Measuring Quality in Patient Access

For years, relatively little attention was paid to patient access. However, with today’s consumer-driven healthcare environment, where the focus on patient satisfaction has become a competitive advantage, ensuring positive outcomes in the patient access department is critical.

The Advisory Board released a survey recently highlighting hospital executives desire to meet consumer expectations and improve patient engagement. In order to develop a successful patient-centric strategy, healthcare organizations need to define and address the challenges in achieving high quality patient access.

Defining a Positive Patient-Provider Interaction

A well-constructed patient access experience can be defined as one where both the provider and patient understand and agree upon the financial implications of the services expected. Data from multiple sources, both current and historical, should be considered to support the financial clearance process. The most common sources of data include eligibility and coverage information from payers, Medicaid agencies, credit agencies, patient accounting systems and managed care contracts. Once the data from all of these sources have been considered, and the patient is financially cleared, the focus can be exclusively put on the care of the patient. 

This may sound like a straight-forward concept but anyone involved in the healthcare revenue cycle knows that this process is anything but “straight-forward.” Many points of failure can occur along the way including not obtaining a proper authorization, not screening for a particular coverage option, or inaccurately informing the patient of their out-of-pocket obligation. These failures often lead to problems down the road for billing and collection and can negatively impact patient satisfaction. 

Challenges to Achieving Enhanced Patient Satisfaction and Outcomes

There are many challenges to standardization and the improvement of quality outcomes in the patient access arena. Multi-hospital providers often have several patient access systems that are not integrated across the patient access continuum, which disrupts patient registration workflow. Measuring the overall patient access quality in a particular intake area or at the department level is simply not possible across disparate systems. 

To that end, if management of the patient registration/financial clearance process cannot be standardized then the question of, “how many of our patients were financially cleared yesterday?” cannot possibly be answered.  Patients are pushed through the admissions process without enough financial clearance which leads to financial uncertainty for both provider and patient. Couple that with the potential stress of their medical condition, the patient’s clinical outcomes may be compromised, which in turn impacts provider revenue under a value-based reimbursement system.   

For many of the leading healthcare delivery systems, getting patient access right is a high priority. The next phase will be focused on efforts to standardize and improve processes across the enterprise. In order for an organization to be efficient, technology needs to “bridge the gap” between patients and consumers across the enterprise while also providing customization and flexibility. It will be interesting to see how providers meet this challenge and how the patient-provider relationship continues to transform as more healthcare leaders adopt consumer-focused strategies to drive access and engagement.