Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 35, Number 3

National Association ofHealthcare Access Management

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Can External Call Centers Benefit Hospitals’ Access Departments? 5

The Impact of Meaningful Use on the World of Patient Access 7

Making the Case for Patient Self-Service Kiosks 9

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 TopicsThe 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 FormatArticles 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 EditingAll articles are subject to editing by the editorial staff.

ExclusivityArticles 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).

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

Publication Schedule

How to SubmitAll 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:

NAHAMAttn: Access Management Journal2025 M Street NW, Suite 800Washington, 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.

Issue Materials Deadline Publication Date

Issue 1, 2012 (Printed Issue) February 21, 2012 May 2, 2012Issue 2, 2012 (Online Issue) June 21, 2012 August 29, 2012Issue 3, 2012 (Online Issue) October 12, 2012 December 20, 2012

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Table of ContentsFeature Articles

5 Can External Call Centers Benefit Hospitals’ Access Departments? By Steve Chrapla

7 The Impact of Meaningful Use on the World of Patient Access By Gaye Werblin

9 Making the Case for Patient Self-Service Kiosks By Jay Lawrence and Patrick Pichette

Departments

4 Editor’s Letter

11 NAHAM Advocacy Update

13 Member Spotlight: Getting to Know Kevin Poser

15 CHAA Corner: Earning Customer Loyalty: One Step at a Time

18 Book Review: Steve Jobs

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

NAHAM BoArd of directorsHolly Hiryak, RN, MNSc, CHAM, PresidentPatricia Consolver, CHAM, Immediate

Past PresidentJeff Brossard, CHAM, Vice PresidentTammy Stone, SecretaryEd Spires, CHAM, TreasurercoMMittee cHAirsPolicy development/Government relations committeeBrenda Sauer, CHAM, RN, MA

certification commission Elizabeth Reason, CHAM

education committeeTammy Wood, CHAM

Publications/communications committee Jim Hicks, III, CHAA, CHAM, CAM, FHAM

Membership committee Jeff Ferrell, CHAA, CHAM

special Projects committee Tony Lovett, CHAM

reGioNAl deleGAtesNorthwest regional delegateDonna Aasheim, CHAM

southeast regional delegate Paul Shorrosh, CHAM

Midwest regional delegateSuzan Lennen, CHAM

central regional delegateRebecca Holman, CHAM

Northeast regional delegateCatherine Pallozzi, CHAM

southwest regional delegateYvonne Chase, CHAM

ex-officiolegal counsel Michael J. Taubin, Esq.

editoriAl BoArdJim 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 officeExecutive Director: Steven C. Kemp, CAEProgram Manager: Mike CoppsProgram Associates: Caroline Fabacher and Belle McFarlandMarketing Coordinator: Lindsay PullenEducation Manager: Stacey BarnesCertification Manager: Joyce ArawoleEvents Coordinator: Alexandra Zapple

Access Management Journal (ISSN 0894-1068) is published by:

National Association of Healthcare Access Management2025 M Street NW, Suite 800Washington, DC 20036-3309Telephone: (202) 367-1125Fax: (202) 367-2125Website: www.naham.org

© Copyright 2012, 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 2012 membership dues are $165 for Full Members and $1,500 for Business Partner Members. For more information, visit www.naham.org.

Volume 35, Number 3

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Greetings, NAHAM members!

It ’s the holiday season, one of my favorite times of the year because of all the joy, family time, and

lighthearted fun. It ’s easy to feel that childlike sense of wonder as the first few snowflakes fall, or as you

welcome friends f rom far away into your home for a much-anticipated visit.

Then again, it ’s also easy to get caught up in the not-so-cozy spirit of the holidays. Even friendly people

morph into cranky customers once they hit the stores, and the icy slush can be enough to turn your mood

sour the moment you exit your car. It ’s a season of high tempers, dwindling bank accounts, and countless

priorities competing for your time.

Maybe it ’s because we forget that the holidays are a great time to consider all of the gifts we’ve already been

given. You’ve already been given so many gifts, ones that you may not have even recognized yet. They won’t

get old, the warranty won’t run out, and you won’t need to exchange any of them for a different size. These

gifts are the talents and abilities you possess, which you can give back to the world around you.

Every day in your workplace, your dedication to your job makes a difference. Even the most seemingly

meaningless task or interaction likely means something to someone. Your influence stretches f rom where

you work to your home, your community, your country, and the world. While you may feel stressed during

the holidays, these times are all the more taxing for those who live in far more difficult conditions than you

do. You can use the gifts you have to reach out to them.

Take these natural abilities that you’ve been given and pass them to someone else. Volunteer to serve

holiday dinner to the homeless, perform for the elderly at a nursing home, or visit an old friend who doesn’t

see many guests. I guarantee that you’ll experience the happiness that the holidays are meant to bring.

Of course, this isn’t a call to only use your gifts during the holiday season. If you can enhance a single

season by serving others, imagine what you can do during the rest of the year. Just because the holidays are

over doesn’t mean that there aren’t still people who need you. Make a resolution this year to volunteer more,

to dedicate more time to serving your family, and give out of the bounty you’ve already received.

Enjoy this season of giving, hope, and happiness!

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.

Editor’s Letter

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Health Care Reform provides new challenges to providers. The Patient Protection and Affordable Care Act establishes compliance requirements related to financial screening, which impacts patient billing and potential financial assistance. Experts say that in order to meet these requirements, financial screening must be done at the f ront end of the revenue cycle. This will place an additional burden of responsibility on Patient Access teams.

Providers must find ways to be more efficient and provide quality service at a lower cost. In addition, there is a “consumerism impact” on healthcare delivery, which requires providers to take a more patient-centric approach, enhancing the patient ’s overall experience and increasing the level of satisfaction the patient has with their healthcare provider. These expectations will require the complete involvement and cooperation of all clinical and administrative departments within a healthcare organization.

Patient Access Departments must focus on several primary objectives:

y A more patient-centric approach to all interactions;

y Increased patient satisfaction with the provider;

y Reduction of net operating expenses;

y Increased level of financial and clinical screening;

y Established clear financial and clinical expectations for the patients;

y Reduced level of re-work in post-treatment revenue cycle functions;

y Reduced payer denials; andy Increased cash collections.

Is it time we re-think how Patient Access departments have approached work flow and process?Revenue cycle executives have long understood the benefits of critical outsourced functions used in the back-end of the revenue cycle. Can some of these resources serve Access areas? External call center operations should be considered a resource in achieving Access department objectives.

Can External Call Centers Benefi t Hospitals’ Access Departments?

Current pre-Access processes necessitate extensive telephone interactions that, while often redundant, require staff with specific communication skills, including expertise in discussing financial responsibilities. Staff members with interpersonal skills are essential to successful patient interactions, but they are often not available. In addition, the latest technologies are often cost-prohibitive or beyond the resource capabilities of most Access departments.

Some of the functions within Patient Access that benefit f rom dedicated call center operations include:

y Patient scheduling;y Medical necessity screening;y Pre-registration;y Pre-certification of services;y Eligibility and benefits

verification;y Financial screening and

counseling; andy Pre-service collections.

Continued on page 6.

By Steve Chrapla

As Patient Access teams look to improve customer service and enhance efficiency, they should consider implementing an external call center as part of their strategy.

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These pre-Access functions can have a significant positive impact on a facility. A properly structured call center operation can provide the following benefits:

yy Increased patient and physician satisfaction;

yy Standardized processes for all service areas and locations;

yy Timely and efficient scheduling;yy Expedited registration;yy Improved financial metrics/

lower costs and increased reimbursements;

yy Reduction in payer denials;yy Expanded hours of operation;yy Skilled staff specialized in

patient communications;yy Financial counseling specialists;yy Technology including interactive

voice response, call recording, and predictive dialing;

yy Presumptive charity screening technology with hospital-specific criteria; and

yy Management knowledgeable in high-volume call operations.

As with the development of any operational process, the identification and monitoring of key metrics is critical. Below is a list of sample best practices and metrics an effective pre-Access call center would achieve:

Scheduling yy 100 percent of non-emergent

patients are scheduled;yy All cases are scheduled at

a minimum of 12 hours (preferably more) in advance of service;

yy All surgeries are verified against an inpatient-only list;

yy All information collected prior to surgery is in accordance with clinical criteria;

yy Medical necessity is validated to prevent Advance Beneficiary Notices (ABNs);

yy “OK to delay” criteria is established with physicians

Pre-Registrationyy 95 percent of all scheduled

patients are pre-registered;yy 100 percent of all pre-

registered patients have insurance eligibility and benefits verified;

yy Identify specific service lines requiring verbal verification beyond electronic verification and obtain 100 percent;

yy 100 percent pre-certification on all required patients;

yy 98 percent patient demographic data quality

Patient/Guarantor Communicationsyy All non-covered services are

explained to 100 percent of patients impacted;

yy 95 percent of all out-of-pocket costs are requested from patient;

yy 80 percent of POS collection potential is achieved;

yy 100 percent of patients with outstanding accounts receivable will be counseled;

yy Charity care guidelines are explained to 100 percent of applicable patients

Call Center Operationsyy 80 percent of calls are

answered within 20 seconds; yy 50 second average call hold time;yy Less than 5 percent abandoned

call rate;yy 98 percent complete resolution

on one call.

While the potential benefits may be overwhelming, understanding barriers to success is critical. Physicians may feel less involved in their patient ’s treatment or concerned that they will be left out of key communications with their patients. Management may feel that an outsourced service could have an adverse public relations impact. Hospital clinical departments may feel that they are losing control and

will be negatively impacted. Most importantly, patients could take an unfavorable view of the change to an external call center and feel that they are dealing with individuals who do not care about them. These are all important points to consider as you develop a project plan to introduce an external call center.

Begin by performing an analysis of your current operations and determine the financial impact of in-house telephone operations. A GAP analysis will allow you to identify the potential of your Access department, as well as the impact of future revenues as the result of enhanced patient experiences. As you develop an implementation plan for an external call center, always over- communicate with stakeholders. It is also important to identify potential external partners and bring them into the planning process as early as possible. This ensures a high commitment level and the development of a true partnership environment.

While challenges do exist and should be addressed before an Access department chooses to switch to an external call center, there are considerable benefits to choosing this option. Departments should assess their needs and how to best adapt this new solution to their hospital—as in any transition, pre-planning is key to success. l

Steve Chrapla has over 30 years of expertise in healthcare finance and revenue cycle management, including patient accounts and patient access. Currently, he serves as director of third-party Solutions for avadyne Health, and is an active member of the First Illinois Chapter of the Healthcare Financial Management association.

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Continued on page 8.

Medicare and Medicaid electronic health records (EHR) incentive programs provide payments for the “meaningful use” of EHR technology to healthcare processes and outcomes. According to the U.S. Department of Health & Human Services:i

The American Recovery and Reinvestment Act of 2009 specifies three main components of meaningful use:

1. The use of a certified EHR in a meaningful manner, such as e-prescribing.

2. Th e use of certifi ed EHR technology for electronic exchange of health information to improve the quality of healthcare.

3. The use of certified EHR technology to submit clinical quality and other measures.

“Meaningful use” means that providers need to demonstrate their use of EHR technology to make concrete, measurable improvements.

CentraState Medical Center (CSMC) is a 282-bed community hospital in Freehold, NJ. By taking a multi-disciplinary approach and

The Impact of Meaningful Use on the World of Patient Access

By Gaye Werblin

CentraState Medical Center developed and implemented a plan that qualified their hospital for “meaningful use” incentives.

utilizing the expertise of expert consultants, the hospital was able to change processes and implement many new workfl ows to qualify for meaningful use incentives.

Identifi cation of Work Plan:The hospital IT department was the project manager for this large-scope endeavor, undertaken in early 2010. It was crucial to identify up-front what was needed to complete the project so that systems could be modified and processes amended. The project managers determined that Patient Access would be involved in eight major areas:

1. The capture of a patient ’s race and the ability to retrieve and send the value.

2. The development of the health information exchange (HIE) and the mapping of fields in the registration system to the values identified and sent in the HIE, in addition to the identification of locations that will not be part of the HIE.

3. Th e revision to the privacy statement and the ability to document that a new version has been provided to the patient.

4. The ability to explain the opt-out ability to patients and the process to block information from going to the HIE. This includes developing scripts for Access staff to use when communicating with patients.

5. The capturing of the patient ’s primary physician during registration and ensuring correct information in regards to HIPAA.

6. Provision of account numbers to enable computerized physician order entry (CPOE) for clinicians.

7. Facilitating throughput in the facility to ensure that patients are being moved out of the emergency department in a timely manner, not exceeding the two-hour boarding time benchmark.

8. Developing policies to support all operational changes and additions to workflow.

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Implementation of Workplan:1. At CSMC, Patient Access

staff currently capture race and ethnicity information, which enables mapping the fields in the HIE.

2. Access Management is involved with the HIE team to determine and map the necessary fields for the HIE interface.

3. The privacy statement was amended by legal counsel. Staff were responsible for distributing the revised notice of privacy practices document, which has facilitated the need for a new version and field to document in the ADT system.

4. The Access staff must be well-versed in explaining the HIE and how to opt out or opt back in. Scripts are a helpful tool to accomplish this. Fields in the registration system also had to be tailored to block the data if the patient did decide to opt out.

5. Prior to meaningful use, CSMC did not capture the patient’s primary care physician. In order to capture this information, a field had to be mapped for the HIE transmission and the Patient Access staff had to be educated and scripted to ask for this information correctly. New selections were added to dictionaries in the event that the patient 1) did not have a primary care provider, 2) was unable to accurately identify their primary care provider, or 3) the primary care provider was not on staff at CSMC.

6. When CPOE was introduced to clinicians, their workflows were reviewed. Surgeons wanted to book their cases and then enter their pre-admission testing orders and their pre-op orders

via CPOE. The challenge for Access staff was to amend existing workflows to be able to provide an account number. The long-term solution was the development of a short form pre-admitting patients scheduled for a procedure, which produced an account number in a timelier manner.

7. For the last four years, CSMC has focused on improving patient throughput. CSMC engaged BluePrint Healthcare IT to develop and build a bed management system (BedConnect). By implementing this solution, CSMC has been able to reduce throughput numbers dramatically.

Challenges:It is vital that Access staff be included on the hospital project teams for meaningful use and the HIE. Processes and internal workflows have to be amended to ensure compliance.

Capturing the patient’s primary physician can be difficult. Patients cannot always identify their primary physician, which can easily cause an HIPAA exposure. CSMC spent a large amount of time on education with Access staff, teaching them scripts of how to ask who the primary physician is and how to be able to extract the information during a conversation. It is also important to note that the interactions with patients and call center statistics do increase when an organization starts to gather this information.

It is also very important to review the expectations of clinicians in regards to CPOE. If the clinicians are expecting to see a patient before registration staff has had time to do a quick registration, their expectations will not be met.

And if the account is not easily accessible for the clinicians to post orders, then orders often get placed on incorrect accounts, which ultimately causes billing issues.

Education is key to Access department success. Staff must understand meaningful use and, more importantly, how the HIE functions. It is also important to develop or amend policies to document the changes in workflow and create accountability. Finally, enough cannot be said about throughput. Facilities should consider an automated bed management system to improve patient throughput as well as monitor all phases from admission to discharge. Throughput also needs to be addressed by inpatient units.

The Future:Through incorporating several key strategies, hospitals can introduce workflows that address meaningful use incentives. While meaningful use is currently in its infancy, its impact on Patient Access will continue to grow. Hospitals should develop a plan now to address these new changes and identify how to best implement that plan. l

Gaye Werblin is a graduate of Quinnipiac University. She has been employed by CentraState Medical Center in Freehold, NJ for the past 20 years. Werblin currently serves as director of patient access services, and continues to be very involved in the field, having served as chair of the NJHFMa access Committee for two years.

Sources

i https://www.cms.gov/ehrincentive programs/30_Meaningful_Use.asp

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Making the Case for Patient Self-Service Kiosks

By Jay Lawrence and Patrick Pichette

Improving customer service and the patient experience is a goal at the heart of Patient Access. Introducing a patient self-service option helps to ensure patient satisfaction and boost efficiency.

Long lines and uncomfortable delays are the norm for today’s patients. Hospitals are crunched fi nancially and forced to do more with less. Meanwhile, patients expect quality service that’s personalized to meet their needs. Legions of clerical full-time-equivalents (FTEs) are shuffl ing paper, sorting out administrative errors and fi xing denied claims. While other service industries are enhancing their customer experience and fi nding administrative effi ciencies, healthcare continues to lag behind.

What is the ideal solution? The patient might be part of it.

According to a study published by Gartneri, the time is right to adopt patient self-service options:

By extending meaningful self-service functionality to its most important constituent, the hospital makes a clear statement that it is as committed to customer satisfaction as it is to quality outcomes and patient safety. Th e slow but steady adoption of patient self-service underscores the fundamental need to more closely collaborate with the

patient in the delivery of healthcare.

In addition, 89 percent of physicians polled in the 2011 HealthLeaders Media Industry Surveyii say they have or will have electronic health records in place for their patients within two years. This will almost surely drive the adoption of complementary applications to streamline several processes, including the patient registration and check-in experience.

Over the last year, Patient Access managers f rom across the United States have expressed a high level of interest in adopting self-services such as online pre-registration and kiosks for on-site check-ins, with the hope of creating administrative efficiencies and enhancing the patient experience. In most cases, the barrier to implementation is building the business case and proving return-on-investment (ROI) to senior management.

While this is not an easy task, there are several examples of pioneers that have proven ROI and demonstrated that patients are ready to be part of the solution.

Proving ROITo reference the Technology Adoption Lifecycle,iii the adoption of patient self-service kiosks is moving from “early adopter” hospitals to “early majority” hospitals that are more conservative, but open to new ideas. Early adopters, meanwhile, have been using self-services long enough to share key findings, including lessons learned and ROI figures that can help the early majority to build their business cases.

One notable early adopter is the Southlake Regional Health Centre, a 365-bed hospital in Newmarket, Ontario, Canada, that has seen a quadrupling in size over the past 10 years and handled approximately 600,000 visits in 2009. Southlake knew that it needed to embrace technology and a process redesign to keep pace with this explosive growth.

Led by Judy Dewsbury, a project was launched to centralize scheduling and registration. After an extensive review of current industry practice

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combined with an internal process review, Southlake concluded that a centralized model with “Welcome Centers” located at key entry points to the hospital and supported by a centralized scheduling and preregistration team would yield efficiencies and patient flow simplification. They also implemented a new patient self-service system during the summer of 2010, beginning with a trial period in their Cataract Clinic. The revised model proved to be such a success that it was implemented throughout the hospital. Southlake proudly touts their system with the slogan, “Welcome, we have been expecting you...” at key points in the hospital.

The immediate benefits of this new technology included improving the accuracy of patient registration data, expediting patient processing, and improving patient satisfaction as well as hospital productivity. According to Judy Dewsbury, manager, Patient Access, “The new system makes it faster for patients to register and check in for appointments, including outpatient tests, clinic visits and surgical procedures. Our redesigned process, [which] includes at-home pre-registration, self-service kiosks and Welcome Centers on-site, is speeding up wait times by as much as 75 percent and saving the hospital as much as $400,000 annually.”

Using a two-step registration process, a patient pre-registers either online, by phone, or by fax at least 48 hours prior to their arrival. When a patient arrives for their appointment, they can decide to check-in at a touch-screen kiosk or to visit a Welcome Center for personal service.

Regardless of which method the patient chooses, the hospital is notified of their arrival and is ready for their appointment.

After a full year of using the new patient self-service system, the project generated several positive outcomes:

1. 30 percent reduction in registration staff (10 FTEs redistributed from patient registrations to other functions within the hospital).

2. 50 percent reduction in registration data errors.

3. 60 percent reduction in time to see a registration clerk.

4. 78 percent uptake by patients.

5. $400,000 in annual operational savings.

Since Southlake is aware that not all patients are technologically savvy, it established three on-site Welcome Centers to provide more traditional personal service. Dewsbury noted that the Welcome Centers “are meant to transform the patient registration process upon arrival at the hospital f rom an administrative to a patient-centered approach of ‘welcome, we are expecting you.’”

The Southlake story is just one example. There is a long list of other possible use cases for presenting and capturing information using self-service technologies, including: compliance and consent, insurance information and eligibility verification, payments and balances, screening questionnaires, satisfaction surveys, wayfinding and patient

education. The majority of patients have already adopted self-service options in their daily lives while banking, traveling, and shopping. Making patients part of your solution is probably easier than you think.

If you are working on a business case, don’t forget to clearly explain the urgent problem(s) that you would like to address, your ideal solution, desired outcomes, and include success stories f rom early adopters such as Southlake. Demonstrating how ROI will be achieved is key to having your project approved. l

Sourcesi http://www.gartner.com/Display Document?doc_cd=210444&ref=g_rssii http://www.healthleadersmedia.com/pdf/survey_project/2011/Technology_press.pdfiii http://en.wikipedia.org/wiki/Technology_adoption_lifecycle

Jay Lawrence is the CEO of patientWay, a provider of patient self-service kiosks and web technologies as well as process improvement services. Jay’s vision of bringing measurable cost and time efficiencies to healthcare organizations, while improving patient and staff satisfaction, is quickly being realized as leading providers in Canada and the U.S. have adopted patientWay products and services.

patrick pichette is the Chief Marketing Officer and is responsible for telling the patientWay story and ensuring that it remains a market-focused company, by bringing to market self-service technology that meets the needs of hospitals and primary care organizations.

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Advocacy Update

NAHAM’s Government Relations Committee has organized our advocacy efforts around three workgroups:

HIMSS: Our Patient Identity Subcommittee represents NAHAM as a member of the Patient Identity Integrity Solution Coalition, organized by the Healthcare Information and Management Systems Society (HIMSS) to advocate for a national-level patient identity solution. Currently, such a solution is banned by Congress on account of privacy concerns.

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) mandated a Unique Individual Identifier standard for healthcare purposes. Due to privacy concerns, the 1999 Omnibus Appropriations Act prohibited the use of appropriated funds to “promulgate or adopt any final standard…providing for the assignment of a unique health identifier for an individual…until legislation is enacted specifically approving the standard.”

NAHAM Advocacy Efforts Continue to Grow

By Frank Moore

Stay informed of the latest updates in Health Care Reform with NAHAM’s Advocacy Update.

Since Congress enacted this prohibition, health information technology has made significant progress toward improving clinical care, enhancing patient outcomes, and controlling costs. Technological advances now allow for much more sophisticated solutions, including patient consent, voluntary patient identifiers, and sophisticated algorithms, to name a few. During this time, neither Congress nor the Department of Health and Human Services have examined the issue of patient identifiers and how they might be used to accurately identify individuals to ensure patient safety.

As a result of our coalition participation, our efforts will urge members of Congress to request that the Government Accountability Office (GAO) conduct a study on the cost/benefit of implementing an informed national-level patient identity solution for healthcare and health information exchange. Representative Jim Moran (D-VA) is circulating a “Dear Colleague” letter that calls on several representatives to join him in requesting this study from the

GAO: Rep. Fred Upton (R-MI), Rep. Dave Camp (R-MI), Rep. Sander Levin (D-MI) and Rep. Lois Capps (D-MI).

NAHAM will be initiating a grassroots advocacy campaign to urge these members of Congress to sign on to Moran’s letter, and NAHAM members will have the opportunity to urge their members of Congress to support the questioning of the current ban.

On a related front, the workgroup is seeking quantitative data and anecdotal information associated with duplicate medical record numbers and with overlays. The information is to be used as supporting documentation when Coalition members lobby on the Hill and with government agencies. Necessary data points include: patent-data matching error rates (%) - duplicate MR, overlaps and overlays; data elements currently used to match patients (date of birth, name, address, primary physician, etc.); costs to reconcile mismatches (FTEs and dollar amounts, if available) on a

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Advocacy Update

yearly basis; and average costs stemming from mismatches. The workgroup is also seeking anecdotal information, including experienced safety implications of mismatches; costs of mismatches; and matching methodologies and implementation (how easy or hard was it to implement, etc.).

Education: Working with the Joint Commission/CMS workgroup, the Education workgroup has initiated development of a compliance tool kit for NAHAM member facilities, focusing initial efforts on Joint Commission accreditation and the surveys to which members are subject. The workgroup is seeking case studies of recent TJC surveys that can serve as guidance and best practices for other facilities. The tool kit will be featured on the NAHAM website and is intended to become the go-to resource for best practices and guidance. Material will be carefully vetted by Committee volunteers to provide appropriate peer review.

Joint Commission/CMS: This workgroup will focus on all regulatory issues associated with TJC and CMS, with a parallel 2012 goal of developing strong relationships between NAHAM and regulators. This effort is intended to further position NAHAM to engage and influence policy issues that impact member facilities.

Associated with these efforts, NAHAM recently filed comments with the Department of Health and Human Services regarding its proposed expansion

of information collection. The HHS proposal was triggered by Section 4302 of the Affordable Care Act, noting that there is a lack of standardization related to data collection on population subgroups defined by characteristics other than currently used race and ethnicity data points, such as language and disability. Our comments acknowledged the importance of the proposed data collection standards. However, we also noted that information collected during a patient ’s access to healthcare must first and foremost support the healthcare need and the clinical decisions required to ensure quality care for each and every patient. Flexibility on the part of the provider to determine the timing and point of Patient Access for data collection can ensure that both goals are met. Specifically, we urged:

1. The Department should anticipate that responses for many of the proposed questions will be highly subjective – particularly if self-reported. While the proposed standard may achieve common question sets, the data collected may vary widely f rom self-reporter perceptions and understandings to third-party observations. The Department should expect this variability particularly in the question sets for language and disability.

2. Not every question will be appropriate in every provider setting; therefore, any requirements for providers to collect data f rom patients

should be accompanied by adequate flexibility to allow the provider to determine at what point in the Access cycle such data is collected. Likewise, it will be equally important that questions not be imposed on the clinical information gathering that supports healthcare decision-making and the associated processes utilized by the provider.

NAHAM Public Policy Blog: The NAHAM Government Relations Committee launched the NAHAM Public Policy Blog (http://nahamnews.blogspot.com) in 2009 to track public policy proposals and other developments as they occur. The blog receives close to 900 views, on average, each month. It is also attracting online search engines based on search terms such as “point of origin codes” and “tjc national patient safety goals,” suggesting that our blog is used as a reliable source of information for Patient Access and safety. Sixty (60) percent of the blog’s readers are in the U.S.; the other 40 percent are international. There are approximately 20 blog posts each month, and readers may sign up to receive an update when a new item is posted. The blog is searchable by key terms, by date, or by labels or tags located at the bottom of each post. Readers may also comment on posts (comments are moderated). l

Frank Moore is NaHaM’s Government Relations Senior director, based in Washington, dC.

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Member Spotlight

About Kevin Title: Clinic Pre-service Authorization Manager Hospital Name and Location: Ochsner Health System-Louisiana Hospital Website: http://www.ochsner.org/

About Your Hospital1. Whatisnewandexcitingat

yourhealthsystem?We are in the process of upgrading our system here and I am on the ground floor with my department. It has been challenging, yet rewarding, and I am excited about my hospital’s future.

2. What’sitliketoworkatyourhealthsystem?Working here has been both challenging and rewarding. The staff is wonderful and understands my working philosophy. There are tough days but generally we work as a great team.

About Your Career3. Whataresomeofyour

personalprioritiesforyourhealthsystemthisyear?We’ve spent a lot of time preparing for 2012, and I

Getting to Know Kevin Poser

NAHAM’s “Member Spotlight” shares professional and personal insights from NAHAM member Kevin Poser.

know that this proactive measure will give us an advantage this year. Currently, our network is in in a system transition phase, so my main priority is to make this transition as seamless as possible for the patients and staff.

4. Whatisyourbusinessphilosophy?I believe in honesty and integrity and usually work with people who have the same philosophy.

5. Whatisthebestwaytokeepacompetitiveedge?I played very competitive hockey growing up, but an unfortunate car accident ended my chance at playing professionally. Even though my dream didn’t work out, the competitive spirit f rom hockey has remained with me for 33 years.

6. Howdoyoumeasureachievement?I measure my own achievement by the lives I have touched and helped. Monetary gain is always

important but is not the happiness index by which I measure my life. I am here to achieve an absolute happiness rather than a relative happiness. I think of it this way: winning the lottery will not change who I am, and receiving a huge tax assessment would upset me, but I could deal with it. Absolute happiness is the life condition in which I am able to deal with any obstacle that arises. I’m not quite there yet, but definitely on the journey.

7. Whatwasyourgreatestprofessionalaccomplishmentwithinthepastyear?I am very proud of starting a new career in the healthcare industry. I have had numerous careers, but now I finally feel like I am directly giving back to society in my small way.

8. Whatgoalareyouworkingtowardnow?My ultimate goal is to be recognized as a person of action who takes great care of patients and staff.

Continued on page 14.

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Member Spotlight

9. Whathasbeenthebiggestlessonyou’velearned?My nature is always to see the good in people. I try never to judge the book by its cover. Most of the time I am not disappointed, even when I hear an occasional negative comment about an individual. It ’s my view that although tigers cannot change their stripes, they do have the ability to be calm and trained.

10.Whatisyourcareeradvice?Generally, my advice is that honesty and integrity are key to all careers. On a more detailed level, I also recommend always backing up all documentation as supporting evidence.

11.Whatisthemostrewardingaspectofyourjob?Knowing that I am not simply repairing a car. I tell my staff that every case that we are trying to clear could be their mother or father. That is the philosophy that we have when clearing a procedure for someone, and what makes my work rewarding.

12.Whatisyourgreatesttalentonthejob?I am proud of my ability to listen with compassion, but also be a man of action when necessary. I also take pride in treating every individual with the same respect that I would expect them to treat me.

More About You 13.Whatareyourgreatest

passionsinlife?I think my greatest passion is to try to become a better person every day. It may sound cliché but I always look in the mirror and reflect on how my day was. Since I live by that philosophy, birthdays have become a celebration of the growth I have made in the last year.

14.Whatisyourmottotoliveby?Cause and Effect. All of my actions will eventually produce an effect.

15. Whatisyourhobbyorpastime?When I’m not working, I enjoy fishing, or playing any sport.

16.Ifyoucouldmeetanyone,whowoulditbe?That’s a tough question. I could not narrow it down to just one, but top three are Mahatma Gandhi, Dr. Martin Luther King Jr., and Daisaku Ikeda—all men of peace.

17.Ifyoucouldimproveonethingaboutyourself,whatwoulditbe?I both like and dislike the fact that I overanalyze everything. I once had an assistant prepare an excel sheet for me. I changed that sheet at least 10 times in two days! The changes were valid, but it ’s an example of how I second-guess myself.

About NAHAM 18.Whatinspiredyoutojoin

NAHAM?I was searching the Internet to find a good support organization for the healthcare industry and my AVP recommended NAHAM. She also recommended that I obtain my CHAM certification.

19.HowdidyougetintoPatientAccessManagement?I made a career change from risk/compliance in the banking industry. I was quite fortunate that Ochsner was expanding in the revenue cycle area—although I lack healthcare experience, my extensive banking compliance background enabled me to make the leap.

20.WhatdoyoulikebestaboutNAHAM?I enjoy how NAHAM provides valuable educational resources to its members.

21.WhatisyourfavoriteNAHAMeventorexperience?Though I’ve been involved with NAHAM for only a brief time, I have found it to be a excellent resource for keeping up with both new and familiar processes within the Patient Access Management arena.

22.WhatcanNAHAMdotobetterserveitsmembers?I have got to say that I’ve been quite satisfied with what NAHAM provides to the members. l

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CHAA Corner

Current Consumer Trends While many signs point to a gradual economic recovery, the outlook remains uncertain. What does appear certain, however, is that companies will need to work harder and smarter to find and capitalize on growth opportunities. One key aspect of this transformation is a heightened focus on building customer loyalty in a rapidly changing consumer context.

In a 2010 Accenture survey, fewer than 50 percent of consumers declared that they “feel loyal” to the brands they purchase. Moreover, only 28 percent of consumers said that they were willing to endorse these brands to their circle of acquaintances.i

The survey also showed that in the 6 – 12 months prior to completing the survey, roughly 6 in 10 respondents changed their mix of providers in at least one consumer industry—either stopping business with one provider and switching

to another, or expanding their portfolio of providers.

Research also indicates that the economic downturn significantly altered customers’ overall purchasing behavior and what they want from providers—and that these changes are likely to prevail for some time. Now, a majority of marketing executives believe that most, if not all, of their customers have:

yy Higher expectations for product quality;

yy Expectations for more value for their money; and

yy Higher expectations for customer service.

In other words, increasingly higher expectations along the provider life cycle—from creating awareness of brand value to delivering customer service—means that customer loyalty is becoming harder for organizations to earn and even

harder to keep. Today’s customers are generally better informed, less influenced by conventional marketing, and more likely to assess brands based on their own experience or the experience of their acquaintances. Customers are also increasingly aware of their power, as well as their value, and are not shy about exercising this power.

Deliver Innovation and Experiences that Drive Customer-Centric LoyaltyHigh performance requires becoming more agile, analytical, relevant, and consistent. In today’s economic environment, it is critical for companies to transform customer insights into innovative propositions and relevant customer experiences in order to solidify loyalty and engagement along the entire life cycle.

Continued on page 16.

By John Woerly, MSA, RHIA, CHAM, FHAM

Earning Customer Loyalty: One Step at a Time

Keeping communication consistent and customer-service-based across all channels is a key component of enhancing patient satisfaction and earning their loyalty.

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CHAA Corner

Continued on page 17.

Offering innovation is a key element of building customer loyalty and trust. Previous Accenture research among executives in multiple functions and disciplines indicated that the vast majority (89 percent) rated innovation as equally or more important than other initiatives to help sustain customer loyalty and position their companies for future success.ii To effectively drive innovation, companies need to establish the structure, processes, people, accountability, and systems that enable them to profitably translate customer insights into products, services, and experiences that inspire loyalty.

New technologies, such as telemetry, allow providers to develop entirely new products that are tailored to specific customer needs, such as contact centers for pre-registration, financial clearance, financial counseling, and customer service. By combining technology with deep customer insight capabilities, Patient Access departments are launching innovative new offerings, such as “propensity to pay” programs targeted at certain patient populations. This clearly distinguishes the innovators f rom the competition and enhances acquisition and retention of target customers.

While innovation is important, delivering highly relevant experiences consistently and across multiple channels (face-to-face, via telephone, kiosk, email, fax, and internet) is the essence of customer-centricity and engagement. Providers must ensure delivery of the experience that was initially promised to consumers along all touch points and interactions, leveraging deep analytics and insights. Emerging digital media such as blogs, forums, and social networks provide additional opportunities to offer multiple methods to communicate with and “get to know” your consumer.

To improve the customer experience, one aspect organizations can focus on is training employees who come into daily contact with customers. A full 73 percent of marketing executives cited in-person contact with front-line employees as an important channel to reach, influence, or interact with customers and prospects.iii Effectively leveraging new digital channels has also become part of customer experience delivery. As companies adopt digital channels, they must ensure they not only maintain a seamless and consistent connection among all their channels, but also that they tailor experiences for different customer profiles based on real-time insight.

Customer-Centric Loyalty ManagementLoyalty management techniques work to increase the loyalty of profitable customers while improving brand profitability and growth potential. Loyalty strategies are based on these core principles:

yy Support brand fundamentals: Build customer bonds to achieve name recognition, an excellent customer experience, and an emotional attachment to the brand’s essence and heritage.

yy Enable deep customer insight: Understand what matters most to customers in their purchase and repurchase decisions to help forge stronger relationships.

yy Personalize customer routes: Manage communication channels to key performance indicators as appropriate to pre-service, point-of-service, post-service, complaint handling, product assistance, and customer self-service.

yy Support the front-office workforce: Raise awareness of the importance of delivering satisfying experiences and motivate desired workforce behavior by establishing employee rewards.

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CHAA Corner

yy Pilot investments: Manage investments by devising pilot programs that establish a business case for larger investments. (i.e., initially start a Financial Clearance call center, and then add other components, such as Patient Scheduling, Customer Service, Physician Referral Services, etc. until a true Contact Center environment is realized). [See Figure 1]

yy Exploit new technologies: Implement technologies and mobility applications/services to render loyalty management programs more efficient and help increase the return-on-investment.

Mastering Customer-Centric Loyalty to Achieve High PerformancePatient Access managers are in a unique position to lead the growth agenda for their companies. Relevant innovation and customer engagement is the key. By creating compelling new programs and enabling differentiated experiences, your organization can strengthen loyalty and trust with existing customers and engage new ones. The outcome? Your organization can significantly improve its upturn and kick-start its journey to high performance. l

Sources

i. Accenture Global Consumer Behavior research, 2010

ii. “Innovation: a Priority for Growth in the Aftermath of the Downturn.” Accenture, 2009

iii. Accenture Marketing Executive Survey, 2010

John is a senior manager at accenture Management, specializing in revenue cycle management. He has over 25 years progressive management experience in large, multi-site healthcare providers, including physician group practices, public health, for-profit, and university settings. John has previously served on the NaHaM Board, has received numerous NaHaM awards, and is a current member of the Special projects and the Membership Committees.

Figure 1: Healthcare organizations can realize substantial benefits by consolidating an existing call center into a multi-functional/multi-channel contact center

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Book Review

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By Tony Lovett, MBA, CHAM

Steve Jobs

Steve Jobs is an inspiring biography that will change the way you think about leadership.

There is no doubt that Steve Jobs changed the world. Can you imagine a world without an iPod, iPhone, or an iPad? What would the movie industry be without the likes of Toy Story and Finding Nemo? Steve Jobs made all of this possible and more. With his unrelenting drive and demand for excellence, Jobs led Apple and Pixar to never-before-seen performance and market domination that transcended their contemporaries. Many of us were shocked and saddened to learn of the recent illness and untimely death of this pioneering maverick.

While writing his book, Steve Jobs, Walter Isaacson had unprecedented access to Jobs, his family, f riends, colleagues, and most of all his company. The book was inspiring, thought-provoking, and above all, interesting. It offers a raw look at the good, bad, and ugly qualities of Steve Jobs.

Like all great leaders, Jobs had imperfections. In my opinion, Jobs’ candor with the biographer as well as the actual faults he was notorious for only contribute to my admiration for him and the

display of leadership that defines his life. I was most moved by the unyielding perseverance that he exhibited as a leader. Even in the face of obstacles from his peers, employees, and management, Jobs knew what he wanted and did not waver from his expectations. He often went to great lengths to perfect aspects of his products that would never be seen or appreciated by consumers. Jobs once said, “A great carpenter is not going to use lousy wood for the back of a cabinet, even though nobody’s going to see it.” His unyielding standards have become the benchmark for many industries.

I was personally most motivated by Jobs’ idea of “falling in love with your company.” He believed that if you selected and groomed talent that would fall in love with your company, all other factors, such as performance, customer satisfaction, and market share, would fall into place. This concept is exemplified in my favorite of Jobs’ quotes: “My job is not to be easy on those that I work with, my job is to make those around me great.” Steve Jobs viewed and treated his human capital just as he did the

products he created, continually striving to cultivate greatness.

As leaders, we are all faced with day-to-day challenges. Unfortunately, the realities of the daily grind sometimes cause the quest for greatness to take a back seat. Reading Steve Jobs inspired me to carefully examine myself, and re-focus my priorities as a leader. We should all take the time to encourage our teams to think creatively, never accepting complacency or satisfaction with the status quo. I encourage you to read Steve Jobs and find your own inspiration from this exceptional leader. l

tony Lovett has worked in the healthcare industry for the past 21 years. Currently, he is patient access director at Cypress Fairbanks Medical Center, part of the Conifer Health Solutions family of hospitals. With more than 100 hospital relationships throughout the nation, Conifer Health Solutions operates over 18,000 beds within 66 acute-care hospitals in 13 states. tony holds his CHaM along with a Master’s in Business administration.

Access Management Journal The Official Journal of the National Association of Healthcare Access Management Volume 35, Number 3

Access Management Journal Discussion Guide 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 reach professionals engaged in Patient Access Services in healthcare delivery. Each issue of the Journal has a supplemental Discussion Guide to raise awareness and provoke conversation around the issues, concepts, and critical objectives of Patient Access Services departments. Each Discussion Guide includes thought-provoking questions to help members better explore the Journal’s content with their staff teams and discuss the articles’ pertinence to their organization and profession as a whole.

Can External Call Centers Benefit Hospitals’ Access Departments? As Patient Access teams look to improve customer service and enhance efficiency, they should consider implementing an external call center as part of their strategy. By Steve Chrapla

Name some of the challenges presented by current pre-Access processes. What must a hospital take into consideration before adopting an external call center? Would an external call center be a good fit for your hospital? What steps would you take to introduce one?

The Impact of Meaningful Use on the World of Patient Access CentraState Medical Center developed and implemented a plan that qualified their hospital for “meaningful use” incentives. By Gaye Werblin

What are the three main components of meaningful use? Name the eight major areas that Patient Access was involved in during the implementation of new

workflows. Why is it sometimes difficult to capture a patient’s primary care physician information? How might your hospital introduce new workflows to qualify for meaningful use incentives?

Making the Case for Patient Self-Service Kiosks Improving customer service and the patient experience is a goal at the heart of Patient Access. Introducing a patient self-service option helps to ensure patient satisfaction and boost efficiency. By Jay Lawrence and Patrick Pichette

How was Southlake able to leverage technology to improve the flow of patients and the patient experience? What were the key benefits Southlake experienced by following a registration process redesign? Is your IT department aware of how self-service technologies can help patients and staff? If so, would they

support implementing these technologies?

Discussion Guide

Discussion Guide

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.

National Association ofHealthcare Access Management

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