Patient Access Management Challenges, News, and Progress

One of the most overlooked, but arguably one of the most important aspects of the hospital experience is patient access. Patient access encompasses the front-end registration process and all of its supporting financial dealings with providers, patients, and payers throughout the healthcare experience.

Let’s take a look at the industry and cover recent news, updates, and challenges related to patient access management.

Out-of-Pocket Costs Increase and Patient Collections Decrease

A recent study published by Crowe Horwath revealed that hospitals are collecting a significant amount less from patients that have higher out-of-pocket costs as opposed to those with lower deductibles. In fact, the stats showed that those patients with account balances that were greater than $5,000 had four times lower collection rates than low-deductible health plan patient accounts.

According to the report: “While average patient balances for high-deductible plans increase, payment collections vary based on the size of the balance. As healthcare providers analyze the ‘realization’ (i.e., the percentage of net revenue versus gross revenue) of their managed care contracts, they also should understand risks associated with high-deductible plans and should recalibrate their AR valuation and potential impacts on revenue recognition to account for these new market factors.”

Price Transparency Remains a Struggle for Patient Access Management

As reported by Healthcare Finance, the Pioneer Institute recently published an 18-month follow-up study to a previous study that showed “little price transparency with the Commonwealth’s hospitals.” The more recent study, unfortunately, shows that Massachusetts hospitals are still failing to meet the goal, by not being able to provide pricing estimates to consumers after the request was made, within two days. The law requires this two-day response period to be met, and the average is two to four business days according to the survey. The Pioneer Institute states:

“Response time ranged from a few minutes at Baystate Franklin Medical Center in Greenfield and Morton Hospital and Medical Center in Taunton, to six or seven days at some other hospitals.”

Health Information Access Taken to the Bedside

Providing secure and reliable patient access to information has been an ongoing dilemma for healthcare professionals for quite some time. Patient portals, mobile apps, and other IT solutions have attempted to meet this goal in the past.

According to an article in Search Health IT, the University of Colorado now provides this access to health information for patients right at the bedside. The benefit and ultimate goal of this type of information sharing is to increase patient engagement, which can lead to improved outcomes and greater satisfaction. Certainly, access to this type of sensitive information outside of the hospital setting is important, but in-patient involvement in care is equally important, which is why the University of Colorado is trailblazing this practice for others to follow suit. Health information such as vital signs, lab results, and test results are provided to patients in real-time via Samsung tablets and Samsung’s Knox Custom Configurator according to Trevor Smith, senior account manager of strategic accounts at Samsung.

Tackling the Hospital Revenue Cycle Management from the Front-End

Becker’s Hospital Review published a revenue cycle management (RCM) tip recently that was simply: “Start in the front office, not the back office.” According to the brief article, any healthcare organization that desires to reduce claims denials needs to concentrate on access management first, which deals with the front end of the revenue cycle process. This advice was credited to Ryan Feldt, manager at ZirMed, a provider of cloud-based revenue cycle software and predictive analytics, who offered his advice in a 2016 article in Becker’s:

“The front office holds the keys to preventing the most frequent causes of denials, including ineligible/uncovered services, failure to obtain prior authorization, lack of medical necessity, incomplete/inaccurate patient demographic information and services covered by another plan or payer. Nearly all eligibility-related information can be uncovered and confirmed prior to the time of service — by leveraging effective and accurate patient eligibility verification technology which can save your staff time and increases their effectiveness, as compared to manual methods.”