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The Future of Access: A Patient-Centric Vision
2014 NAHAM
Presentation
Karen Shaffer-Platt
• Vice President, Revenue Cycle/Patient Concierge Services at UPMC
• 25 years experience in Access and Revenue Cycle Management in both the Hospital and Physician Services
• 15 years of IT project management experience, including direction of system training and development, system installation and data conversion
• Graduate of the University of Pittsburgh
• Member of the National Association of Health Care Access Management (NAHAM), American Association of Health Care Administrative Management (AAHAM), and Healthcare Financial Management Association (HFMA)
Georgina Trunzo
• Executive Director for Patient Access Services at UPMC
• 30 years of Health Care experience
• Includes Patient Registration, including the various hospital integrations and conversion to new computer ADT systems.
• Graduate of the Pennsylvania State University with a degree in Health Planning/ Hospital Administration and a minor in Finance.
• Member of NAHAM (National Association of Healthcare Access Management) and she has published articles and presented nationally on Access topics.
Presenters
UPMC Health Systems
• UPMC is a world-renowned health care provider
and insurer based in Pittsburgh, PA, inventing new
models of accountable, cost-effective, patient-
centered care.
• The largest non-governmental employer in PA (62,000+
employees)
• Operates 22 academic, community, and specialty hospitals
and 400 outpatient sites, employs approximately 3,500
physicians, and offers an array of rehabilitation, retirement,
and long-term care facilities.
UPMC Health Systems: Annual Patient Activity
Admits more than 264,000 inpatients and observation
cases
Sees more than 3.6 million outpatient
office visits
Cares for nearly 650,000 emergency
visits
Performs nearly 174,000 surgeries
Makes more than 500,000 home care
visits
Patient Experience Value
Every patient believes that every individual involved in his or her care has demonstrated
dignity, respect and kindness while listening to his or her unique needs. This vision is
only achieved by showing every patient in every interaction that we truly care.
The UPMC patient experience vision is built upon our values as an organization.
Access of the Future
UPMC conducted a revamp of the current access models within the Hospital and Physician divisions to prepare for Access of tomorrow.
Competing Demands
Transparency More Payors in the
Marketplace
Transition from
Quantity to Quality
Measures New Competitive Marketplace
Accountable Care
Measures
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
Access Redesign
Timely and Appropriate
Access
Positive Patient Experience
Streamline Points of Entry
Standardized and Simplified Workflows
Transition Across Business Units
Administrative Cost Savings
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
5+ Million
• Patients currently in Epic
16,000
• Epic Patients Daily
425
• New Epic Patients Daily
40
• Newborns that use parents registration
50
• ED and Urgent Care
150
• Registration via automation or not necessary
ONLY 185
New Detailed Registrations
per day
New Patient Volume
Welcome Patients
• Welcome Calls for all NEW
patients to UPMC • 1 Complete new person
interview for the organization
• Way-finding information
• Payment expectations
• Pre-payments secured
• Walk-in Patients
• Streamlined process
• Appt &Quick Reg
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
Central Contact Center
Workforce
Management Central Scheduling Contact
Center Decentralized Ancillary Schedulers
Decentralized Department Schedulers
“Virtual Call Center”
The Patient
Epic Questionnaires
• Used as a decision support tool by the Contact Center to allow cross training of scheduling agents
• Enables scheduling agents to schedule for 20+ diverse sub specialties. Including: Orthopaedics, ENT, Neurosurgery, Dermatology, etc…
Decision Support
Technology for Optimization – Epic Questionnaire
CRM (Customer Relationship Management)
• Epic feature utilized by the Contact Center to allow a concise communication pathway between Patient Access Specialists, Centralized Billing and decentralized department staff
• CRM topics used to kick off backend automation. For example, patients removed or added to work queue.
• Provides central location for documentation of patient contact, call activity and resolution
Technology for Optimization
Customer Service CRM Reporting for Operations
SUB TOPIC Sep Oct Nov Dec Jan Feb 6 Mo Trending 6 M
o Avg
6 M
o M
in
6 M
o M
ax
Feb D
aily A
vg
23 - Insurance Not On Account 929 1117 924 1010 1002 1144 1021.00 924 1144 57.2
13 - Charge on Wrong Account 329 417 355 387 307 363 359.67 307 417 18.15
52 - Incorrect Insurance Information 291 351 304 261 297 320 304.00 261 351 16
8 - Coordination of Benefits Issue 265 266 200 292 355 412 298.33 200 412 20.6
37 - Missing Patient Payment 106 121 112 110 108 98 109.17 98 121 4.9
16 - Coding Review Procedure Code 80 103 77 152 108 133 108.83 77 152 6.65
53 - Incorrect Demographic Information 58 94 83 66 155 62 86.33 58 155 3.1
Customer Service provides Access feedback on why patients
are calling, and how future calls maybe prevented.
Tutorials/training sent with report cards.
Agent Monitoring Tools
CMS Interval reports are
delivered every 3 hours:
Agent Report Card
QA Score 90% 90% 98% 95% 97%
Adherence 88% 88% 94% 96% 96%
Other Job Duties 2 2 1.0 1.0 0.8
Scheduling Overflow AHT 358 420 323 299 293
Scheduling
Overflow ACW 111 180 74 60 52 Scheduling
Overflow Calls
Taken 918 543 837
Consumer Referral
AHT 359 360 319 295 263 Consumer Referral
ACW 107 150 87 67 58 Consumer Referral
Calls Taken 186 101 162
Televox AHT 407 510 388 391 360
Televox ACW 113 312 101 140 63
Televox Calls
Taken 50 12 31
Total Calls Taken (All Skills) 1368 764 1259
Outbound Calls 311 233 248
#N/A 102 202
The access model at UPMC stresses a positive patient overall experience.
UPMC is changing its Point of Service (POS) model to allow for value based care and moving away from the transactional model.
• Some topics that will be covered include:
• 72 Hour Initiative
• Post appointment scheduling
• Discharge Planning – transition of care
• Technology requirements
Point of Service Model
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
Access Leadership – Managed Centrally
Recruitment and Placement Services
• Operational site management
can focus on day-to-day
business operations rather than
time intensive recruitment
process.
• Promotes staff retention and a
better patient experience.
Operational managers “try out”
new hires prior to permanent
placement. A happy employee
who fits in the site culture
provides for a better patient
experience.
• Cost savings with being able to
maintain an efficient staffing
model with the ability to “flex-up”
with floater pool staff to cover
incremental patient volume days
or PTO.
• Centralizing recruitment and
placement of Patient Access
staff simplifies the HR
processes. Applicants only
need to be processed once.
Cost saving in HR time and in
background check utilization.
• Use of a consistent partnership
with the Floater Pool provides
for a consistent workflow for
recruitment and hiring of Patient
Access staff.
• Replace competition with
collaboration in attracting and
hiring the best Patient Access
candidates.
• Simplified and efficient
interview process. Applicants
seeking jobs only need to
apply once to be considered
for all available open Patient
Access positions.
• Promotes staff retention and
job satisfaction new hires have
the opportunity to “try-out” a
job before they commit to
permanent placement.
• Applicants are consistently
provided the appropriate
training and orientation to be
successful in their Patient
Access role.
Applicants Human Resources Site Management
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
Continued shift in
liability to patient
• Consumer Centric Approach
ACA Guideline Changes 1/1/2014
• All Large Employers must change or be subject to fines
Increased Patient
Advocacy and
Education
• Traditionally Patient Liability Consisted of Copays
• Deductible Thresholds have grown and will continue to grow
• Coinsurance is included on many plans
2014 – What to expect?
Historically 60% of copays are paid at the time of service.
During the full life cycle of a claim
only an additional 20% of copays are
collected.
We collect 65.5% of deductibles and
49.1% of coinsurance during
the full life cycle
Education has begun and will be
critical moving forward to ensure
collection of Deductible and
Coinsurance at the time of service.
Time of Service Collections - Education is Essential
Based on historical AR for PSD and Hospital services using UPMC Health
Plan Commercial data from January 2013 to January 2014.
• At the Enterprise level, we collect 60% of Copays at the POS
• At Physician Offices, we collect 80% of Copays at the POS
• At Radiology sites, we collect 21% of Copays at the POS
Patient Experience
Patient Counseling: Our most effective approach
• Proactive discussions with patients at appropriate times in comfortable settings
• Not on a gurney, while under sedation or medicated for a procedure
Patient Education
•Reminder of benefit changes
•Out of pocket liability Scheduling
•Benefit overview
•Out of pocket liability
•Financial Assistance Pre-Arrival
•Out of pocket liability
•Payment Collection
•Financial Assistance
•Referral to Patient Concierge
Point of Service
•Patient Education – Claims Adjudication
•Financial Assistance
•Post Service Work Queues – Outstanding balances
Customer Service
•MyUpmc / HealthTrak
•Dynamic Messaging on Statements
•eStatement Hyperlinks Communication
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
Transition of care is accomplished by a proactive Discharge Planning program and onsite post appointment scheduling for all necessary follow-up appointments, labs, and testing – continuum of care plan.
Both programs are very patient orientated and value services for the patients that transition across business units.
The Physician Services Central Scheduling facilitates and schedules appointments for targeted patients through the Discharge Planning Protocol (DPP) program.
This concierge service follows discharge instructions for each patient qualifying for any of the DPP initiatives, scheduling appointments with both Primary Care Physician (PCP) and Specialists. Attempts include scheduling of PCP appointments to occur within five days of discharge.
Post Appointment Scheduling and Discharge Planning
Discharge Planning
Several wellness visit campaigns are conducted within the Contact Center and at the department level for existing
patients
Happy Birthday Campaign
Patient Quality Outreach
Benefit Education Calls
Welcome Back Calls to Patients that have not been to a UPMC Facility for over 18 months.
Patient Experience
POS Enhancements
Welcome/Kiosk
• Automated Check In
• Streamline Throughput
• Improved Patient Experience
MyUPMC
• Direct Scheduling
• Appointment Reminders& Appointment Check In
• Pre-registration
• On-line bill payment, eStatements
• Payment due reminders
• 24/7 Live Chat for appointments, billing and payments
• Discharge Summaries
Telephony
• Centrally managed Workforce/real time call monitoring
• Hold departments to phone scheduling KPI and reporting standards
• Call Forecasting to staff to current volume
• Quality Assurance (QA) for call recording
• Standardized Training
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
An evidence-based management approach
• Proactively, point of service departments are given report cards that measure:
• Department KPIs
• Copays, Press Ganey scores, etc.
• Operational KPIs down to the user level
• Check-ins by users, scheduled appointments by user, etc.
Quality assurance checks are done via randomly monitored phone calls and department site visits. This data is available monthly for all departments to see and the data is shared among peers.
New Operational Model
Front Desk KPIs
• KPIs measured, reported and trended centrally.
Business Units held accountable.
• Registration Updates
• Check In Volume
• Same Day Appointment Volume
• Appointments by Phone Volume
• Total Appointments Scheduled
• Daily Average Check In
• Daily Average Same Day Appts
• Patient Wait Time (EpicCare sites)
• Patient Liability Copay,
Coinsurance, Deductible,
Prepayment, other patient
payments
• 72 Scheduling
• Charge Posting Reconciliation
• Validation and verification of
Privacy/TPO/HIE on Account
• HealthTrak Adoption
• Concierge Form Usage
• QA Results
• Utilization of FYI Notes
• Offered concierge services
• Offered to schedule follow up
appointment
• Advised of MyUPMC activation
number
Department Report Card – User Level
Weighted Score 1 1 0.5 0.5 0.5
Name Login ID Job Title
Avg Daily
Check In
Avg Daily
Scheduling
Avg Daily
Referrals
Avg Daily
Edits/Denials/
EDIs
Avg Daily
UPAY Tx Total
Front Desk User 1 USER1 Access Lead 0.80 6.70 0.00 0.15 1.70 8.43
Front Desk User 2 USER2 Access Lead 0.05 24.30 0.00 0.00 22.60 35.65
Front Desk User 3 USER3 Patient Information Coordinator 0.90 23.20 0.00 0.00 14.15 31.18
Front Desk User 4 USER4 Patient Information Coordinator 31.20 16.10 0.00 0.00 10.65 52.63
Press Ganey
HVI February 2014
All CMI
February 2014
All UPP
February 2014
Press Ganey 75th
Percentile Rank
Clerks treat with courtesy/respect 97.39 94.99 93.77 95.40
Clerks/receptionists helpful 96.54 92.20 90.53 92.00
Access
Ability to get desired appointment* 90.8 89.6 86.7 90.9
Convenience of our office hours 92.1 90.3 88.2 90.5
Courtesy of registration staff 95.8 94.0 92.9 94.0
Ease of getting clinic on phone 90.6 91.0 88.0 88.9
Ease of scheduling appointments 92.5 92.3 90.0 91.2
Information about delays 90.7 87.9 82.0 86.3
Moving Through Your Visit
Wait time at clinic 90.2 88.4 81.3 86.2
Waiting area comfort/pleasantness* 91.2 89.4 86.9 91.7
CGCAHPS Questions - AVG% Yes Definitely
Standard Press Ganey Questions
Encounter Charge Posting Efficiency & POS Cash Collections
Cognos Reporting
UPMC Patient Experience
Concise Registration Data
Flow of Services
Scheduling Protocols
Administrative Collaboration
Financial Coaching
Continuum of Care
POS Enhancements
One Touch Scheduling
KPIs
Patient
Centric
Experience
UPMC Real Guiding Principal for Change
Patient
Centric
Experience
“Insanity: doing the same thing over and over again
and expecting different results.” Albert Einstein
Questions
