Schegistration A Patient-Focused Approach

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Schegistration A Patient-Focused Approach

• Cathy Gragg
• Revenue Cycle Manager
• Tucson Medical Center

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ABOUT US

• One of the 300 largest hospitals in the country
  and the largest in Southern Arizona. We are the
  largest single level facility in the US with
  nearly 27 miles of combined hallways
• Licensed for 609 adult and skilled nursing beds,
  62 psychiatric beds (Palo Verde Mental Health
  Services) and 90 bassinets
• Serve more than 37,765 inpatients and 114,929
  outpatients annually
• Over 1,000 physicians represent 60 specialties,
  from anesthesiology to vascular surgery
• TMC HealthCare is Southern Arizona's regional
  nonprofit community hospital
• TMC's campus also serves as home to the Tucson
  Orthopedic Institute, the Cancer Care Center of
  Southern Arizona and the Children's Clinics for
  Rehabilitative Services

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OBJECTIVES

• Review the importance of a centralized model
• Review the issues that we were trying to solve
• Describe the obstacles we encountered that drove
  the need to make this change
• Review the process we implemented and how we
  automated the patient interview at the point of
  scheduling
• Benefits realized
• Lessons learned

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WHERE WE STARTED

• May 2006, implemented EPICs Cadence Scheduling
  system
• September 2006, implemented a centralized
  scheduling model (user security changed)

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New Teams formedCENTRAL SCHEDULING TEAM

• Purpose for Creating the Team
• Issues identified
• Call Wait times and Abandonment rates
• Scheduling needed input from departments in order
  to schedule complex procedures
• Schedulers needed resources
• Created new staffing model
• Like processes grouped
• Gain efficiencies with centralization
• Ensure that all service lines were represented

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Central Scheduling - New Staffing Model
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PRE-ADMIT TEAM

• Purpose for Creating the Team
• Issues identified
• Team members separated physically
• No visibility to workload productivity
• Gain efficiencies with centralization
• Like processes grouped
• Integrating pre-service would fully support the
  organizations needs
• Identified an opportunity for physical space
• New building space became available

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Pre-Admitting Team New Staff Model
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PROCESS IMPROVEMENTS STILL NEEDED

• August 2007, kicked off Central Scheduling
  Process Improvement Committee
• Objective - Centralized access point with
  multiple portals transparent to the customer.
  One transaction to complete scheduling an
  appointment

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Potential Causes
Communication
Education-office staff
Technology/Equipment
No contact info
Order not confirmed with phy.
Registration not available after scheduling
completed
Cant ID requested test
Pt. unaware test has been ordered
System resource sharing
Prep instructions
Registration not available when needed by
departments
Wrong test ordered
Pt. wants to clarify w/ physician
Wrong pt tele
Doesnt meet SOC, ie sedation or anesthesia
Order needs clarification
Why does Central Scheduling need more than one
contact with physicians offices and patients to
complete the OP scheduling process ?
New patient
Confirm appt w/ pt
Order does not meet requirements
Unable to reach pt on 1st attempt
No prior auth.
Order incomplete

CS staffing ability to respond to all calls
Pt. will not schedule due to no prior auth.
Order element missing
Pt. refuses to schedule
Scheduling request after 4 PM
Order incorrect
Appointment time not soon enough
Order cannot be located
Specialty procs. Bx, etc
Pt. not ready to schedule
Compliance requirements
Scheduling Coordination
Revenue
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Process Improvements Implemented
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Process Improvements Recommendations

• IN SCOPE
• Walk-ins with Rx in hand
• Same Day/Next Day cases
• Targeted Physicians
• Patient requests to schedule with department
• Reschedule cancellations, no-shows
• All dissatisfied patients /MDs with CS process
• Call to stay with initial location of call (CS or
  VL)
• MD offices whos patient has not been scheduled gt
  one week
• Patients with Rx who were incorrectly scheduled
  24 hours in advance
• Series patients

• OUT OF SCOPE
• Routine cases not meeting In Scope criteria
• All In Scope criteria beginning in Central
  Scheduling

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PROBLEMS WE STILL NEEDED TO RESOLVE

• MISSING PATIENT INFORMATION
• AFS staff not always the first point of contact
• Missing patient information or inaccurate
  information
• Unable to reach the patient prior to their
  appointment
• Late add ons
• Duplication of efforts
• Entry into two systems

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PROBLEMS WE STILL NEEDED TO RESOLVE cont

• VERIFICATION COVERAGE/BENEFITS
• Decreased time from time appt scheduled to appt
  time
• Data in EPIC different than what was in legacy
  system
• Ineligible for coverage listed
• Not a covered benefit requires financial
  clearance
• High deductibles / co-insurance identified
  requires financial clearance

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PROBLEMS WE STILL NEEDED TO RESOLVE cont

• AUTHORIZATIONS
• Inability to obtain auth early enough
• Customer dissatisfaction
• Numerous calls to physician offices for patient
  info
• Patients delays and financial clearance issues

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PROBLEMS WE STILL NEEDED TO RESOLVE cont

• DUPLICATION OF EFFORTS
• Schedulers would ask similar information that
  registration needed
• Registration would call the patient
• Patient perceived this as a duplicate call

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SPECIAL CONSIDERATIONS FOR SCHEGISTRATION

• Central schedulers needed to be trained to
  collect guarantor, and coverage information.
• Department schedulers need to be trained to
  collect demographic information.
• This may increase the length of calls for all
  schedulers, thus impacting bandwidth for the
  Central Scheduling department. Scheduling time
  will be impacted but will be balanced by a more
  streamlined registration process

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HOW WE GOT THERE

• May 2010, Implemented EMR
• New Security for staff added
• Realocation of personnel
• Automated schegistration for Central Scheduling

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Schegistration Model Security changes

• User
• Central Scheduler
• Registration representative
• Cannot schedule into all OP areas

• Role
• Order transcription
• Referral Management (authorization)
• Schedules for all OP areas including completing
  registration to include
• Demographics
• HAR creation (if appt w/in 48 hours)
• Create / edit guarantor
• Add / edit coverage

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PROGRAMMING CHANGES - SCHEGISTRATION

• Added new programming point to jump the scheduler
  into registration before appointment entry when
  the patient has unverified registration info
• Demographics / guarantor - new or elapsed
• Created new programming point to fire after
  appointment is made to jump the scheduler into
  registration if the appointment is scheduled
  within 48 hours.
• Scheduler creates the account

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• PRIOR STATE

• CURRENT STATE

• Collection of demographic, guarantor, and
  coverage information is moved up to the time of
  scheduling. Afterwards, this process will result
  in two distinct workflows
• Appointments within 48 hours (one-call)
• Scheduler collects demographic, coverage,
  guarantor information and create the account.
  The scheduler checks eligibility via real-time
  eligibility.
• Appointments scheduled past 48 hours
• At the time of scheduling, the scheduler will
  collect demographic information. After
  scheduling, registration staff will collect,
  review and verify coverage and guarantor
  information as well as create the account. The
  registrar communicates co-pay information to the
  patient and collects via the phone if possible.
  If unable to collect the copay over the phone,
  the patient is instruction to pay the copay at
  the sign in desk.

• Central scheduled into outpatients departments.
• After the scheduling, registration contacts
  patients to collect demographic, guarantor, and
  coverage information. Some of this information
  may be verified at the time of this
  pre-registration phone call, although it is
  possible that not all of this information is
  verified during this call.
• If there are eligibility or co-pay
  issues/information that needs to be communicated,
  the patient may be contacted again.

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BENEFITS REALIZED

• Enterprise system allowed for schedulers and
  registration staff to work within the same system
• All users had access to same information,
  including where the authorization would be
  entered
• Implemented hard stops for missing financial
  clearance
• No Auth
• ABNs
• Financial Waivers

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BENEFITS REALIZED cont.

• Pre-schegistration

• Post-schegistration

• Call times
• Avg talk time 256 min
• Percentage of pre-registration at point of
  scheduling 7

• Call times
• Avg talk time 326 min
• Percentage of pre-registration at point of
  scheduling 21

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LESSONS LEARNED

• Need to broaden scheduling access for all
  registration staff
• Department schedulers do not collect demographics
  
• RTE (real-time elig) needs to be complete for ALL
  high volume payors
• Documentation overlaps proved to be problematic
  i.e., schedulers document in referrals while
  registration documents in FYI and Acct Notes
• Only works well when scheduling with the patient
• Still issues with obtaining Auth from physician
  offices for appts made inside 48hrs of DOS

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QUESTIONS
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CONTACT INFORMATION

• Cathy Gragg cathy.gragg_at_tmcaz.com
• Revenue Cycle Manager, Enterprise Wide Scheduling