Health First
Rockledge, FL
“One Call” Vision for Access Management is Achieved
Health First operates three not-for-profit hospitals and multiple outpatient facilities on Florida’s East Coast. Its 20 medical practices represent more than 70 physicians and schedule an average 13,666 procedures each month. Like many large multi-facility healthcare organizations, Health First’s patient access management system was comprised of various nonaligned components. It was disorganized, inefficient, difficult to use, and prone to error.
Patient scheduling—including appointments, pre-registration, and insurance and medical necessity checks—was done by phone or fax in four or five separate systems. Patient and physician satisfaction suffered from long call wait times, unavailable schedulers, busy fax lines, or the need to make multiple calls. Faxed physician orders often resulted in lost, illegible, or inaccurate orders. The system was unable to place patient reminder calls, costing Health First an estimated $500,000 each year in lost revenue opportunity from a 15 percent no-show rate. Automated insurance eligibility, medical necessity or authorization checks could not be made efficiently at the time appointments were scheduled. Employee usage of multiple scheduling and verification systems led to high staffing levels and expensive ongoing training.
Patient Access Director Michelle Fox implemented Health First’s patient access program in 2004 with a vision: to streamline all pre-arrival services such as patient scheduling to strengthen Health First’s relationships with patients and physicians while improving the organization’s bottom line. “I wanted a seamless system where we can schedule, collect, check insurance, financial aid counsel, and send an appointment reminder—anything we needed to do before the patient’s service with one call,” says Fox.
Fox formed cross-organizational committees and began researching closed-loop access management
systems in use by similar healthcare organizations. To her surprise, it was a challenge to find
peers or an integrated enterprise package that allowed her “one call for all needs” vision to
come to fruition seamlessly. “When I was hired in June 2004 to handle patient access there was
not a central scheduling process or pre-certification. We had a lot of room for opportunity—especially
reimbursement,” reflects Fox.
Foremost, Health First sought to make it easier for the customer—clinician, patients
and the departments that rendered the care alike. Close on the heels of ease and increased satisfaction,
came the need to optimize reimbursement and create accountability for authorization.
After lengthy discussion and evaluation, Health First chose SCI Solutions’ suite of web-based technologies: Schedule Maximizer, Order Facilitator, Revenue Accelerator, Provider Portal, and Patient Portal.
“To be successful we held a very candid meeting to explain to the clinical departments that patient access supported that this was a partnered effort between them and patient access—this isn’t a bureaucratic top down hospital decision. We explained this and it was a huge mental shift for our health system. It was an epiphany. This wasn’t administrative driven coercion, but a mutually beneficial improvement made all the difference.”
Since going live with Health First’s new access management system in January 2008, Fox has noticed significant improvements. Our goal is to increase our referrals. For example, Fox explains, “At Mr. Smith’s annual exam, his physician determines that Mr. Smith needs an MRI. With our new system, the physician’s office staff can self-schedule the test online or over the phone and give Mr. Smith a complete appointment itinerary, directions to the diagnostic facility, and the necessary preparatory instructions—all before he leaves the office. We have just helped our referring physician care for Mr. Smith and eliminated their need, and our schedulers need, to chase him down after the fact to schedule his test. And our hospital’s diagnostic center sees a patient who is well prepared for his test and pre-screened for medical necessity. It is a win-win for everyone.”
With its user-friendly provider portal, Health First expects to decrease call volume to its central scheduling office by 20 percent. In conjunction with order facilitator technology, the orders are now accurate, legible, and electronically signed. If a provider prefers a CT with contrast, for example, the system facilitates the office’s accurate submission. Insurance authorization and medical necessity checks are now performed at the time of scheduling with one call. Better reimbursement, patient-driven work flow, fewer reworks, and reduced write-offs immediately translate to better profit margins. “I like the concept that the provider portal allows physicians to deliver quality care instead of concentrating on the logistics required to coordinate care,” says Fox.
Prior to adopting its new access application, Health First’s 15 percent no show rate equated to 15,600 lost visits. The new access system automatically places a HIPAA-compliant reminder call, letter, or email according to the patient’s preference; the hospital expects this reminder call to cut the no-show rate in half and return $436,800 to its bottom line. In addition to appointment date and time, the reminder call informs the patient that all copayments must be paid prior to the service or the patient’s appointment will be rescheduled. As a result, up front collections have increased. In the first month, appointment reminder contributed to increased collections of $55,000 in captured revenue to scheduling improvements such as the new appointment reminder feature.
Flexible reporting features built into the system allow Health First to compare itself to industry benchmarks while monitoring internal goals. For example, the access management audit trail helps the hospital organization manage medical risk.
Health First’s new patient access system will round out its offerings with self scheduling. The Patient Portal gives the patient the ability to self-schedule mammograms beginning in 2009. Because 70 percent of all Health First’s 164,000 annual procedures are mammograms, the organization expects the impact on its central scheduling department to be significant. Call waiting, call volume, and fax processing times will be cut dramatically. At the same time, patients will have more control over their own healthcare, improving satisfaction and building hospital loyalty.
Health First plans to widely promote the self-scheduling and online pre-registration options. “This is yet another feature that enhances our reputation for patient-drive care within the community,” says Fox.
By streamlining the access management enterprise system, patients experience fewer healthcare hassles and are provided with a higher level of care. Providers increase their referrals by improving the scheduling and order process while enhancing revenue at the same time. “At Health First, we are pleased to provide premiere ‘one call’ service without increasing our staff. And the enhanced revenue stream is directly attributable to our ability to effectively manage patient access at any point of care. They have a good experience with us before they even walk through the door.”
client quote:
“SCI Order Facilitator has streamlined our orders workflow, increased provider and patient satisfaction and reduced operational delays.”
Mary Godwin, Manager Centralized Scheduling
Baptist Health Care
 |
Sign up for a free Webinar |
 |
Watch our 3-minute PowerView summary |
 |
Request an SCI Patient Access consultation |
 |
Put the SCI Superheros to work for you |
