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.

Posted in

MedeAnalytics

MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

Leave a Comment





Get our take on industry trends

Why Unconventional Businesses Will Find Success in Healthcare: It’s the Data

January 7, 2020

It seems everyone is moving into healthcare. It’s a rapidly growing industry, historically dominated by large, well-embedded companies and organizations, and “pure tech” companies have had difficulty breaking in. That, however, is changing.

Read on...

Data and Social Determinants of Health

December 19, 2019

By Scott Hampel – I think a lot–and I’m not the only one–about how we can improve the ways we pull information from data. Data on its own is inert: just waiting to be understood and then used. And that’s a major challenge for many organizations. Data is often trapped in different applications with no easy or convenient way to extract it.

Read on...

Why Social Determinants Need Analytics for Success

December 10, 2019

Many challenges face healthcare’s underserved. There are issues with food, housing, reliable transportation, steady employment and more. Each contributes to and is one element of social determinants of health (SDH). In communities around the world, public and private organizations are taking steps to address SDH-related issues and challenges that negatively impact healthcare.

Read on...

Healthcare Organizations Recognize Importance of AI for Reporting

November 21, 2019

Healthcare providers continue to recognize the value of using AI in reporting operations throughout the organization. AI has many strengths when applied to the healthcare industry:

Read on...