Health care reform will revamp patient access: Get ready now
Still many unanswered questions
There will be dramatic changes in the works for patient access departments as a result of health care reform legislation. That is for certain. But many important details are still unclear.
"There's so much we still don't know about what's really in the health care reform bill and how it will be implemented," says Peter Kraus, CHAM, CPAR, a business analyst with patient financial services at Emory University Hospital in Atlanta. "I suspect a lot of misinformation continues to make the rounds. For now, all of us in access should continue to pay close attention to developments, to better address the challenges to come."
Candace A. Gray, director of admitting/registration at BayCare Health System in Clearwater, FL, says, "We have a lot of unanswered questions right now. We are anxiously waiting for the details to come out."
Patient responsibility
In the meantime, Cheryl L. Webster, director of patient registration services at William Beaumont Hospital Royal Oak (MI), is working on scripting to help her staff field patient questions and concerns.
"Patients have been provided with little information. They may sometimes have the idea that 'everything will be covered,'" she says. "They may not expect to have a copayment that is their responsibility."
As more information comes in about the patient's out-of-pocket responsibility under health care reform, managers will share it with front-line staff and financial counselors to help them prepare for the inevitable questions. "So far, we have not had many inquiries," says Webster. "I hope that the media will provide enough solid information, so that our patients have realistic expectations."
As it seems that patients will have more financial responsibility, "it's going to be even more important to collect at the time of service," says Gray.
The need for charity assistance and write-offs for self-pay patients may decline. However, "access will still have to work with patient balances after insurance payments," says Kraus. "These probably will continue to rise."
New systems needed?
At Swedish Covenant Hospital in Chicago, the patient access department is looking at front-end technology to provide an immediate response to requests for authorization and pre-certification, and patient estimator software to determine the cost of services. "We are currently exploring this capability with our existing vendors," says Rose Jeanfreau, director of patient access services.
It's not yet known if the BayCare Health System's access department will be able to use its current eligibility systems to verify benefits, or if new systems will be necessary as a result of health care reform. "With accountable care organizations, we are not sure how determining eligibility will work. It appears patients will be able to jump in and out of various networks," says Gray.
Health insurance companies, however, are expected to play a bigger role in patient care decisions. "This, in turn, will make processes become more laborious as we attempt to justify the necessity of tests and procedures," says Jeanfreau.
Departments will need to continue to work with physicians and case managers to explain the necessity of admission, tests, and procedures, while verifying the patient's insurance eligibility and benefits. "Having to further justify medical necessity prior to patient admission, tests, or procedures may delay patient services even more," says Jeanfreau.
Education for patients
Jeanfreau says that changes in health care will call for "even more" patient education on the benefits of discharge follow-up and preventive care. The department is looking at the possibility of implementing post-discharge follow-up calls, performed by nonclinical staff in contact centers.
Jeanfreau says that at this juncture, she would like to improve uninsured patients' access to the facility's charity care and financial assistance programs.
"One way this can be accomplished is by shifting uninsured patient financial education to the front end, upon discharge from the ED," says Jeanfreau. Staff would assist patients in the enrollment process and explain the available programs. The department also is looking at providing online enrollment to charity care and financial assistance programs.
The goal is to strengthen the relationship with the uninsured population, with appropriate scripting and easy-to-understand education. "By assisting them with enrolling into one of our programs, we could potentially secure their interest in continuing to receive services at our facility if and when universal insurance kicks in," says Jeanfreau.
Gray says she expects her department will have to become more efficient, lean, and streamlined as a result of health care reform, to decrease expenses due to reduced reimbursement.
If more people are covered by insurance, utilization may surge, at least initially. "It will be interesting to see whether a greater volume of patients seriously impacts access, clinical staffing, and patient wait times," says Kraus. "I do not necessarily see hospital revenue increasing. This may mean doing more with less, though we've been tapping that vein for years."
It remains to be seen how reform will affect the cost of health care. "In general, I'm not aware of much in the reform package that addresses spiraling health care costs," says Kraus. "We're victims of our spectacular technological success, which doesn't come cheaply, as well as our disinclination to take better day-to-day care of ourselves. We're also not very sophisticated in assessing outcomes."
Consumers often press for the latest in drugs or procedures, regardless of whether they are proved to offer significant improvement over established, less costly approaches. "It is a touchy subject, but one we avoid at our financial peril," Kraus says.
[For more information, contact:
Candace A. Gray, Director, Admitting/Registration, BayCare Health System, Clearwater, FL. Phone: (813) 852-3075. Fax: (813) 635-2652. E-mail: [email protected].
Rose Jeanfreau, Director of Patient Access Services, Swedish Covenant Hospital, Chicago, IL. Phone: (773) 878-8200. E-mail: [email protected].
Peter Kraus, CHAM, CPAR, Patient Financial Services, Emory University Hospital, Atlanta, GA. Phone: (404) 712-4399. Fax: (404) 712-5731. E-mail: [email protected].
Cheryl L. Webster, Director, Patient Registration Services, William Beaumont Hospital, Royal Oak (MI). Phone: (248) 898-0860. Fax: (248) 898-3834. E-mail: [email protected].]
There will be dramatic changes in the works for patient access departments as a result of health care reform legislation. That is for certain. But many important details are still unclear.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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