Does a metric answer the question – is our access good?

Good patient access is not easy to define and even harder to measure. It takes a combination of metrics to paint the full picture. This blog series examines one of the most common metrics used by access leaders – schedule utilization.

Terminology

The use of nomenclature in health care has long been problematic for industry stakeholders, let alone patients. Terms like “Otolaryngology” and “Hematology” require studies in ancient languages, and then we have a habit of shortening the terms – like “Gyn-Onc” (pronounced “guy-knee-onc”) to further complicate matters. Even experts stumble upon the vast array of acronyms that pepper the health care landscape – from ACO to MSP to QPP. As we center our efforts on improving access for patients, there may be opportunity to examine how shifts in our communication can prove beneficial.

We are excited to announce two new industry partners to the Patient Access Collaborative: Abax Health and Gozio Health! Read more about them below.

Abax Health

Abax Health’s AI powered clinical analytics and patient engagement platform, Clarity, is dedicated to ensuring every patient receives the care they need, when they need it, and that the health system realizes the revenue related to all of their missed procedures. Clarity uses advanced artificial intelligence and machine learning to identify when a patient has a “missed referral” for a procedure and ensures that the procedure gets scheduled.  The platform analyzes millions of patient records to find missed referrals, quantifies the financial impact of the missed procedures, and then our concierge team of outreach specialists get to work reminding the patient of the procedure, educating the patient on its necessity, and then conducting all of the administrative scheduling and financial clearance steps (Patient Access functions) involved in getting that patient scheduled for the appointment. Visit their website.

Can a tube of toothpaste inform our access improvement journey?

Behavioral science provides evidence that consumers are influenced by their experience and many other factors related to purchasing decisions. Price is often cited as the most influential component of our buying decision, but many other determinants come into play. This fact led researchers to develop a "better" experience to encourage us to brush our teeth. Over the years, various components like fluoride have been introduced by toothpaste manufacturers, but perhaps the greatest innovation was striped toothpaste in 1955 by Leonard Marraffino. According to Aquafresh, the stripes represent concepts - tooth decay prevention and breath freshening, which produced the first two-striped toothpaste based on Marraffino's patent. As consumers, we rarely think about the stripes and certainly don't consider which color fights tooth decay and which freshens our breath. But the novelty propelled an entire era of influential consumer packaging - think about the laundry pods, for example. We can "see" the product at work, something that ridesharing companies like Uber and Lyft took advantage of as well. When we log onto our app to call a car, we are not getting a different product (a taxi serves the purpose just as well), we are getting a different experience. As consumers, we love it. 

By Nkechi Okwu-Lawrence and Elizabeth Woodcock

With medications being such an integral part of population health management, handling prescription refills in an effective manner is vital to success. As access teams become more engaged in efforts to improve refill management, it’s important to identify best practices. The Patient Access Collaborative invited three members to present their approaches to refill management, all of which are proving to be a value-add to their organization.

Laddy Rua, Contact Center Manager, Prescription Line, and Kirsten Peck, Contact Center Supervisor, Prescription Line, from Baystate Health discussed the efforts to improve refill management by focusing on their employees. Medical assistants work in the Patient Access Center, answering inbound calls from pharmacies and patients. They use work pools that are strategically managed to level the workload among the team. Per diems are staffed during non-business hours to further maximize efficiencies. Onboarding protocols for new team members include shadowing, side-by-side mentoring, and weekly one-on-one’s.

USF Tampa General Physicians initiated its call center decades ago; while scheduling is the primary function, there is an inbound patient clinical concern team. The team, as described by Christine Kilfoyl, RN, BSN, and Desiree Thomas, LPN, consists of nurses, medical assistants, and a recently hired pharmacist. Approximately 60% of the daily inbound calls to the clinical concern team are for prescription refills, with the team fully handling 80% of these calls. Kilfoyl notes that department relationships are “very, very important” for their team, in order to share knowledge and maintain currency. “Carve outs will kill you,” is a mantra for the team, which aims to standardize workflows and adhere to institutional policies to successfully manage refills in a centralized manner.

Ami Shumway, Operations Director, Loma Linda University (LLU) Health, details the team’s focus on first call resolution. This goal was a key driver of hiring pharmacy technicians, aiming to improve patient satisfaction and reduce the excess administrative burden being placed on the clinical teams where possible. Shumway and other access leaders engaged the LLU School of Pharmacy, which has aided in the recruitment of the technicians, as well as pharmacists and pharmacy students. A mere six months into the project, Shumway highlights that first-call resolution has increased by a notable 64% for prescription-related calls.

For PAC members, head to Webinars to listen to the panel of experts who presented on August 16, 2022 under the title, “Centralized Refill Management.”

There's nothing more frustrating than to discover an opportunity, only to recognize that too much time has already passed. For many PAC members, that's been the case with patient satisfaction survey results that are often released months after collecting the data from patients. The lack of timeliness combined with low response rates have plagued stakeholders. An alternative that shows promise is on the horizon. To address this issue of timely feedback related to access, post-call surveys are now deployed by many PAC organizations in their ambulatory contact center.

What is a post-call survey? After the caller and the agent have completed the call, the caller is requested to score the conversation. The caller may be automatically prompted to provide feedback - or the collection mechanism may be a follow-on text or email. The results are compiled and reported back to management, allowing for near-immediate feedback at the agent or organization level (and often, an intermediate area such as the specialty or department, as applicable).

Patient Access Collaborative is Seeking Speakers for our 2023 Educational Calendar!

The Patient Access Collaborative is planning our 2023 Educational Calendar which includes webinars, virtual conferences and our annual symposia. If you are interested in speaking and can deliver exciting, innovative information that would be valuable to our members, please submit a Request to Speak form.

By Matthew Shore, CHFP, Project Manager I, Organizational Excellence

I’m sure it’s no secret to Patient Access Collaborative members that employee engagement and morale are very important in our industry. Engaged employees are happier, more loyal, more productive, and more devoted to the organization’s mission. It is for these reasons that I launched a team newsletter for the access center at Montefiore Health System.

Weill Cornell Medicine, amidst staffing shortages and a push for digital acceleration, searched for a patient engagement solution that would improve website navigation while boosting patient access and acquisition. In just two weeks, Hyro deployed a customized conversational AI assistant capable of finding physicians based on multiple criteria and booking appointments end-to-end, with no training or coding required. So far, Weill Cornell Medicine has increased converted appointments online by 47% with Hyro's conversational AI, while lowering their bounce rate by 31%.

Read the Case Study

Tina Tolomeo, DNP, MBA, APRN, FNP-BC, AE-C, Senior Director, Patient Access at Yale Medicine shares how her team measures success.

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There are a number of ways to measure success in the field of Patient Access. One is to measure performance of the access center, the doorway to healthcare delivery. 

By Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC

As with any complex, multi-faceted process, there are opportunities to improve scheduling. Calls may be processed by a health care organization with ease, but if there is nowhere to put the patient – that is, no appointment slot available – then picking up the telephone matters none.

By Chris Profeta, MPH

The Bump Rate

The bump rate is an access metric used to measure internally-driven appointment cancellations and, by proxy, disruptions to care caused by the health system. A bump is defined as a patient appointment that was cancelled by an internal stakeholder – the physician or provider for example. The reasons for the bump may vary but the key factor is the appointment change is instigated by the system, not the patient. The rate is derived by dividing the volume of bumps into all scheduled appointments across a designated period of time. 

Why do the best teams make the most mistakes? The answer may not be so apparent. In a ground-breaking study by Google, five factors were identified as characteristics of effective, high-performing teams: dependability, structure/clarity, meaning, impact, and (most importantly) psychological safety. The best teams, it turns out, don’t make the most mistakes – they are simply the ones who reveal them.

Many Patient Access Collaborative members are surprised when they listen to one of our educational sessions. The speakers, you see, are all required to include their challenges, reflect on their mistakes -- or whatever positive spin they want to put on the language of fallacy. In doing so, we are creating psychological safety. The term, according to Amy Edmonson, PhD, a Harvard Professor who recognized the relationship between performance and candor in teams, is a “shared belief that the environment is safe for interpersonal risk taking.”

This month the Member Spotlight is on Karla Esqueche, a Epic Analyst-Team Lead at Montefiore Medical Center. Learn more about Karla below. Want to be a part of our PAC Member Spotlight? Fill out the form here.

How long have you been a member of the Patient Access Collaborative?: 4 years

Have you checked out the PAC Job Board? Reaching over 2,000 access leaders, our job board is a great way to advertise your open position to the highest quality and most relevant candidates in the industry - or to find a new role you'll love! 

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Well into year three of COVID-19, our members are experiencing staffing shortages and challenges with retention. To help those institutions facing these problems, we surveyed our members who reported the lowest turnover rates for their access teams via our benchmarking survey -- and asked them key questions about their retention tactics. Sharing these strategies and tactics with all our members is at the core of what we offer as an association – an opportunity to learn from each other.

Internal Transfer Hold Period – most of these organizations reported that the period the employee must wait until a transfer can be made is six months. Some exceptions are made if they apply for a promotion or if the current and new departments agree to the transfer. There were a few organizations that reported no waiting period.

By Elizabeth Woodcock, Executive Director

Work-from-home is here to stay, but the transition isn’t easy. University of Maryland Faculty Physicians’ Director of Patient Access Services, Lori Bruelheide, MBA reports that the new model means new challenges related to employees: “Being late to work still exists – we’ve traded the excuses related to traffic to problems with technology.” To mitigate these challenges, Lori – and the two other panelists who joined her at the PAC’s webinar on Work (Far) from Home – supply the equipment for their remote associates. Scott O’Neil, the VP of Patient Access and Service at University of Vermont Health Network not only sends the telecommunications and computing equipment, but also a desk and a chair. The University of Vermont is now recruiting from all 50 states as a response to the labor pandemic. With such a sparsely populated state, Vermont is particularly impacted by the staffing shortages that are affecting health systems across the nation. O’Neil exclaimed that the applicant pool “blew up” after opening applications from all states, concluding, “This [out-of-state hiring] isn’t new – it’s just new to us in healthcare.”

By: Kevin Pawl and Susan Flath Sporn, Boston's Children Hospital

It’s no surprise to anyone that after the past few years of pandemic disruption to normal hospital operations, it is time to begin to reset expectations and best practices. The Patient Access world we lived in during 2019 is now different in 2022; patient backlogs are common, wait times while acceptable during active Covid response time were better are now getting worse, clinics are short staffed, and patients expect the flexibility Virtual Visits offered them over the past 3 years.

Appointment durations set the tempo for not only the provider template but all clinical operations. The workflows of the registration desk and patient work-up stations, the rooming process, provider time with the patient, discharge and check-out activity all drive off the appointment durations of the template. Optimally timed appointment durations are key to a well functioning clinic, 

Appointment durations are typically presented in minutes as "new" (longer) and "established" (shorter) time slots.  Common durations are 10, 15, 20, 30, 40, and 60 minutes; the time is built into the template based on the selected duration. Because time cannot be used concurrently and is perishable by nature, the manner in which slots are constructed is a leading factor in the volume of patients managed in an ambulatory practice that uses an appointment template. The appointment slots are, in essence, the seats on the airplane. Data regarding industry norms by specialty can be useful in constructing or reviewing your templates. Consider gathering the industry norm as you sit down with leaders at your organization; if the durations you are using vary from the norm, this may lead to a fruitful dialogue about whether there should be a difference -- or if this data may present evidence to justify a change.