just simply won't get the
• 12:53
  - movement
• 12:54
  - if you're not driving the level of accountability
• 12:56
  - to that level of ownership that's assigned at
• 12:59
  - the project management plan. I mentioned that frequency
• 13:02
  - of touches,
• 13:04
  - is a big driver of progress,
• 13:06
  - but that is driven off of a well
• 13:09
  - structured
• 13:10
  - project management
• 13:11
  - plan. You know? It also requires some of
• 13:14
  - the additional support to drive that level of
• 13:16
  - ownership.
• 13:18
  - We know that oftentimes,
• 13:20
  - the folks who are managing the day to
• 13:22
  - day operations
• 13:23
  - are bogged down
• 13:25
  - with just that,
• 13:27
  - managing the staff to make sure that they
• 13:29
  - are covering shifts to ensure that folks are
• 13:32
  - getting the daily work done, and they often
• 13:34
  - don't have time to pull themselves away from
• 13:36
  - the day to day operations.
• 13:38
  - And so it does require some additional resources
• 13:41
  - from time to time,
• 13:43
  - both from a revenue cycle transformation
• 13:46
  - subject matter expertise, if you need to bring
• 13:48
  - in an additional pool of subject matter exports
• 13:52
  - experts or or support
• 13:54
  - and project management resources to help drive that
• 13:57
  - accountability
• 13:58
  - and that ownership.
• 14:00
  - Yeah. Great insight, Victor. I appreciate everything that
• 14:03
  - you've shared so far,
• 14:05
  - especially down to, you know, some of these
• 14:07
  - more fundamental challenges around concepts of, you know,
• 14:10
  - assigning ownership, taking accountability,
• 14:13
  - how to navigate change management, all really important
• 14:16
  - stuff for our listeners.
• 14:17
  - And for anyone who's listening in who thinks,
• 14:19
  - okay, I I really do wanna take the
• 14:22
  - patient intake piece of the revenue cycle more
• 14:24
  - seriously. I wanna drive improvements starting at the
• 14:26
  - front end.
• 14:28
  - How can leaders really start here? Is there
• 14:31
  - a small win or a first step you
• 14:32
  - think they could take in the next thirty
• 14:34
  - or even sixty days?
• 14:36
  - You know, what's most important is
• 14:38
  - that before they initiate
• 14:40
  - any project, whether it's rolling out technology or
• 14:43
  - process improvement initiatives,
• 14:45
  - that they understand
• 14:47
  - and take the time,
• 14:49
  - to understand what their current state looks like.
• 14:52
  - Go through... Take the time. It... It'll be
• 14:55
  - a few hours, maybe a couple of days,
• 14:58
  - to go through pretty detailed granular process
• 15:02
  - mapping sessions to understand what your current state,
• 15:05
  - what your current process,
• 15:07
  - what your current data and technology integration
• 15:10
  - looks like today.
• 15:12
  - And the reason I say that, it doesn't
• 15:14
  - take a lot of time. But by going
• 15:16
  - through that detailed process,
• 15:18
  - you will easily identify, number one, whether you
• 15:22
  - already have a good process in place and
• 15:25
  - you just need to reinforce
• 15:27
  - ownership and making sure that folks follow the
• 15:29
  - process correctly. Or two,
• 15:32
  - that you have process gaps in place that
• 15:34
  - do require additional technology and integration and education
• 15:40
  - to drive the objective and the goals that
• 15:43
  - you're trying to achieve.
• 15:44
  - So understanding your current state, go through a
• 15:47
  - very detailed granular process mapping session, document it,
• 15:51
  - understand
• 15:52
  - what your current state is. And only then
• 15:54
  - can you determine
• 15:56
  - what are going to be
• 15:57
  - the high priority process improvement initiatives that are
• 16:00
  - gonna drive and yield the most benefit to
• 16:03
  - the organization.
• 16:04
  - Well, Victor, thank you so much for your
• 16:06
  - time and your insights today. It's been such
• 16:08
  - a great conversation.
• 16:10
  - Thank you, Erica. I really appreciate it. And
• 16:12
  - we also wanna thank our podcast sponsor, MedMetrix.
• 16:16
  - Listeners, be sure to tune in to more
• 16:17
  - podcasts from Becker's Healthcare by visiting our podcast
• 16:21
  - page at beckershospitalreview.com.