Creating a patient-focused scheduling center resulted in several unexpected boons for Piedmont Healthcare, from improving the patient experience to reducing denials.
When Georgia-based Piedmont Healthcare set out to streamline and centralize its scheduling process, it did so with one thing in mind: the patient experience.
That focus blossomed into what is now the Patient Connection Center (PCC), a centralized department that completes preservice functions for hospital‐based services. Creating the PCC streamlined the patient scheduling process, and also resulted in several unexpected financial and productivity benefits.
The PCC department, with 240 full-time employees, scheduled 491,948 services and processed 576,326 inbound calls in 2018, according to data that Allyson Bonner Keller, FACHE, executive director of the PCC, shared at the HealthLeaders Revenue Cycle Exchange in Ojai, California, earlier this year.
Centralized patient services
Instead of placing multiple calls to patients from local clinics and departments, the PCC is centralized for all hospital-based services at Piedmont Healthcare and aims to prepare patients for their visits with a single phone call.
Prior to going live with the PCC in 2017, Bonner Keller says a patient might have been contacted eight separate times during the scheduling process, such as to collect insurance information or to schedule the patient visit.
"If I was a patient, what would I want?" she says. "I wouldn’t want to be contacted eight different times."
By streamlining processes, scheduling has not only become an easier experience for patients, but Piedmont has realized some unexpected perks.
- Reduced number of times a patient was contacted by 66%
- Increased point-of-service collections 19% last fiscal year and are on a trajectory to increase by another 10% this year
- Reduced the initial denials from 9.6% of net revenue to 8.6%, which equated to more than $1.8 million
Bonner Keller says centralized scheduling has helped reduce denials because all the information needed to secure a patient account prior to service is gathered ahead of or during the scheduling process for all service lines, which helps to ensure a clean claim.
"It is now the responsibility of anyone scheduling a patient to make sure that insurance coverage is in the system and CPT codes are identified so that authorization can be obtained," she says.
A 'one-call philosophy'
Bonner Keller refers to the streamlined process as the "one-call philosophy," and says it involves pre-call prep work by the PCC team. The team not only aids in appointment scheduling, it handles a wide array of preservice functions from medical necessity review, to insurance eligibility verification and authorization, to price estimates, and preservice collections.
Once a medical order is entered into the electronic health record—either by a physician or a PCC indexer who enters fax orders—the prep team reviews the order ensuring all pertinent information is included; that it meets medical necessity for Medicare, if applicable; pulls real-time insurance eligibility data; and generates estimates for patient financial responsibility. The goal is to complete the prep work in 30 minutes or less, Bonner Keller says.
Once the prep is finished, the order is moved to the scheduling work queue. From there, schedulers can contact the patient.
"We really are focused on preparing the patient for those services," Bonner Keller says.
That means when the PCC representative calls the patient, he or she isn't working with the patient on scheduling only but also sharing information like basic patient instructions and where the patient should go on the day of his or her service.
Getting patients ready for their visits also includes preparing them financially. When informing patients about their financial responsibilities, the PCC representatives also ask them to make a small payment upfront. They tell patients how much they'll owe based on their insurance benefit and ask them how they'd like to pay.
The fact that people will often pay when asked was both surprising and validating, Bonner Keller says.
"Many people will pay when you inform them and ask them for the money," she says. "You don’t have to twist people's arms."
Bonner Keller says that the PCC is also planning to add preservice payment plans for patients.
Structuring the PCC
In creating the PCC, Piedmont engaged an outside company to implement the Lean Six Sigma philosophy within the organization. They also worked with a team of 32 Piedmont employees, half of whom were mangers and half who were staff-level people "who do the work every day."
"That helped in engaging them in the redesign and taking them along in the journey," Bonner Keller says.
The PCC is organized by service line. That's why, although it's centralized, Bonner Keller says she doesn’t like to call it central scheduling. She says that conjures a picture of "100 people in a room all scheduling everything without any specialized knowledge. That's not how we're organized. We really have teams within teams."
For instance, there are separate scheduling teams for main radiology services, mammography, and cardiac imaging, allowing people to specialize.
"I don’t think it's reasonable to expect every person to know everything," Bonner Keller says, adding that she believes having dedicated teams is what reduced call length the most.
Developing the PCC also involved restructuring staff positions (there were no job losses or pay cuts), rewriting job descriptions, and creating career ladders and paths for employees to advance or move within the PCC.
Two years later, Bonner Keller continues to develop the PCC.
"We are in a constant state of improvement," she says. "We have daily huddles with our staff where they identify opportunities and help problem solve."
She says she hopes to add new capabilities like automating the process behind inputting patient benefit information and automatically generating estimates for the patient portal.
It all comes back to the PCC's original focus on patient experience.
"This was [about] putting the patient in the center of the design," Bonner Keller says.
Alexandra Wilson Pecci is an editor for HealthLeaders.
Complete preservice functions for a patient visit to ensure clean claims.
Use a 'one-call philosophy' when scheduling and informing patients of financial responsibilities to streamline communications between the patient and hospital.
Create teams within teams to divide scheduling tasks by service line.