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Access Management Journal Official Journal of the National Association of Healthcare Access Management

Volume 35, Number 2

Assembling a Team...Don’t Forget Your Analyst!

5 11

At-Your-Service Access Options: Keys to Successful Healthcare Delivery Strategies

13

Front-end Patient Financial Triage: Applying Clinical Techniques to the Business Side of Healthcare

National Association of Healthcare Access Management

TM


Access Management Journal Author Guidelines The NAHAM Access Management Journal is published by the National Association of Healthcare Access Management (NAHAM). It is designed to share ideas and experiences, and to learn about trends and developments in the field of Access Management. The Journal welcomes news, articles, and story ideas from members and other writers.

Article Topics The NAHAM Access Management Journal accepts unsolicited articles but does not guarantee publication of all submissions. The Journal accepts a variety of article types, including: • First-hand experience with trends in the field • New projects that your organization is developing or implementing • New products or services that have increased your job productivity • News from committee or affiliate meetings • Trends or problems emerging in the workplace or the field in general • Reports on legislation or policy issues that affect the field • The “lighter side” of the workplace • Book reviews related to work or the field • Articles on topics of special relevance to front-line staff The NAHAM Access Management Journal welcomes submissions from the industry. Specific products or companies cannot be endorsed in editorial pieces and therefore should not be mentioned in the body of the article. Company and/or product information may be included in a brief description contained in the author biography at the end of the article.

Submission Format Articles should be submitted in English, by email in a Microsoft Word file. If email is not available, files can be sent on a CD via mail. Times New Roman 12 pt. or Arial 10 pt. font is preferred. Articles should be accompanied by a cover sheet that includes the article title, author(s) name(s), address, telephone number, email address, brief biography (one to two sentences that contain the author’s name, credentials, current position, and committee name and/or chapter affiliation, if applicable), and photo. Photos or graphics must be camera-ready and can be submitted as an attachment via email along with the article. Acceptable photograph file formats are JPG, TIF, and PDF. Photos must be high resolution (300 DPI). Hard copy photographs also may be mailed. Graphs, tables, and charts also may be submitted to further illustrate the article. Quotes and statements from sources must be attributed. Facts (such as statistics) must be referenced. Do not use abbreviations. Acronyms may be used after the first full reference.

Copy Editing All articles are subject to editing by the editorial staff.

Exclusivity Articles should not be under consideration for publication by other periodicals, nor should they have been published previously (except as part of a presentation at a meeting).

Copyright Authors must agree to a copyright release, transferring copyright ownership to the Access Management Journal before an article is published.

Publication Schedule Issue

Materials Deadline

Publication Date

Issue 2, 2011 (Online Issue)

July 1, 2011

September 1, 2011

Issue 3, 2011 (Online Issue)

November 1, 2011

January 2, 2012

Issue 1, 2012 (Printed Issue)

March 1, 2012

May 1, 2012

How to Submit All articles and accompanying photos or graphics should be submitted via email to the NAHAM editorial team at journal@naham.org. Additional information also may be found on the NAHAM website at www.naham.org. Microsoft Word files on CD, hard copy photographs, or supporting materials can be mailed to: NAHAM Attn: Access Management Journal 2025 M Street NW, Suite 800 Washington, DC 20036 If you would like your photos or files returned, please include a self-addressed stamped envelope. Alternatively, articles may be submitted via our secure online form, which can be found at www.naham.org. Before completing the online form, please have an electronic copy (.doc or .txt file preferred) of the article ready for upload. Any accompanying attachments must be sent via email to journal@naham.org. Submit an article to the Access Management Journal today! Authors earn 3.0 contact hours per published article. To view issues of the Journal online, visit www.naham.org.


Access Management Journal The Official Journal of the National Association of Healthcare Access Management

Volume 35, Number 2

Table of Contents Feature Articles

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Front-end Patient Financial Triage: Applying Clinical Techniques to the Business Side of Healthcare By Passport Health Communications Inc.

11 13

Assembling a Team...Don’t Forget Your Analyst! By Lori Carson, CHAM At-Your-Service Access Options: Keys to Successful Healthcare Delivery Strategies By Cindy Dullea, RN, MBA, BC, CHAM, and Tricia Fletcher, CHAM

Departments Editor’s Letter

17

NAHAM Advocacy Update

19

Member Spotlight: Getting to Know Betty McCulley

22

CHAA Corner: Memories of My First NAHAM Conference

26

Book Review: Blue Ocean Strategy: How to Create Uncontested Market Space and Make the Competition Irrelevant

Editorial Board Jim Hicks, III, CHAA, CHAM, CAM, FHAM Chair, NAHAM Publications/Communications Committee, MedAssets, Fernandina Beach, FL Donna Aasheim, CHAM St. Louis University Hospital, St. Louis, MO Terri Boyd, RN, BSN, CHAM Altarum Institute, Alexandria, VA Tony Lovett, MBA, CHAM Cypress Fairbanks Medical Center, Houston, TX Betty McCulley, CHAA, CHAM Trinity Medical Center, Birmingham, AL Brenda Sauer, CHAM, RN, MA New York – Presbyterian Hospital, New York, NY Gwendolyn Rhoss, MBA, CHAM Hospital for Special Surgery, New York, NY Cheryl Jackson-McKinley Baton Rouge General, Baton Rouge, LA

NAHAM National Office Executive Director: Steven C. Kemp, CAE Program Manager: Mike Copps Program Associates: Caroline Fabacher and Belle McFarland Marketing Coordinator: Lindsay Pullen Certification Manager: Stacey Barnes Certification Manager: Joyce Arawole Events Coordinator: Alexandra Zapple Access Management Journal (ISSN 0894-1068) is published by: National Association of Healthcare Access Management 2025 M Street NW, Suite 800 Washington, DC 20036-3309 Telephone: (202) 367-1125 Fax: (202) 367-2125 Web site: www.naham.org

© Copyright 2011, National Association of Healthcare Access Management. Indexed in Hospital Literature Index, produced by the American Hospital Association in cooperation with the National Library of Medicine. The printed edition of Access Management Journal is not to be copied, in whole or in part, without prior written consent of the managing editor. For a fee, you can obtain additional copies of the printed edition by contacting NAHAM at the address provided. The National Association of Healthcare Access Management (NAHAM) was established in 1974 to promote professional recognition and provide educational resources for the patient access services field. The Access Management Journal subscription is an included NAHAM member benefit. NAHAM 2011 membership dues are $165 for Full Members and $1,500 for Business Partner Members. For more information, visit www.naham.org.

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NAHAM Board of Directors Holly Hiryak, RN, MNSc, CHAM, President Patricia Consolver, CHAM, Immediate Past President Jeff Brossard, CHAM, Vice President Tammy Stone, Secretary Ed Spires, CHAM, Treasurer Committee Chairs Policy Development/Government Relations Committee Brenda Sauer, CHAM, RN, MA Certification Commission Elizabeth Reason, CHAM Education Committee Tammy Wood, CHAM Publications/Communications Committee Jim Hicks, III, CHAA, CHAM, CAM, FHAM Membership Committee Jeff Ferrell, CHAA, CHAM Special Projects Committee Julie Johnson, BSHA, AAHA, CHAM Regional Delegates Northwest Regional Delegate Donna Aasheim, CHAM Southeast Regional Delegate Paul Shorrosh, CHAM Midwest Regional Delegate Suzan Lennen, CHAM Central Regional Delegate Rebecca Holman, CHAM Northeast Regional Delegate Catherine Pallozzi, CHAM Southwest Regional Delegate Yvonne Chase, CHAM Ex-Officio Legal Counsel Michael J. Taubin, Esq.


Editor’s Letter Greetings, NAHAM members: Vacation season is here! Pack your bags, your hiking boots, or your beach umbrella and head out for an

adventure. This is the time of year where we can take a break and recharge from our jobs, our commutes, and the other stresses of our daily routine. It’s so important to take time for yourself, and spend time relaxing with your family and friends.

Too often, we expect that we can work (and work, and work!) without taking any time for a break. It’s unrealistic to think that we can work all the time. As humans, we need time to recharge, reflect, and

look at the big picture. A global workforce study conducted by Towers Perrin, one of the world’s largest

management consultant firms, discovered that those who take time to renew are more apt to have creative breakthroughs, a broader perspective, and better long-term thinking skills.

How we feel influences how we perform. No matter how much you love your job, if you don’t allow

yourself time away from it to relax and refresh, you’re at risk for burnout. You’re also at risk for health

problems. According to a recent global study conducted by the Center for Work-Life Policy, 81 percent

of respondents believe that their jobs are affecting their health. You certainly aren’t of much use to your company if you’re constantly sick or feeling burnt out.

4

While it’s important to take a vacation, it’s also important to take some time out of each day to recharge at

Access Management Journal

work. The Energy Project, which launched a program called “Take Back Your Lunch,” conducted a study to investigate how much time people typically take for their lunch breaks. Sixty percent of respondents

stated that they took less than 20 minutes per day for lunch. Twenty percent took less than ten minutes. Surprisingly, one quarter of respondents said that they never left their desks for lunch.

These findings are consistent with research by the American Dietetic Association that discovered that one third of people eat lunch at their desks at least two to three days per week. Is it any wonder that so many people drift through their jobs like the living dead—emotionally and mentally overtaxed, with little else

left to contribute to their co-workers and families? Simply taking a lunch break, even if it’s a few moments away from your desk, offers you a chance to relax, to let go of the stress you’ve built up through the morning, and approach your job with more energy, focus, and engagement.

You dedicate so much time to your job—as you vacation this summer, don’t forget that you earned this time of relaxation and renewal. It’s a beautiful time of year, so get out and enjoy it! Best wishes, Jim Hicks, III, CHAA, CHAM, CAM, FHAM Jim Hicks is a Senior Consultant at MedAssets, serves on the NAHAM Board of Directors, and chairs the Publications/ Communications Committee.


Front-end Patient Financial Triage: Applying Clinical Techniques to the Business Side of Healthcare By Passport Health Communications Inc. Learn about the concept of patient financial triage from experts at Passport Health Communications Inc.

Situation Analysis If the concept of patient financial triage makes so much sense, then why, some may ask, hasn’t it been around as long as clinical triage?

The truth is that financial triage has been around for a long time, in some fashion. But the way it has historically been done is known to be best practice.

The fundamental idea of triage is thorough up-front analysis to inspire better decision making that produces better end results. Anything less is unacceptable on the clinical side of healthcare. Hospitals employ highly educated, intensely trained nurses and other specialists to handle the task of triage and pay them well to do it. Healthcare organizations invest constantly in making triage more efficient and error-free because the smallest clinical mistake can have serious consequences.

It can take 30 days or more for a hospital to even begin determining whether a patient service can be written off as charity care, or whether a government-subsidized plan will cover the charges. Best case scenario is a negative effect on A/R days. When neither Medicaid nor charity is legitimate and the patient owes the full balance, it is only partially retrieved by in-house or third party collection or is never collected at all.

Other Factors Necessitating Up-Front Financial Triage:

y Economic conditions –

Findings from an American Hospital Association (AHA) survey released in summer 2010 said despite some analysts’ optimism about the economy improving, nearly 75 percent of hospitals reported reduced operating margins, and 87 percent reported increased bad debt and charity care as a percent of total gross revenue. Hospitals can no longer afford to miss any reimbursements or patient payments.

y Uninsured – The Centers for

Disease Control reported that 46.3 million Americans – or 15 percent of the population – were uninsured during 2009. Some earlier estimates predicted that without reform, the number of uninsured would surge to 60 million by 2015 (Robert Wood Johnson Foundation). It remains to be seen what effect reform will have, but the uninsured as a percentage of the total

Continued on page 6.

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opposite of what is now

The same expectations have not been realistic in Patient Access. Obviously, the stakes are not the same, but mistakes are costly. In an environment where performance is measured by how many registrations get completed in an hour or shift, there is ample opportunity for error and no time for manual research that would prevent it. Most registrars do everything they can just to meet the minimum financial clearance to get the patient to the next department. The real financial triage work is left to financial counselors or other employees in the back office.


population has not changed as dramatically during the current recession as the general public is led to believe; for the past 20 years it has held close to 15 percent (U.S. Census Bureau). It is fair to assume the U.S. will always see millions without coverage, so the need for up-front financial triage will not go away.

y y Underinsured – America’s

Health Insurance Plans reported in summer 2010 that 10 million Americans were enrolled in a Health Savings Account, an increase of 25 percent over the previous year. Just because patients are insured doesn’t mean they can or will pay the plan’s outof-pocket portion, especially those enrolled in high deductible plans.

y y Declining reimbursement

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rates – A report from Moody’s Investor Service predicted declining rate increases and “tighter reimbursement ” for Medicare, Medicaid, and commercial payers for the foreseeable future, even though reform is meant to ease hospitals’ uncompensated care burden.

Best Practice Insured Patients Most healthcare organizations verify insurance eligibility, which should be the first step in the up-front financial triage of any insured patient. As soon as possible after an insured patient schedules a visit, front end employees should validate coverage directly with the payer (including through third party connections such as a clearinghouse) to make sure it is still current.

Having insurance doesn’t inherently mean, however, that patients are able to pay for their care. Some patients may not be able to pay their deductible. A family of four with one working parent earning $30,000 annually, for example, may be covered by the parent’s employer, but because of their financial circumstances also qualify for charity care. So the hospital can bill the payer for a portion of the charges and write off their $6,000 deductible as charity. Other patients have the wherewithal to pay but intentionally avoid payment.

y y More than 4 in 10 employers

told PricewaterhouseCoopers that in 2011 they will increase employee contributions for health insurance premiums and increase cost-sharing with higher deductibles and co-pays. As high-deductible plans become more attractive to employers trying to control healthcare costs, it becomes all the more imperative for hospitals to collect patients’ financial liability up-front. In order to do this, they must determine the current deductible, co-payment, and co-insurance and how much has been met for the given year.

It stands to reason, too, that there is some natural link between the economic recession and rising HDHP enrollment. HDHPs are the most attractive option – in many cases the only affordable option – for small businesses looking to trim costs and for workers who lose employersponsored benefits. Even as the economy improves, hospitals should expect to have to ask for

a larger share of payment directly from their patients. Technology’s role: Not all patients are forthright about their finances. Some capable patients may claim to need the hospital’s assistance with a high deductible. Others may be too proud to seek help they truly need. Fortunately, software is available to help hospital employees distinguish between the patients who can pay and those who can’t. New revenue cycle tools access major credit reporting bureaus to generate a patient’s medical credit score. The score, based on employment, income, debt, and payment history, tells hospital staff whether a patient has the ability to pay and ranks how likely he or she is to pay. Medical credit scores are not always necessary. A hospital may determine, for instance, that it does not want to check a patient’s score for a $20 copayment. The preferred triage strategy can depend on the Continued on page 7. Passport conducted a survey in summer 2010 of more than 300 Patient Access professionals representing 200 hospitals. Estimating and collecting patient payments was cited as one of the top three goals and challenges among respondents. Software to facilitate the estimation and collection process was given by more than half of respondents as being most helpful in accomplishing overall departmental goals.


Rank

State

Uninsured

Percentage of Population

1

California

6,822,000

18.6%

Passport research

2

Texas

6,084,000

25.1%

among hundreds of

3

Florida

3,619,000

20.0%

hospitals and healthcare

4

New York

2,720,000

14.1%

5

Georgia

1,703,000

17.8%

organizations across the

6

Illinois

1,638,000

12.9%

7

North Carolina

1,421,000

15.4%

approximately 10 percent

8

Ohio

1,309,000

11.5%

of patients registered and

9

Arizona

1,273,000

19.5%

10

Pennsylvania

1,211,000

9.9%

treated as self-pay actually

U.S. has consistently shown

qualify for state Medicaid.

Source: U.S. Census Bureau, Current Population Survey, 2009 Annual Social and Economic Supplement

estimated charges, a process also recently improved by technology. Patient payment estimation software merges a hospital chargemaster, payer contracted prices and the patient’s coverage and benefit levels to produce a quick, accurate estimate. Using such a tool with an integrated eCashiering solution that processes cash, e-Checks, debit, and credit cards gives hospitals everything needed to estimate and collect a payment up front.

Step 1: Find coverage. Most organizations would agree that the ideal self-pay scenario is one where the patient is actually eligible for government assistance. A 40 percent reimbursement from Medicaid (as an example; it varies by state) is better than spending 2.5 percent of the balance trying to collect from the patient (Healthcare Financial Management Association) with little return.

McKinsey & Company, providers can expect to retrieve only 5 to 10 percent of a selfpay patient’s balance after the patient is treated and leaves the facility. A community hospital with 120,000 annual patient encounters and a 7 percent self-pay population treats 700 uninsured per month. If the average charge is just $500 and the hospital writes off even half of the charges, then it stands to lose $175,000 every month, or $2.1 million annually. These conservative hypothetical estimates show how the smallest patient population represents big dollars.

The most common reason why patients who qualify for Medicaid seek treatment as self-pay is because they are not aware of their own eligibility. Verifying government eligibility and beginning the enrollment process during pre-registration or registration is an excellent customer service. It is good for the hospital because it secures reimbursement, and it is appreciated by patients because it eases their personal financial burden.

A hospital with 250,000 annual patient encounters and a 7 percent self-pay population treats 1,458 uninsured per month. If 146 of those patients should be enrolled in Medicaid, and the average reimbursement is just $1,000, then the hospital could unnecessarily be writing off $146,000 in legitimate monthly claims, or nearly $1.8 million per year. A goal of the Patient Protection and Affordable Care Act is to reduce the total number of uninsured in the U.S. by adjusting regulations for commercial insurers and expanding government programs. The same people who would otherwise be uninsured may have insurance or be eligible for insurance beginning in 2011, so hospitals are wise to run the appropriate checks for every selfpay encounter. Step 2: If the patient is not eligible for Medicaid, check eligibility for charity care. Perhaps a patient earns too much money to qualify for Medicaid benefits but too little to pay for a needed surgery. Patients who fall into this category could be eligible for some level of charity Continued on page 8.

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Uninsured Patients Every self-pay patient should be evaluated before admission using a best practice financial triage process so Patient Access employees assign the correct financial classification.

y y According to a study from


care and should always be screened against the organization or facility’s guidelines.

An eligible charity case is much more valuable to a hospital than a simple write-off. In terms of finances, nonprofit hospitals must provide some amount of uncompensated care to receive favorable tax breaks from the federal and local governments.

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For years, Congress has been unconvinced of whether nonprofit hospitals provide enough charity care to justify a taxexempt status. For mission-based facilities, free care is just one of several benefits the hospital gives the community, and debate among elected officials has revolved around setting levels that assure fair and equitable distribution for taxpayers. Recent updates from the Internal Revenue Service Form 990 Schedule H tightened regulations requiring hospitals to properly allocate charity care, collect and analyze data, and be able to report allocations with more transparency. Auditors routinely check whatever the hospital claims, so having an up-front system in place to document and support every legitimate charity case guarantees accurate accounting. Not that this message isn’t well-received on the back end, but knowing it up front eliminates a lot of worry for the patient and avoids unnecessary

work and delays on the part of the hospital. And most importantly, it shows the hospital is carrying out its mission of service to the community.

y y Too many non-profit hospitals are not meeting voluntary guidelines set by AHA for informing patients about charity care and helping them qualify. A report issued by The Access Project and Community Catalyst found that while most facilities had charity care available, only 42 percent provided application forms, and only one in four provided information about who qualified.

Like finding unknown Medicaid eligibility, telling a patient that he or she is not responsible for payment because of the hospital’s charity policies is also a welcomed customer service. Step 3: Confidently ask for payment if the patient does not qualify for either Medicaid or charity care. Patients with too much income to fit into either assistance category should be expected to make payment before service. When patients push back – and some will – a medical credit score as previously described can help the registrar respond accordingly. Running a score will produce more current, accurate and detailed information than what the patient may be willing to divulge. With a firm understanding of the patient’s

ability and propensity to pay, employees can then proceed with confidence and offer any approved discounts or payment plan options to encourage payment. Patient Access staff should receive the same training and scripting that financial counselors use during discussions with patients. They should be courteous and consistent but firm, explaining that the hospital exhausted all other payment avenues as a service to the patient. Patients who still refuse to pay for non-emergent services should be asked to reschedule when they can make payment or denied the service. This can be the most difficult and uncomfortable scenario in financial triage, but according to the McKinsey & Company data, hospitals who don’t collect up-front are asking for bad debt. Technology’s role: Historically, it has not been practical to address these financial triage tasks while the patient is on site. It is the job of hospital financial counselors to gather the necessary information from patients and determine eligibility, but because each account requires heavy paperwork, research, and follow-up, it is rarely completed pre-service and is often delayed for weeks or longer. Triage software automates the decision tree and immediately identifies the correct classification. The best tools even have built-in features for converting paperwork to electronic formats, further automating and accelerating the process. Continued on page 9.


Self-Pay Patient Financial Triage

1

Eligible for Medicaid?

2

Screen for Coverage

Eligible for Charity Case?

Screen for qualifications YES

YES

3

4

Able to Pay?

Verify ability and propensity to pay YES

Properly document assistance

Set up payment plan or third party financing terms

Proceed to treatment

Proceed to treatment

Proceed to treatment

Conclusion Loose comparisons can be made between patient financial triage and U.S. Health Care Reform. Back end patient financial triage is inefficient and costly. Inefficiency and cost are the two main drivers of reform. The Health Information Technology for Economic and Clinical Health (HITECH) Act made technology the bedrock of reform, just as technology eliminates inefficiency in financial triage. Technology is the enabler that allows patient financial triage to occur before treatment, in the same manner that clinical triage was designed and has always occurred.

Proceed to treatment

It reduces expenses, including back end labor costs and the hard costs associated with tracking down patients, preparing and sending multiple invoices, potential third party collection fees and other costs to collect. It increases reimbursements from government payers. It fosters a better-run charity care program. It increases patient payments. It improves patient satisfaction. There are no downsides to moving financial triage to Patient Access, and with innovative software, any healthcare organization can achieve this best practice. l

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back end to the front.

Collect total amount due YES

Begin enrollment process

With integrated revenue cycle software, each step in the decision tree occurs in a matter of seconds. Technology saves valuable time by automating processes and it eliminates human error, so tasks that have always been the responsibility of financial counselors can now shift to Patient Access. It is the only way patient financial triage can move from the

Does Not Qualify for Financing


Sources American Hospital Association: “Hospitals Continue to Feel Lingering Effects of Economic Recession,” 2010.

PricewaterhouseCoopers Health Research Institute: “Behind the Numbers: Medical Cost Trends 2011,” 2010.

Centers for Disease Control: “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2009,” 2010.

Modern Healthcare: “Uninsured Americans by State,” March 1, 2010.

Robert Wood Johnson Foundation: “The Cost of Failure to Enact Health Reform: 2010-2020,” 2010. U.S. Census Bureau: “Income, Poverty, and Health Insurance Coverage in the United States: 2008,” 2009. America’s Health Insurance Plans Center for Policy and Research: “January 2010 Census Shows 10 Million People Covered by HSA /High-Deductible Health Plans,” 2010. Moody’s Investor Service: “Transforming Not-for-Profit Healthcare in the Era of Reform,” 2010.

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Healthcare Financial Management Association: “Understanding Your True Cost to Collect,” 2006. McKinsey & Company: “U.S. Health Care Payments: Remedies for an Ailing System,” 2009. Kaiser Family Foundation: “Summary of the New Health Reform Law,” 2010. The Access Project and Community Catalyst: “Best Kept Secrets: Are Non-Profit Hospitals Informing Patients About Charity Care Programs?” 2010.

Passport Health Communications Inc. creates software and solutions to enable hospitals and healthcare providers to improve business operations and secure payment for their services. Founded in 1996 and headquartered in Franklin, Tenn., the organization is among the nation’s fastest-growing Softwareas-a-Service companies. Its eCare ® brand of revenue cycle management solutions are available across multiple platforms and are delivered to one in three U.S. hospitals and more than 5,000 other healthcare facilities in all 50 states. © Passport Health Communcations Inc. Reprinted by permission.

Passport Health Communications Inc. internal research.

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Assembling a Team... Don’t Forget Your Analyst! By Lori Carson, CHAM Creative solutions to Patient Access challenges are often necessary. At Gwinnett Medical Center, the team turned to a commonly overlooked source—the IT department—and was able to increase efficiency, streamline processes, and lower costs with their suggestions.

With updates to new technology moving at the speed of light, it’s important for those in Patient Access to form a bond with their Information Technology (IT) support. As an IT analyst, I can personally attest to how beneficial it is for me to be involved with Patient Access on

a daily basis. Understanding the challenges Patient Access faces helps me to find solutions for them that increase efficiency, raise quality standards, and lower costs. I’m sure many other medical environments share these goals. Together, our hospital and IT team at Gwinnett Medical Center were able to discover practical, cost-effective solutions.

Efficiency: Doing More in Less Time Shaving minutes off of registration time increases efficiency and patient satisfaction. As time permits, I spend time side-by-side with registration associates observing what they do in order to understand where time can be gained. Our team has implemented a number of solutions based on registrar ideas and my observations. For instance, a simple fix came in the form of changing the order of questions on the MSP Questionnaire completed by the patient. To increase the efficiency of the registrar entering this information in the system, we matched the order of the questions on the printed form to the order of the questions on the online entry form. Even

tiny changes like this one can make staff happy and processes more efficient. Getting rid of the “blue cards” or embossed plates that were stamped on each paper in the patient’s chart saved time and contributed to patient safety. Our team implemented a forms management system that receives the registration information and places patient identifiers on all registration forms, armbands, and additional labels for any clinical forms not already in the system. These labels can be reprinted at any time. Two barcodes on the materials identify the patient and the form. Once scanned, these are automatically stored in the right section of the corresponding patient’s chart. Our next phase of implementation includes sending an updated face sheet at discharge so physicians or ambulance companies can print or receive faxed copies with the latest insurance information for their billing. The information is far more legible when printed directly from the system. Continued on page 12.

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I am part of the financial applications team at Gwinnett Medical Center, which is responsible for the support of about 80 financial systems. We have nine analysts total, classified by the areas we support. My area is Patient Access. I work very closely with the scheduling, health information management, and patient accounting analysts to round out the revenue management team. Our other analysts include payroll, accounting, human resources, practice management, and technical services. We all have various committees or teams that share ideas and work through issues together. I found Patient Access so intriguing that I joined NAHAM and even earned my CHAM certification. Being a member of NAHAM gives me additional resources to understand how Patient Access works.


Quality: Getting It Right the First Time Everyone makes mistakes, and Patient Access is no exception. Whether there’s a typo or a patient provides incorrect information, data entered into the system will occasionally need to be corrected. Since qualitychecking every patient’s chart is physically impossible due to patient volume, we implemented two systems to aid Patient Access in correcting their own mistakes. The first system processes insurance eligibility in real time, verifies addresses, and checks patients’ propensity to pay during registration. This provides registrars with the ability to financially secure the encounter and ensures bills will be sent to the correct provider and guarantor.

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The second system provides a quality score for the overall encounter the day after it is entered into the system. This is a totally automated process that incorporates complex rules and sorting. If an error, such as an incorrect format for a Medicaid number, is received, the system flags the encounter and presents the error to the registrar for correction. The registrar can then correct the error and get the right information into the system for billing and claims management before it is actually sent or filed. Because I work closely with the registrars, trainers, Patient Access Managers, and the

Director of Patient Financial Services, I am able to suggest rules that can catch errors. Since I understand the format of the data received and the values it will contain, we can correctly write those rules the first time. Together, our team currently and consistently achieves better than 98% accuracy by the time a bill drops. Our next phase of implementation is real-time quality checking, so errors are caught even before registration is completed. This will further advance our quality scores.

Cost – Turn Less Into More Concerns frequently center around our medical center’s bottom line. Our team was able to replace one system that checks address and credit and another that checks eligibility with a single system that does both. Replacing two systems with one reduces license and annual support fees. We were able to save money by implementing systems that provide more, but cost less. We were able to get the clinical areas on-board with the success of the forms management system, and they now print many of their forms with this system as well. This has greatly reduced the need for a third party to print forms we also have to store. Our team has successfully reduced the space needed for storage as well as the cost of printing by an outside vendor.

All of these programs work because we consistently rely on each other to provide the best tools for our associates. In your medical environment, your analysts are vital to your success. They can communicate with your users, understand their issues, and translate those challenges to those in IT who only speak “geek.” Once you discover the value they can offer, you will find that, as a team, you can provide satisfaction to patients, associates, and physicians. Invite your IT support to your next staff, task force, or committee meeting— you may be surprised at how much they can contribute! l Lori Carson, CHAM, has been a senior systems analyst at Gwinnett Medical Center in Lawrenceville, Georgia for nine years. During those nine years, she has been involved with the Patient Access team daily, implementing systems that help conserve time and money. To better understand the needs of her team, she joined NAHAM. In 2008, she earned her CHAM certification.


At-Your-Service Access Options: Keys to Successful Healthcare Delivery Strategies By Cindy Dullea, RN, MBA, BC, CHAM, and Tricia Fletcher, CHAM Self-service options are becoming an increasingly popular offering for customers. While providing customer care and streamlining processes are the top benefits of having a hospital self-service kiosk, many additional advantages also exist.

must address three major concerns:

Across other industries, the value has become clear: Customers like having self-service options, and hospitals gain a competitive edge in their markets and benefit from labor-saving efficiencies.

y Increasing Cash Flow –

To succeed in this competitive healthcare environment, hospitals

y Improving Customer

Service – In the interest of improving physician and patient satisfaction, hospitals should make it a top priority to become more consumerfocused. This concern will only grow as markets become even more competitive.

y Reducing Administrative

Expenses – Hospitals are dealing with growing financial pressures. Legislative drivers (HITECH, RACs, HIEs, etc.) are prompting change, and hospitals are seeking ways to cut overhead without adversely affecting service satisfaction. Healthcare insurance reform and the aggressive nature of reimbursement audits continue to place financial pressure on hospitals. As a result, hospitals must improve their ability to see more patients without increasing costs.

“Self-service is a clear and present trend in many other industries and will be embraced more enthusiastically by the Healthcare Delivery Organizations during 2011. As time goes on, patients will view patient self-service as a market differentiator. There is a real need to improve the patient experience, to better coordinate care, to become more operationally efficient, and to improve the quality of patient information. As part of the IT infrastructure underlying the Real Time Healthcare System, patient self-service kiosks offer a way of contributing to these goals.” Source: Gartner Group – “Three Good Reasons for Deploying Patient Self-Service Kiosks” © 2011

Continued on page 14.

13 Volume 35, Number 2

Healthcare is once again racing to catch up with other industries. Many organizations now realize that offering selfservice technology options is key to becoming more competitive in today’s—and especially tomorrow’s—healthcare market. Hospitals striving for success are adopting customer service strategies that have been employed effectively in other service industries such as travel, banking, and retail. These industries have been able to survive—and even thrive—largely thanks to automated self-service. This strategy has enabled them to operate more efficiently with fewer staff, while maintaining a high level of customer satisfaction.


Becoming More Competitive

Starting at the Beginning

With the institution of Health Care Reform, providers should expect to encounter an estimated 32 million new patients. The increase in patient volume, coupled with a rise in self-pay delinquencies, creates a recipe for financial disaster. Hospitals must improve their ability to see more patients—using fewer dollars— while improving customer service. The best way to do that is by saving administrative dollars so that clinical operations can be funded.

Scheduling, the key component of hospital Access Management, is often very labor intensive, inefficient, error-prone and paper-driven. Smart “rules-based” scheduling is a great solution that provides quality and profitability coupled with a method to enhance efficiency.

A new generation strategy with a strong self-service component is needed for efficient Access Management. Because it is the first impression/interaction for the customer, Access Management is vitally important for successful health systems. Customers can be either lost or gained based on their ease-of-access experiences.

Smart “Rules-Based” Scheduling A successful healthcare selfservice strategy also supports increasing cash flow by managing the revenue cycle as early in the access process as possible. When done correctly, self-service in healthcare— which includes free-standing check-in kiosks, tablets, online patient and provider portals, etc.—can offer a range of benefits to patients and healthcare organizations alike.

1. Provider Office SelfScheduling Portal. Providing physicians the ability to electronically connect with the hospital to schedule appointments online at their convenience makes the entire healthcare delivery process more efficient, allowing physicians to focus on delivering quality care, instead of the logistics required to coordinate it. Key Features y y Ability to book appointments directly into the hospital or to designate selected procedures to be requested y y Ability to update and validate patient demographic and/or insurance information based on hospital preferences Continued on page 15.

14 Access Management Journal

Three valuable self-service tools for successful healthcare include:

Smart “Rules-Based” Scheduling

Intelligent, rules-based algorithms

No human intervention

Multi-department, centralized or decentralized

Workload and resource balancing

24/7 Self scheduling


y y Authorization and referral

capabilities based on insurance plan and procedure being scheduled or requested y y Ability to run medical necessity checks with up-todate ICD9 and CPT4 codes y y Ability to present forms to be printed and filled out prior to the scheduled appointment y y Prints out an itinerary with procedure descriptions, preparation notes, and direction information for the patient to have prior to leaving the physician’s office y y Communication tool between the hospital and the physician office on the status of a patient’s appointment, i.e. rescheduled, no-showed, or cancelled y y Allows users to enter multiple ICD codes for a medical necessity check and designate the levels for each code y y Offers the ability to integrate the provider portal login screen with your enterprise or corporate website

Key Features y y Allows consumers to schedule appointments online at their convenience y y Enables a consumer to preregister and complete any necessary forms y y Lets consumer maintain demographic and insurance information y y Provides ability to manage household schedules with an at-a-glance view of upcoming appointments and printable calendar y y Enables request for automatic appointment reminders

rescheduling, or cancelling scheduled appointments y y Lets hospital control whether an appointment can be requested or scheduled y y Allows hospital to define patient-friendly procedure names and questions y y Displays a splash screen featuring hospital-specific information (important phone numbers, directions, hospital photo, logo, links to external health-related websites, etc.) y y Ability to customize banners with logos and links y y Provides CAPTCHA security y y Offers the ability to integrate the consumer portal login screen with your enterprise or corporate website 3. Appointment Self-Check-in Kiosk. Customer-focused and efficient, an automated lobby kiosk expedites patient arrival and check-in processes. Key Features y y Secure customizable PHI look up ŠŠ Meets Health Insurance Portability and Accountability Act (HIPAA) and Americans with Disabilities Act (ADA) Section 508

ŠŠ Compliant with the

Joint Commission on Accreditation of Healthcare Organizations ( JCAHO) by providing and documenting patient information

ŠŠ SCI-standard look-up

requirements of last name, first name, and date of birth can be customized to include SSN, gender, driver’s license number, phone number and/or MRN

y y Manual and card-swipe lookup options ŠŠ Patients can look up their current day appointments

by manually entering minimal customer definable demographic data

ŠŠ Driver’s license swipe of

magnetic strip to ‘pull’ minimum customer definable demographics for appointment lookup, alleviating the need of manual entry

y y Patient demographic validation

with direct and indirect update options ŠŠ Allows patients to view and indicate that their demographic data has changed

ŠŠ Allows patients to view and directly update changed demographics at the selfservice kiosk and proceed with appointment check-in process

ŠŠ Customer-definable

parameters control the above options and whether upon an update to allow appointment self-service check-in or direct patient to the registration clerk

y y Insurance data validation ŠŠ Allows patient to view and validate current insurance information

ŠŠ Customer-definable parameter to allow appointment checkin to proceed if there are insurance changes or if the patient has no insurance or direct the patient to the registration clerk

y y Insurance Card Scan capabilities ŠŠ Customer definable parameter to request an insurance card scan from every patient checking in at the self-service kiosk or only when the patient has indicated that insurance has changed

Continued on page 16.

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2. Consumer/Patient SelfScheduling Portal. Enables consumers and patients to view, pre-register, or schedule appointments online and at their convenience.

y y Facilitates changes,


y y Document Review, Accept/Not Accept, and Signature Options ŠŠ Customer-specific documents are displayed to the patient with control options to review the document content, accept or not accept the viewed document and/or require the patient’s signature

y y Document Patient Identification ŠŠ Documents viewed, accepted, and/or signed by the patient can be appended with a unique patient identifier

y y Wayfinding ŠŠ Help your patients find

their way by displaying maps from their current location to their appointment location

ŠŠ Maps are both viewable and printable

y y Kiosk design options to best meet your needs ŠŠ Desktop, wall mounted, free standing, and tablet hardware options

ŠŠ Other configurations available

Healthcare is More Than Ready Adopting self-service technology is a proven strategy that helps providers adapt to the needs of a changing patient population without having to add numerous F TEs to their staff. It is one of the only technologies that helps improve efficiency, while also enhancing the patient experience. No single technology is going to solve every challenge, but implementing a strategy that includes self-service options is surely a step towards the answer. l Cindy Dullea, RN, MBA, BC, CHAM, is Senior Vice President of Marketing for SCI Solutions and has more

than 35 years of experience in the healthcare arena. Her significant healthcare information systems experience comprises multiple executive consulting positions. She also has significant knowledge of managed care. Cindy has a Bachelor of Science in Nursing from Salve Regina University, an MBA from Stephens College, is certified in Nursing Informatics, and holds a CHAM. Tricia Fletcher, CHAM, has almost 20 years of experience in healthcare. She began her career working a midwest hospital and currently works as a manager of sales support for SCI Solutions. In this position, where she has served for the past 11 years, Tricia conducts onsite needs analysis as well as informative software presentations for sales prospects and customers. Tricia holds a Bachelor of Science in Health Administration from Eastern Michigan University and is CHAM certified.

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E-Learn Manager™ E-Learn Associate™ NEW Certification Preparation Products brought to you by NAHAM E-Learn Manager™ and E-Learn Associate™ are interactive study aids complete with narrated instruction, learning activities, downloadable materials, and online quizzes—all designed to help certification examination candidates and potential candidates assess their readiness to take the Certified Healthcare Access Manager (CHAM) or Certified Healthcare Access Associate (CHAA) examinations. For detailed information, pricing, and to order E-Learn Manager™ and E-Learn Associate™, please visit www.naham.org.


Advocacy Update

Debt Ceiling and Deficit Reduction Debate Preoccupies Washington By Frank Moore

Stay informed of the latest updates in health reform with NAHAM’s Advocacy Update. It has been a year since Health Care Reform legislation was passed and state challenges have made their way through federal courts. Current public policy debate centers on the nation’s debt limit and deficit reduction strategies, which may significantly impact health policy.

With this challenge, finding savings in Medicare and

NAHAM Government Relations Committee Continues Work in Three Strategic Areas The NAHAM Government Relations Committee continues to focus on three strategic areas: education, policy and standards, and the Health Information and Management Systems Society (HIMSS) Work Group. The committee hopes to increase awareness of the latest policy issues affecting Patient Access managers while raising the value of the profession among policymakers and other healthcare organizations.

The Education Task Force focuses on providing information through the Access Management Journal, NAHAM news blog, and the NAHAM website. This group monitors and reports emerging policy issues, such as the Center for Medicare Advocacy announcement of the use of new technology to fight Medicare fraud, Office of the National Coordinator clarification of EHR certification rules, and the Obama Administration’s release of the National Prevention and Health Promotion Act. The task force will also work with the NAHAM Education Committee to identify webinar opportunities that can provide participants more in-depth policy knowledge. The Policy and Standards Task Force focuses on making NAHAM a resource in the arenas of public policy and standards. Brenda Sauer, chair of the Government Relations Committee, currently represents NAHAM on The Joint Commission’s Hospital Professional and Technical Advisory Committee (TJC PTAC), which provides TJC feedback on developing standards and National Patient Safety Goals. Continued on page 18.

17 Volume 35, Number 2

President Obama and Vice President Biden have squared with House and Senate majority and minority leaders. Republican leadership is against tax increases in favor of more revenue in the form of user fees and savings through means testing of entitlements. Democrats have argued for closing corporate tax loopholes and increasing taxes on the highest-income earners and targeted business sectors. Democrats have also attempted to include job creation measures in the overall debt reduction debates. One option with rare bipartisan support would address the so-called “tax gap,” an estimated $300 billion revenue loss per year, by improving tax compliance.

Medicaid is now center stage. Options for savings include raising the age at which seniors would be eligible for benefits or requiring more affluent Americans to pay more. Hospitals, already having agreed to reductions in provider payments under Health Care Reform, are fighting any further payment cuts. Physician groups have introduced a proposed overhaul of the Medicare physician payment system, arguing that it should be part of any final agreement on the debt ceiling.


Advocacy Update

Coalition for an Informed Patient Identity Integrity Solution Challenging Status Quo In 2010, NAHAM joined the Patient Identity Integrity Work Group of HIMSS. NAHAM has collaborated with other organizations leading the effort to pursue a unique patient identifier that ensures the security and quality of patient data. As part of the Coalition for an Informed Patient Identity Integrity Solution, NAHAM continues to urge Congress to lift the current ban on unique health identifiers for individuals.

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Current coalition efforts focus on securing a congressional request for a Government Accountability Office (GAO) study of options for a unique patient identifier. The GAO study would examine available technologies for achieving a national-level patient identity solution and provide a cost-benefit analysis. Congress would then explore the feasibility of lifting the prohibition against Health and Human Services studying a national-level patient identity solution.

The mismatch between patients and clinical data is a frequent issue. Often, information for one individual exists in multiple databases as duplicate, inaccessible, or unknown information to clinicians who depend on a complete and accurate patient record. Information on different individuals can be “overlaid” and presented as one patient’s record. Incorrect information is not only a potentially deadly patient safety issue, but can incur huge additional costs to the healthcare system. The coalition argues that since Congress enacted the ban on a unique health identifier in 1999, health information technology has made significant strides toward improving clinical care, enhancing patient outcomes, and controlling costs. Significant healthcare reform is impossible without meaningful, system-wide adoption of electronic health records and health information exchange. Informed national-level patient identity solutions are essential to obtaining the full benefits of health information technology and ensuring patient safety.

An informed national-level patient identity solution would enhance the privacy and security of patient health information, and does not mean a national identification number or card. Technological advances now allow for more sophisticated solutions including patient consent, voluntary patient identifiers, metadata identification tagging, controlled segmented access, access credentialing, and sophisticated algorithms. An informed identity solution provides unambiguous identification, is cost-effective, and reduces false negatives in the patient matching process. It is an essential building block in achieving the nationwide exchange of health information, as well as improving patient safety and reducing healthcare costs, fraud, and abuse. As the nation works to achieve the “meaningful use of certified EHR technology” and widespread information exchange, an informed patient identity solution is an increasingly critical factor. l Frank Moore is NAHAM’s Government Relations Senior Director, based in Washington, DC.


Member Spotlight

Getting to Know Betty McCulley NAHAM’s “Member Spotlight” shares professional and personal insights from NAHAM member Betty McCulley. About Betty Title: Corporate Patient Access Director Hospital Name and Location: Baptist Health System, Birmingham, Alabama Hospital Website: www.bhsala.com

About Your Hospital

2. What’s it like to work at your health system? I’ve been working for Baptist Health System for 34 years, and have had many opportunities to grow professionally. My career has been so rewarding, and as anyone in Patient Access (PA) management can attest, it is never boring.

About Your Career 4. What are some of your personal priorities for your health system this year? I’m focusing on compliance training, particularly as it relates to MSP. Our health system continues to struggle in this area, especially in terms of correctly identifying when Medicare is the primary or secondary payer

for our Medicare and Medicare HMO patients. To address this, I have planned an intense training program for the months of July and August. 5. What is your business philosophy? Always do the right thing. Never take shortcuts or treat someone in a manner that devalues your reputation. 6. What is the best way to keep a competitive edge? The best way to keep a competitive edge is to stay involved in national- and locallevel Patient Access associations. 7. How do you measure achievement? In terms of achieving workrelated goals, our health system tracks achievement by monitoring a Patient Access dashboard. Accountability is an important part of our performance standards and is measured during our performance reviews. Continued on page 20.

19 Volume 35, Number 2

1. What is new and exciting at your health system? My health system is in the early stages of planning, building, and implementing a transition from Invision to EPIC. This system change will allow unlimited opportunities to improve our admissions/discharge/transfer (ADT) and resource-scheduling processes.

3. What are some of your department or organizational goals this year? We have two organizational goals this year: y y The most important, of course, is our current transition to the EPIC system. y y Our focus on making a promise to provide excellent customer service to each and every patient each and every day is also important. At times, this can be quite a balancing act when paired with the other important goal of increasing point-of-service collections. To make this work, training, scripting, observing staff ’s interactions with patients, and follow-through are all vital.


Member Spotlight

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8. What was your greatest professional accomplishment within the past year? I was thrilled to be part of the success of a restructured training program. Our program has always incorporated two trainers into its structure. In the past, one trainer visited each hospital in our four-hospital system, performing miscellaneous tasks. This left the trainer with little time to observe the hospital staff and provide intermittent training and coaching. The second trainer would train new employees from each hospital at our central business office.

9. What goal are you working toward now? I’m very involved with updating policies and procedures for every aspect of registration, scheduling, and financial counseling duties to ensure that they are kept current on an ongoing basis.

With the restructure, one trainer is deemed the “traveling trainer” and visits each hospital two days per month to train new employees onsite. If there are no new employees to train on those designated dates, the traveling trainer observes all staff and provides them with feedback. Employees with positive feedback are immediately recognized. Employees who receive negative feedback are given additional training and coaching.

11. What is your career advice? Stay on top of your responsibilities, know when change is needed, and be a part of the change. Most importantly, do not wait for someone to tell you change is needed—be an active and fully engaged leader.

The second trainer’s responsibilities focus more on a quality assurance role: monitoring reports, attending revenue cycle meetings, and updating policies and procedures. The trainers will trade positions one month of each quarter to ensure that they gain experience with each of their responsibilities.

13. What is your greatest talent on the job? I feel that I have the ability to coordinate a good working relationship between PA, HIM, and the business office. It all comes down to communicating as one team united for a common cause. Our senior leadership team meets monthly to review current projects, assess how they impact each area, and address collective goals. The team spends a considerable amount of time brainstorming effective

10. What has been the biggest lesson you’ve learned? Experience has taught me to be proactive, not reactive. Taking this lesson to heart ensures that you don’t have to defend the actions of Patient Access— you place PA in the position of being a quality work performance leader.

12. What is the most rewarding aspect of your job? I really enjoy providing coaching and training to PA leaders and watching them grow professionally.

and efficient ways to improve the processes in the revenue cycle, and brings this same focus to their direct reports. With this strategy, there is little room for “the blame game.”

More About You 14. What are your greatest passions in life? My family is of the greatest importance to me, always. I enjoy reading, so writing is an area I want to explore after I retire. Cooking is another great passion of mine. I plan to travel with my husband and family more, to enjoy long trips to places I haven’t been. I hope that I made a difference to my “work family” through my guidance over the years. I am passionate about those whom I consider to be my lifetime friends. 15. What is your motto to live by? Care about what you do every day—if you do not find joy in what you are doing, give considerable thought to making a change. 16. What is your favorite book? The Godfather is the first book that I picked up and couldn’t put down until I’d read it from cover to cover. A funny story about it: I am one of those people who never misses work for an unplanned reason. Ever! Here’s a confession: When I started reading this book late one night, I couldn’t possibly put it down and had to report off from work the next day. While it may not be my absolute favorite book, it is certainly the most memorable. Continued on page 21.


Member Spotlight

17. What is your favorite movie? The Color Purple 18. What is your hobby or pastime? I really enjoy cooking, reading, and traveling. 19. If you could meet anyone, who would it be? I would love to tell John Grisham how much I love his books in person. 20. If you could improve one thing about yourself, what would it be? I’ve never been completely comfortable analyzing financial reports, and I would probably take some courses to improve in this area.

About NAHAM

23. What do you like best about NAHAM? I like having “the total package” at my disposal. The networking opportunities are worth gold. If its members really understood how rewarding it is to work on a committee or serve on the board at NAHAM, there would be a long, long waiting line. For those less inclined to serve in a volunteer role, there is still the opportunity to make lifetime connections and bring great value back to your facility by attending the Annual Educational Conference & Exposition.

24. What is your favorite NAHAM event or experience? My favorite experience happened in 1996, when I took the CHAM exam in Orlando at the conference. The exam was harder than I expected, and I was concerned about my performance. Weeks later, I received both a phone call from Nancy Farrington congratulating me on passing the exam and a Disney postcard, which she mailed to me again with congratulations on becoming a CHAM. This personal touch meant a lot to me and I still have the postcard. 25. What can NAHAM do to better serve its members? With its board members working with regional delegates and the addition of the ambassador role, I believe that NAHAM is serving its members well. NAHAM has truly become the leading resource for successfully managing patient access services. l

21 Volume 35, Number 2

21. What inspired you to join NAHAM? I embraced the challenge to learn more about Patient Access outside of my small world at one hospital.

22. How did you get into Patient Access Management? I started out as an admitting representative on night shift so I could drive my four children back and forth to school. Within six months, I was promoted to supervisor, then a few years later to PA director and eventually to corporate PA director for a tenhospital health system. After a few years, I moved to a business office director position, but eventually returned to my first love, which is Patient Access.


CHAA Corner

Memories of My First NAHAM Conference (with gratitude to NAHAM and Dale Williams) By Theresa M. Rodriguez, CHAA, CHAM, CMIS With inspirational keynote speakers, a wide selection of educational sessions, and numerous networking opportunities, the NAHAM Annual Conference presents many exciting experiences. Get a firsthand look at all it has to offer through the eyes of a first-time attendee (and Dale Williams Scholar).

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The results are in: Theresa Rodriguez, you have passed your CHAM exam and you are now a Certif ied Healthcare Access Manager. What’s your next move to advance your career in Patient Access? Now that the CHAM exam was over, I found myself pondering several challenging questions: What should I do next? How could I advance in the field of Patient Access? For answers, I turned to the NAHAM website. As I clicked on each page, the next step in my career presented itself plainly on my screen. I discovered an entire page dedicated to the NAHAM 37th Annual Conference & Exposition in San Antonio, Texas. This would be an extraordinary opportunity to network with my peers and get updates on the advancements available in the field that I love so much! My only dilemma was that my small 58-bed community hospital would never have the funding to send me to a conference of this size. I had never attended

a conference before, but with my recent CHAM certification, to me the sky was the limit. I approached my supervisor to discuss the possibility of attending the conference, but found my assumption confirmed—there was not money available to send me to the conference. Though disappointed, I had faith that somehow, all of my hard work would soon pay off—and it did. January 27, 2011 was the day that things began to turn around for me. Browsing through my inbox, I saw an email from NAHAM: “NAHAM Seeks Dale Williams Scholars Program Applicants.” The qualifications for the scholar program were simple: you had to be a NAHAM member and a first-time attendee to the conference. I emailed my completed application to NAHAM before the deadline and eagerly anticipated the results. When I found out that I had won the Dale Williams scholarship, I tried to maintain my composure, but soon after the call ended, I

was running around my office, excitedly telling my co-workers the news. I couldn’t believe that I was going to attend the NAHAM 37th Annual Conference and Exposition in San Antonio, Texas. All of my expenses, including registration fees, airfare, and hotel, were covered by the scholarship. It was an unbelievable honor to have been chosen. During the weeks leading up to the conference, I enjoyed reading well wishes and congratulatory emails from many NAHAM staff members. Everyone was so kind and worked very hard to make sure that I had the best conference experience possible. Despite my endless emails, the NAHAM staff were patient, thorough, and quick in their responses. This made the process much simpler for someone like me who rarely leaves her small community of 1,400 in Watervliet, Michigan.

Continued on page 23.


CHAA Corner

Conference Day 1: Tuesday, May 24 My day began at 11:00 a.m. with registration and a NAHAM University lunch. This was followed by two preconference symposia: NAHAM University and Customer Service Symposium. These are not included as part of the conference, but I highly recommend them to both new and veteran conference attendees.

After a short break, I was off to the NAHAM Regional Meeting. I met many new people from my region and reconnected with some familiar faces from aIPAM, our Illinois chapter. We even had some Patient Access staff from

Prior to the conference, I received a special invitation to attend the SCI Solutions dinner at The Republic of Texas on the River Walk. It was such a hot evening, but the walk over to the restaurant was well worth what I gained. At the start of dinner, I found myself sitting next to a woman named Maxine who was so full of life that I couldn’t help but smile in her presence. The funny part is I didn’t even know she was the NAHAM ambassador until almost the end of the night. She literally welcomed me with open arms and told me that she knew Dale Williams very well. She shared with me how special Dale was and congratulated me on earning my honor. While we talked, I noticed that Maxine seem to be suffering from a bad case of poison ivy on her chin. Luckily, I knew of a solution that might help. My mother works for a dermatologist back home in Michigan and since we all know that mothers know best, I called her for help. My mom gave us a laundry list of treatments that might help, and Maxine and I set off for the nearest drugstore to find something that would get her through the rest of the conference.

While at the drugstore, we discovered that there was an urgent care clinic nearby. Heartened by this news, we set out to get Maxine some real medical treatment. I was happy to walk with her and pleasantly surprised that I had a chance to give back to NAHAM by helping their ambassador get some relief from her poison ivy. It’s amazing how events can come full circle in life. Maxine and I met some amazing staff at the urgent care clinic. They were helpful and their customer service skills were exceptional. Who would have thought that while attending a Patient Access conference, we would be on the receiving end of Patient Access? After Maxine was treated for her poison ivy, we headed back to our hotel— we both had to wake up early for the First-Time Attendee and New Member Breakfast the next morning. Conference Day 2: Wednesday, May 25 I woke up excitedly anticipating what this next day would offer. How could I ever top the experiences I had the day before? As the day progressed, I discovered how popular my new friend Maxine really was. She introduced me to so many amazing people and told the story of our trip to the clinic with every new introduction.

Continued on page 24.

23 Volume 35, Number 2

NAHAM University was an interactive forum where representatives from facilities all over the country brought issues to discuss. It was amazing for me to hear the dilemmas of larger healthcare organizations and know that they are facing the same problems that we are, just on a much larger scale. I was grateful for the chance to network and discover what other facilities were doing to solve challenges raised by recent Health Care Reform. The Customer Service Symposium, presented by a panel of customer service experts, provided me with lots of helpful information. At the close of the symposium, I received a customer service toolkit made by the panel. I have since used this toolkit to help introduce new concepts to our Patient Access manager.

Canada in attendance. We met the delegates from our region and even the upcoming president. Everyone was excited to know that this year’s Dale Williams Scholar hailed from the Midwest Region.


CHAA Corner

I attended the First-Time Attendee and New Member Breakfast, where I met many attendees who were also new to this experience. We played several icebreaker games and got to know one another. At the end of the breakfast, we all received some helpful hints on how to best prepare for the next few days. This was a great start to the day and an even better start to the conference. While the timing of the breakfast is early, I strongly suggest that anyone new to the conference attend.

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Following breakfast, I was ushered right to the Opening General Session with keynote speaker Mike Rayburn. He was phenomenal. I have never felt so engaged in a speaker’s presentation. Rayburn put his audience’s imagination to work with the one small question: “What if ?” He also did some amazing things with a guitar. I was so impressed that I purchased his DVD, CD, and book. I had the chance to meet with him and get him to sign my book. Next, I attended several Learning Labs and Industry-Sponsored Symposia that were informative and inspiring. Each Learning Lab series offered at least five presentation options. This variety allowed me to choose which topics I wanted to learn more about. The NAHAM Committee meetings followed the Learning Lab series. All attendees were welcome to attend and find out more information. They could even choose to join

a committee if they wanted to. After a very full day of learning and networking, I gratefully took a seat in the Stress-Free Zone. I enjoyed the massage that I received, and it was just what I needed before I headed to the Opening Welcome Reception. The reception was wonderful. After dinner, I had the first chance to meet the vendors. The opportunities for networking with peers continued, but getting to explore the products available to patient access was another fabulous addition. The goodies and giveaways were an added bonus. I found so many products that I would love to have in order to streamline the Patient Access department at my hospital. As day two of the conference came to a close, I was excited but also exhausted. While I definitely had time to explore Texas and the River Walk, I was much too tired and needed to prepare for another amazing day of learning. Conference Day 3: Thursday, May 26 Thursday’s schedule included two Industry-Sponsored Symposia and two more Learning Lab series. There were so many opportunities for learning, and I made sure that I took lots of notes to share with my coworkers at home. During the day’s General Session, I was recognized along with many other attendees for gaining either CHAA or CHAM

certification. It was wonderful to be individually recognized for this accomplishment. My new friend Maxine was called the stage to give her report as the NAHAM ambassador, but she stayed onstage afterwards to present me with my award as the Dale Williams Scholar. After I exited the stage, everyone congratulated me and said that my speech was wonderful. One attendee even told me that I fit in well with NAHAM. I felt so welcome and at ease. It was also an amazing feat that I gave a speech, since I’m not a great public speaker, but I felt that I was speaking among friends. Later that evening, Jim Hicks commended me for my speech and said, “Nice job.” The rest of my day continued with more opportunities for learning. I attended several Learning Labs after the General Session, followed by lunch in the exhibit hall. This was another opportunity to meet the vendors and network with newfound friends. After lunch, I attended one more Learning Lab and the Industry-Sponsored Symposia. The Networking Reception was the final event on my NAHAM schedule. During the reception, I met a lady who just as full of life as my new friend Maxine. Interestingly, she also carried around a lizard. I couldn’t have imagined how many interesting people I’d meet at a single conference. Continued on page 25.


CHAA Corner

Conference Day 4: Friday, May 27 Friday opened with breakfast at 7:30 a.m.—but this was not an ordinary breakfast. This was the time when all the winners of the various vendor drawings would be announced. I could not miss this; I had my eye on a Kindle that I really wanted. While I didn’t get much sleep the previous night, I was up and on time for that breakfast.

I couldn’t believe my trip was almost over; I didn’t want it to end. I had to remain focused because I still had one Learning Lab and the Closing General Session to go. As I tried to focus on the final Learning Lab, all

The Closing General Session was just as phenomenal as the Opening General Session. I never expected to see the wonderful woman with the lizard who I had met the night before, on the stage as our final speaker. Her name was Kathy Dempsey, and her story was life-changing for me. This was the finale that the whole experience deserved. I wanted to stay after the session to meet with her again, but if I didn’t gather my luggage and catch a cab, I would miss my flight. Luckily, my flight home was just as uneventful as my journey to San Antonio. The only thing I needed was a week off to recover from all the fun and learning that I gained at the conference. l

Theresa Rodriguez currently works for Lakeland Community Hospital Watervliet, a small 58-bed, not-forprofit hospital that employs about 300 people. She began working in the Patient Access department in 2004 and has served in several departments, but her passion will always be with Patient Access. She enjoys the interaction with patients, their families, and the various other departments needed to make an exceptional experience for the patient. Theresa became a Certified Healthcare Access Associate (CHAA) in 2007 and became a Certified Healthcare Access Manager (CHAM) in January 2011. She is also a Certified Medical Insurance Specialist through the Practice Management Institute.

25 Volume 35, Number 2

Although I didn’t win the Kindle or any other prize, for that matter, many of my new friends did. It was exciting to recognize people who I had met going up to retrieve prizes. Just as I love interacting with my patients and their families, I love meeting new people. This conference was definitely a great place to do just that.

I could think about was how I would forever be grateful to NAHAM and Dale Williams for giving me the opportunity of a lifetime. I tried very hard to stay engaged in the Learning Lab, but I kept thinking about how I had to begin saving for the NAHAM 38th Annual Conference & Exposition in San Diego, California in 2012.


Book Review

Blue Ocean Strategy: How to Create Uncontested Market Space and Make the Competition Irrelevant By Michelle King-Robledo, MBA, CHAM

Discover how the Blue Ocean Strategy can contribute to the success of your organization.

Access Management Journal

26

Blue Ocean Strategy: How to Create Uncontested Market Space and Make the Competition Irrelevant is a national bestseller written by academics and management strategists W. Chan Kim and Renee Mauborgne. The book presents a straightforward and practical approach to competition that is versatile and widelyapplicable. The Blue Ocean Strategy may be used for creating competitive plans or improving core processes. Opponents have claimed that the theory is merely an adaptation of the Strength, Weaknesses, Opportunities, and Threats (SWOT) analysis. However, unlike the SWOT analysis, the Blue Ocean Strategy (BOS) allows a practitioner to not only identify a business opportunity, but to create a definitive implementation path.

boundaries. Organizations in red oceans fight ferociously for their limited share of the market by reducing prices or through minimal product-differentiation strategies. The size of red ocean markets increases only in response to changes in the external environment—namely, changes in demographics, legislation, or technology. In contrast, the blue ocean is “uncontested market space” and represents uncharted territory. Value innovation is a key component. It involves adding a feature or service that increases customer satisfaction and utilization. Competition in blue oceans involves identifying potential clients using a threetiered system:

Red and Blue Oceans

Tier 2- Customers who choose not to utilize the product.

Kim and Mauborgne claim that there are two types of existing market spaces: red and blue oceans. Red oceans are markets in which competition currently exists. The market is fixed, with minimal fluctuations, and new products are created within established

Tier 1- Existing customers on the verge of leaving.

Tier 3- Customers from a different market. Consumers within the three tiers are categorized as non-customers, because they are outside of

the existing market share. The objective is to increase sales by generating demand from among the three tiers of non-customers. The blue ocean strategy is formulated by adopting the positive features of an existing framework, then innovating to add value to the product. Any competition then becomes irrelevant because the product operates outside of the red ocean, targeting a larger market segment. Case studies of several blue ocean companies are presented throughout the book, including Cirque du Soleil, Southwest Airlines, and IKEA.

Successful Organizations Cirque du Soleil was able to effectively compete and thrive in the declining circus industry by operating outside of that industry’s boundaries. The Ringling Brothers, Barnum and Bailey Circus is one of the most successful groups in the industry. Smaller circuses benchmark their shows using Barnum and Bailey’s standards. Despite this success, Barnum and Bailey Continued on page 27.


Book Review faced declining sales as audience enthusiasm waned and criticisms from animal rights groups increased. In addition, there was little variety in the types of circus acts presented. Loyal customers stayed only because of tradition. Cirque du Soleil formulated a competitive strategy that retained traditional circus features and added to them. The result was a circus of theatrical, acrobatic performers and clowns entertaining an audience under a big tent. They successfully increased their revenue by attracting audiences from the pool of non-customers. Patrons were the traditional circus attendees, (tier 1) unenthusiastic audiences, who may have been on the verge of leaving, (tier 2) people who liked musical performances, and (tier 3) theater patrons.

The furniture giant IKEA created value for its customers by forming strategic partnerships with its suppliers in more than 50 countries worldwide. The retailer created strategic partnerships with the lowest cost, most efficient manufacturers to create their product offerings. We can successfully employ these same principles in the medical environment to help ensure a successful transition

Kaizen Teams We can develop blue ocean opportunities by making use of quality- and performancemanagement tools. Patient Access management teams should incorporate the principle of Kaizen into their work philosophy. Kaizen is a Japanese word that means “change for the better.� The five elements of Kaizen are: teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. A Kaizen team uses these elements to ensure that quality becomes a departmental responsibility. Efforts should center on quality improvement by eliminating waste, standardizing processes and managing performance. The benefit of a Kaizen team is that it incorporates continuous quality improvement into the regular scope of operations. Quality assurance extends beyond the customary checks for registration errors. Efficiency is continuously measured and improved by collecting cycle times from the waiting room, registration process, and interdepartmental transitions. Kaizen encourages staff and leaders to partner as both groups work cohesively to optimize performance.

Workflow Optimization By optimizing workflow using the principle of Kaizen, Patient Access teams can develop blue ocean opportunities and increase their value. Optimizing performance creates value by maximizing the utility of all available resources through planning and strategic alignment. Simple tasks that may increase efficiency include: y y Having registrars complete simple administrative tasks during slow periods, e.g., performing insurance verification on routine lowdollar outpatient procedures. y y Cross-training staff in order to accommodate unplanned absences and heavy patient flow more efficiently. y y Resdesigning all inpatient and outpatient processes to include financial clearance/counseling. I highly recommend Blue Ocean Strategy: How to Create Uncontested Market Space and Make the Competition Irrelevant. The methodology can be used to ensure success in the constantly changing and competitive medical industry. l Michelle King-Robledo is currently a student at Texas A&M Commerce and will graduate with her second master’s degree in January 2012. Her career in Patient Access began when she enlisted in the U.S. Army. Since then, she has worked for facilities in Massachusetts and Texas, and is particularly interested in quality management and revenue cycle operations. Michelle is an avid reader and fitness enthusiast; her favorite activities are distance running and Zumba.

27 Volume 35, Number 2

Another successful organization, Southwest Airlines, has enjoyed the distinction of being a pioneer in both successful humanresource management and valueadded service. The organization reduced operating costs by eliminating non-value-added services. As a result, Southwest Airlines flourished while the airline industry overall declined.

to the Patient Protection and Affordable Care Act (PPACA). The new legislation presents a unique combination of red ocean expansions and blue ocean opportunities. Patient Access can create value by synergizing departmental processes to work in concert with these new legislative changes. A successful blue ocean strategy will decrease administrative costs while maximizing reimbursement and resource utilization.


Access Access Management Management Journal Journal Official Journal of the National Association of Healthcare Access Management Volume Number 2 National Association of Healthcare Access Management Official 35, Journal of the Volume 35, Number 2

Access Management Journal Discussion Guide Access Journal Guide For members of Management the National Association of Healthcare Access Discussion Management and their staff

For members of the National Association of Healthcare Access Management and their staff The Access Management Journal helps to enhance the overall performance of NAHAM members and their staff teams. Its articles reachManagement professionalsJournal engaged in Patient Access in healthcareof delivery. Each issue ofand thetheir Journal a Its The Access helps to enhance theServices overall performance NAHAM members staffhas teams. supplemental Guide to raise awareness and Services provoke in conversation theEach issues, concepts, and critical articles reach Discussion professionals engaged in Patient Access healthcare around delivery. issue of the Journal has a objectives of Patient Access Services departments. Discussion Guide includes questions to help supplemental Discussion Guide to raise awareness Each and provoke conversation aroundthought-provoking the issues, concepts, and critical members explore the Journal’s with their teams and discuss the articles’ pertinence toquestions their organization objectivesbetter of Patient Access Services content departments. Eachstaff Discussion Guide includes thought-provoking to help and profession a whole. members betterasexplore the Journal’s content with their staff teams and discuss the articles’ pertinence to their organization and profession as a whole.

Front-end Patient Financial Triage: Applying Clinical Techniques to Front-end Patient Triage: Applying Clinical Techniques to the Business Side ofFinancial Healthcare Learn the conceptSide of patientof financial triage from experts at Passport Health Communications Inc. theabout Business Healthcare Learn about the concept of patient financial By Passport Health Communications Inc. triage from experts at Passport Health Communications Inc. By Passport Health Communications Inc.  What should be the first step in the up-front financial triage of any insured patient?  Have you ever had to deal with patient whofinancial was abletriage to payoffor their healthcare services but refused to do What should be the first step inathe up-front any insured patient? so? How did you handle the situation? Have you ever had to deal a patientsolution who wasfor able to organization? pay for their healthcare services but refused  Would triage software be anwith appropriate your How would you implement it?to do so? How did you handle the situation? 

Would triage software be an appropriate solution for your organization? How would you implement it?

Assembling a Team…Don’t Forget Your Analyst! Creative solutions to Patient Access challenges are often necessary. At Gwinnett Medical Center, the team turned to a commonly Assembling a Team…Don’t Forget Your Analyst! overlooked source—the IT department—and was able to increase efficiency, streamline processes, and lower costs with their Creative solutions to Patient Access challenges are often necessary. At Gwinnet Medical Center, the team turned to a commonly suggestions. overlooked source—the IT department—and was able to increase efficiency, streamline processes, and lower costs with their By Lori Carson, CHAM suggestions.

 Carson, What are the specific solutions that the Gwinnett Medical Center IT staff was able to offer to the Patient By Lori CHAM Access team? Whatare arethe themembers specific solutions thethat Gwinnet Medicalmore Center IT staffand wasinvolved able to offer the Patient  Who of your ITthat staff could become engaged with to Patient Access? Access team?  Does your organization have regular meetings with Patient Access management staff that your IT department benefit from attending?  would Who are the members of your IT staff that could become more engaged and involved with Patient Access?  Is your IT department aware of the issues that Patient Access registrars face with system limitations or  Does your organization have regular meetings with Patient Access management staff that your IT department processes? would benefit from attending? 

Is your IT department aware of the issues that Patient Access registrars face with system limitations or processes?

At-Your-Service Access Options: Keys to Successful Healthcare Delivery Strategies At-Your-Service Access Options: Keys to Successful Self-service options are becoming an increasingly popular offering for customers. While providingHealthcare customer care and streamlining processes are the top benefits of having a hospital self-service kiosk, many additional advantages also exist. Delivery Strategies

Self-service options becoming an increasingly offering By Cindy Dullea, RN,are MBA, BC, CHAM and Tricia popular Fletcher, CHAMfor customers. While providing customer care and streamlining processes are thelessons top benefits of to having a hospitalinitiatives self-service many additional advantages also exist.  What related self-service cankiosk, healthcare learn from other industries?  Dullea, What types of self-service areFletcher, appropriate for hospitals to implement? By Cindy RN, MBA, BC, CHAMproducts and Tricia CHAM  Would your organization’s patients be receptive to a self-service kiosk?  What lessons related to self-service initiatives can healthcare learn from other industries?  What types of self-service products are appropriate for hospitals to implement?  Would your organization’s patients be receptive to a self-service kiosk?

Submit an article to the Access Management Journal today! Discussion Guide Authors earn contactto hours published article. Submit an3.0article theper Access Management Journal today! Discussion Guide Discussion Guide ToAuthors view issues of the Journal online, visit www.naham.org. earn 3.0 contact hours per published article. To view issues of the Journal online, visit www.naham.org.


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Access Management Journal Volume 35-2  

NAHAM's Access Management Journal, Volume 35-2.

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