Special Feature: Leveraging KPIs to Optimize Patient-Access Performance. ORGANIZATIONS THAT ARE COMMITTED TO TAKING A DATA-DRIVEN APPROACH TO MONITORING PATIENT ACCESS CAN ELEVATE OPERATIONS AND SET THE STAGE FOR A ROBUST, EFFICIENT, AND PRODUCTIVE REVENUE CYCLE. Monitoring and managing patient-access performance has never been more important as hospitals and health systems face an influx of newly insured patients, navigate rising patient payment responsibilities, and cope with increasingly sophisticated payer rules. Just how important is patient access? “Fundamentally, the patient-access performance drives everything else in the revenue cycle,” says HFMA’s Sandra J. Wolfskill, FHMFA, director of healthcare finance policy for revenue cycle MAP. If an organization becomes stronger in collecting patient payment at the time of service and referring self-pay patients to financial counseling, it generally will see a boost in patient collections and reduce the number of accounts going to bad debt. Similarly, if front-end staff preregister scheduled patients efficiently and accurately, their efforts can reduce payer denials, preserving cash flow and growing revenue. There are not only financial benefits to smooth patient access, but also advantages related to patient satisfaction, because patients appreciate an easy and well-organized entrance to the care episode. “If you get things right in patient access, then the rest of the revenue cycle flows pretty easily,” Wolfskill says. “If you get things wrong, there can be a cascading effect that significantly impacts an organization’s bottom line.” Data can play a key role in optimizing patient-access functions. Getting performance in line often begins with objectively measuring performance, recognizing improvement opportunities, holding staff accountable for performance, and evaluating progress toward predetermined goals. Well-defined and industry-comparable metrics—otherwise known as key performance indicators (KPIs)—are essential to these efforts. Without the right measures in place, an organization can lose focus. “People pay attention to what you measure,” says Jane Berkebile, system vice president for revenue cycle management at OhioHealth, based in Central Ohio. “To get staff and leaders on board with patient-access improvement, you should establish the major factors that demonstrate performance, clearly define metrics that reflect those factors, ensure data are reliable, and routinely provide the information to stakeholders in a format they can understand.” Determining the Right KPIs Although organizations have flexibility in selecting which patient-access KPIs to measure and report, certain indicators are more common than others. These metrics can be divided into two distinct categories: strategic measures and operational measures. Strategic measures are more consistent throughout the industry because they assess patient-access performance at a high level. In particular, the following five measures are used frequently across diverse organizations. Preregistration rate. This measure of patients preregistered against number of scheduled encounters provides insight into how well patient-access staff are collecting information and how effective they can be in setting payment expectations and working exceptions. Insurance verification. This measure of verified encounters against registered encounters indicates how well an organization proactively confirms insurance and takes advantage of relevant technology. Preauthorization rate. This measure of number of procedures authorized divided by those requiring authorization affects denials management and patient satisfaction. Point-of-service collections. This measure of up-front payment collection influences exposure of the organization to bad debt, accelerated cash collections, and possibly collection costs. Conversion rate of uninsured to a payer source. This measure of how well the organization is identifying patients who qualify for a funding source can affect bad debt and customer service. Setting Priorities for KPI Analysis After an organization decides on its strategic measures, it can choose which operational measures it wants to examine. “These will depend on the hospital and its priorities,” says HFMA’s Wolfskill. “Although strategic measures can often be collected so that organizations can benchmark against other similar organizations, operational measures tend to be more facility-specific. The best practice here is to look at your processes and identify those measures that are going to help you demonstrate performance both at an organization and individual level.” Many organizations will select among the following for operational focus. Registration accuracy. Collecting the right registration data is critical because the rest of the revenue cycle is built on this information. For example, if a registrar collects an incorrect patient address, this error can affect patient billing and claims payment, resulting in denials and possibly bad debt. “We have technology installed throughout our health system that measures the quality of our registrations,” says OhioHealth’s Berkebile. “It automatically checks registrations to verify they are correct and complete based on more than 300 different rules. The system provides daily feedback directly to our registrars about errors that need to be fixed, and it calculates an accuracy rate, which we include on our monthly patient-access dashboard. The system also generates an individual-level scorecard that shows staff-specific improvement opportunities.” Although software certainly is helpful in gauging registration quality, other means also can aid this task. “We have a quality and training team that pulls random samples of accounts per month and rates them on correctness to give a quality percentage,” says Karen Levering, system director of patient access for St. Elizabeth Healthcare, based in northern Kentucky. “We have found this method of spot-checking registration beneficial for objectively assessing accuracy and comprehensiveness.” Customer service. Many metrics can help a hospital understand how patients feel about the service they receive in the organization. For instance, a hospital may want to track and report patient satisfaction scores. “We share our Press Ganey results related to patient access because we want to show how the hospital is doing in terms of patient perceptions,” Berkebile says. “Our patient access department doesn’t just collect registration information or ask for payment; we consider ourselves to be the face of the hospital, and we want to make sure we are presenting the best face we can. We examine satisfaction scores by department, focusing on the emergency department, outpatient services, and inpatient care, so we can see where there are customer service glitches that need addressing.” Another way to measure customer service is by looking at patient scheduling. “We have a central scheduling department that schedules all diagnostic services throughout our health system,” Berkebile says. “We take calls, faxes, and online requests from patients and physician offices. We even have web scheduling for our physician offices for a number of procedures. Our goal is to get patients into one of our facilities on the same day a request is made whenever possible. To learn how we are progressing toward that goal, we monitor the same-day success percentage, aiming for 98 percent.” An organization also can assess customer service by periodically observing the interactions between staff and patients. “We have a check sheet of key customer service points, and we audit staff to make sure they are meeting these standards,” says St. Elizabeth’s Levering. “For example, we verify that the staff person looks the patient in the eye, uses his or her first name, and so forth. Based on these audits, we can evaluate performance and identify opportunities for coaching and training to further improve patient interactions. We find it beneficial to have a detailed list of actions and behaviors to watch because everyone defines ‘being nice’ differently, and we need to give staff concrete actions to take to ensure interactions are respectful, courteous, and patient-focused.” Denials. The strength and reliability of the patient-access function is reflected in the denial rate. If an organization has a healthy patient-access process, then the denial rate should be low. “We review our inpatient denials on a monthly basis to make sure we are appropriately capturing medical necessity, registration details, preauthorizations, and insurance verification,” Berkebile says. “Metric change can point to global issues and more immediate problems as well. For instance, if one month we see a spike in denials because preauthorizations haven’t taken place, this will prompt us to look at what’s happening with our preauthorizations and check to see whether there are snags with a particular facility, payer, or individual.” Staff turnover. This metric is an important indicator of potential for ongoing success. “We find it helpful to track staff turnover in the context of other patient-access measures,” Levering says. “Let’s face it: If you are collecting money efficiently and sending out clean claims, but your staff are quitting, then you are not successful. By keeping an eye on staff retention, we can support more long-term continuity in the department.” Setting Targets An effort to use KPIs to enhance patient access can succeed only if staff are assigned performance targets to which they can aspire. In other words, once an organization determines the KPI metric, it must establish goals it aims to reach. For example, if a hospital chooses to measure eligibility verification, it may want to set a target of 98 percent, striving to reach this level each month. Organizations have a lot of leeway in defining targets. However, it is crucial to take a thoughtful and data-driven approach. “It’s imperative to create reasonable targets that staff can meet, yet these should still require them to reach a little,” says OhioHealth’s Berkebile. “Staff want to do their best, but if they feel the goal can’t ever be achieved, then they won’t try—and you may not make the progress you want.” When establishing targets, an organization may want to begin with a smaller goal and then raise the bar as performance improves. “We consider national benchmarks and industry performance as well as our own historical data,” says St. Elizabeth’s Levering. “In some instances, our current performance is higher than the national metric. Because we don’t just want to meet the level of others—we want to go beyond that, if possible—we sometimes base the target on our own data over the industry standard. A national benchmark is a good starting point, but if we are outperforming that, then we aim for the higher target.” Leveraging a Dashboard or Scorecard Once an organization determines which measures to monitor and defines realistic targets, it should establish an effective way to share this information with staff and leadership. One method is to create a patient-access dashboard or scorecard that provides a brief snapshot of the established measures, showing performance as compared with the target goal. Dashboards can take many forms, ranging from simple to complex. “We use a spreadsheet format and a stoplight coloring system, which allows us to share a lot of data in an easy-to-read tool,” Berkebile says. “The colors clearly show where performance is good [green], concerning [yellow], and problematic [red]. This not only reveals improvement opportunities at a glance, but also helps prioritize which areas to work on first.” “We use both organizational scorecards and individual-specific ones,” Levering says. “For instance, we have individual scorecards that show performance at the registrar level, but we also have patient-access scorecards that show a variety of metrics, including conversion rate, preregistration, and so on.” When designing a scorecard, hospitals should consider displaying current, historical, and targeted performance as well as where the organization falls as compared with peers, if possible. “On our scorecards, we always show a continuum, so we are not merely sending out the numbers for the current month, but providing a comprehensive picture of where we ended the previous year, what our target is, how we did this month compared with last month, and so forth.” Berkebile says. “Our goal is to present a detailed picture of what’s going on with patient access.” To be effective, a dashboard must be a living document that is regularly updated and reviewed by leaders and staff. “In our organization, all patient-access managers review the dashboard monthly, as does our revenue cycle management team, which includes patient access, health information management, and the business office,” Berkebile says. “Additionally, we present the data to the CFOs at the various hospitals that are part of our organization. During these meetings, we talk about global results and improvement opportunities. For facility-specific issues, we engage the particular CFO and controller and have more focused improvement discussions.” St. Elizabeth also reviews its dashboards with revenue cycle staff once a month. “This helps staff assess their performance and see how it relates to the overall organization,” Levering says. “Moreover, it assists our managers in objectively holding staff accountable, showing where there are performance shortfalls and areas of strength.” Responding to Performance Changes One advantage of a dashboard or scorecard is that it can clearly and quickly point out concerning trends that warrant attention. “When our scorecard shows a troubling metric change, we focus in on the area and do a deep dive, looking into why the problem exists and how we need to fix it,” Levering says. “We then implement an action plan that helps us address the issue and improve performance.” When seeking root causes for more persistent problems, an organization should consider forming a team of stakeholders to address the issue. Ideally, team members should primarily include the staff who are actually doing the work to make sure any solutions proposed are practical and workable. Several strategies are useful to improve performance. “When our red-yellow-green system triggers action, we approach the problem from different vantage points,” says Sharon Kelley, interim vice president, patient financial services for Rochester General Hospital, Rochester, N.Y. “We consider whether this is something we could fix with coaching or training. If so, then we work to provide staff with the appropriate resources. If it is a system issue, then we may consider altering workflow or updating processes. In some situations, we may change the target for the measure if we find that it’s unrealistic, although that doesn’t happen often.” Even though it is necessary to respond to changing metrics, hospitals should be careful to avoid prioritizing one area at the expense of another. The ideal approach is to keep all the measures in balance. “You have to be able to walk and chew gum,” says St. Elizabeth’s Levering. “You need to balance multiple priorities so one does not outshine the other. For instance, if you are improving patient collections by bullying patients into paying, then your customer-service scores are going to suffer. You must find ways to increase patient payment while still maintaining strong customer service.” Strategies for Success Although every organization will have its own method for developing KPIs, demonstrating performance, and tackling issues, the following tactics can be helpful for all organizations in designing a patient-access monitoring program. Make sure staff and leaders are committed to using data. “Engaging and responding to metrics can’t be a flavor-of-the-month exercise,” Kelley says. “You have to be confident that this is something your organization is committed to. Otherwise, you will spend a lot of time collecting data but not doing anything with it. Before you start, make sure you understand how you are going to use the data and ensure staff acceptance of the idea.” Don’t measure too many things. There are many ways to measure patient-access performance, and attempting to focus on all of them at once can dilute an organization’s improvement effort. “We try not to track too many things,” Berkebile says. “We look at those elements that show how fast we are liquidating accounts receivable and keeping cash coming in the door, and that’s where we focus. We have found it better to share limited metrics, prioritizing the most impactful rather than inundating staff with lots of data all at once.” Involve financial leadership in determining metrics. It is a good idea to involve leaders in selecting the metrics to monitor and targets to set. “When we consider which metrics to monitor and evaluate, we first engage revenue cycle senior leadership to make recommendations,” Berkebile says. “We then take the recommendations to our performance improvement team, discuss each of the metrics and targets, and then come to an agreement.” Select metrics that empower individual and organization performance. “We study KPIs at an organizational level as well as at an individual one,” Levering says. “This allows us to paint an overall picture of performance while we also drill down to the staff level. Scorecards can be effective at communicating performance without emotion. The numbers speak for themselves, which offsets the time spent addressing the subjectivity that can be raised during staff evaluation and coaching discussions.” Revisit measures annually. “There are many things that can influence the metrics we choose,” Levering says. “For instance, regulatory changes, technology innovations, and insurance modifications may alter what we measure and the performance targets we set. For that reason, it’s important to review metrics annually, keeping in mind what’s going on in the industry and where you are compared with peers.” Don’t be afraid to add something. “Although we revisit our measures as well as our targets every year to make sure they are still relevant and inspiring, we may choose to add something throughout the year if we feel there is an issue that needs further exploration,” Berkebile says. “We may even add something short-term if we feel it is a relatively quick fix.” Keep dashboards simple. Just as collecting too many measures can overload staff, having a dashboard that is excessively long or complex can limit the ability to communicate information. Staff should be able to look at the dashboard and in seconds determine which areas need work and where they are doing well. “We found it best to keep the dashboard at one page,” Kelley says. “That way, staff members do not spend too much time trying to interpret the tool.” Train staff on the dashboard. Although dashboards should be relatively intuitive, it is still beneficial to train staff on what they mean and how to interpret them. “In our organization, it is the responsibility of each area manager to train staff on the metrics and targets, set performance expectations, and share the dashboard each month,” Berkebile says. “We orient people from day one about our metrics and the metrics’ importance, so everyone knows that dashboards will be used to assess patient-access operations both organizationwide and at the individual level.” Start small. “The biggest challenge with this work is getting started, because it can seem overwhelming,” says HFMA’s Wolfskill. “In the end, you have to figure out where you can have the biggest impact and go from there. Perhaps you can begin by looking at one or two measures. Each time you add a measure, you should explain why it’s important to track, how you are collecting the data, and how performance with this metric will impact the employee. Preregistration can be a good place to start because taking care of the scheduled population can have a big effect on the revenue cycle in terms of efficiency, accuracy, and patient satisfaction—particularly on the outpatient side.” hfma.org/Content.aspx?id=26246
Posted on: Thu, 04 Dec 2014 10:19:58 +0000
Recently Viewed Topics
© 2015