Access Management: Appointment Scheduling and Beyond (Part 1)

By Sue Altman

The case has been made for taking stock of your call center’s value to your organization, then evaluating, and acting on, ways to become integral to core operations. From recent survey results, many call centers are still providing only referrals to physicians, not taking the caller’s interest through to fruition. In a sense, these actions tell callers, “We’ll help you get started, but the rest will be on your shoulders.”

There are many reasons offered as to why call centers stop short, from it takes too long (not enough staff) to we don’t have access to scheduling systems and the physicians want total control. While each of these barriers may have merit, there are powerful rebuttals and accommodations to overcome them. The bottom line is, taking a referral through to the appointment is the only direct line from patient need and interest to generating organizational revenue.

Why “referral-only” puts us at risk: The simplest answer is, “If you don’t do it, someone else will.”  This mantra is not limited to concerns about regional competitors. It may be just as true of your call center’s position within your own organization. A centralized scheduling center which facilitates appointments for your clinics or physician-hospital organization (PHO) knows which physicians are accepting new patients. The staff has keen knowledge of wait times and first-available appointment options. They could easily pick up the physician referral requests handled by the stand-alone marketing-referral call center, and they could facilitate an appointment with ease.

There is also a new “threat” in the market: for-profit call centers who handle referrals, appointment setting, eligibility/insurance verification, and accurate patient registration. For many healthcare organizations, this service would replace three or four internal departments. Outsourcing is attractive to senior leadership because it offers both a one-stop package with accuracy and service level guarantees and an interim business solution for health systems that need to restructure fragmented services (but cannot afford any disruption to patient access).

The Driving Forces

Customer Service: For several years, there has been a growing trend in healthcare to centralize communications and scheduling functions. Some of this has been driven by “ideal patient experience” initiatives. When evaluating service levels of the mini-call centers (scheduling units) across an organization, it is common to find that phones are not answered as well in point-of-service locations. These settings put staff in a situation of having to choose. Do I answer the phone? Or, do I take care of the person in front of me? The presenting patient wins out…and the phone waits.

By routing these calls to a centralized center, the point-of-service benefits from a quieter environment, allowing better service and greater attention paid to each patient. The benefits derived from dedicated staff, measurable quality metrics, and customer service training have also been described in studies of best practices.

Efficiency: Recently, the recession has escalated projects that deliver greater economies of scale and operational efficiency. Operating fewer, but larger, contact centers makes good economic sense and warrants enough staff to achieve better service levels.

Enterprise Systems: Every healthcare IT article these days expounds the virtues of electronic medical records (EMRs) and enterprise solutions. The leading systems include a variety of functions, including fully integrated scheduling. What this means is that many of our current barriers to scheduling will be resolved or, at least, minimized. Schedules of employed physicians will be accessible on the primary system. Affiliated physicians will also be moving to electronic schedules, thus consolidating the number of software systems schedulers would need to access.

But the most powerful drivers which have given appointment and scheduling centers more importance is their strategic role in access management and the organization’s revenue cycle. These two functions are the core of every healthcare organization’s financial survival.

Access Management: Access management deals with a host of strategies to enable attracting, scheduling, managing, and retaining patients. It has become much more complex than back in the 1980s and 1990s when marketing and referral call centers were first established. Back then, our industry’s focus was to attract patients, ideally those with commercial insurance, and connect them with our affiliated physicians and organization’s services.

In a recession, Medicare and Medicaid may now be viewed as relatively decent-paying programs. Today’s health systems are challenged to develop multi-tiered strategies for managing commercially insured, government funded, under-insured, and unfunded patients. The first point of contact – often a referral or scheduling center – needs to understand more than the insurance match process. Staff need to understand and be able to navigate the ins and outs of eligibility, enrollment, and authorization requirements.

Revenue Cycle: The term revenue cycle encompasses a broad set of administrative services, including the process of registering, benefit counseling, creating, submitting, analyzing, and ultimately collecting payment for patient medical bills. For our purposes, much of this activity is carried out in the business office and automated by robust analytical software. However, revenue cycle improvement gurus are recognizing that one of the most important steps is gathering correct demographic and insurance data on the front end, thus avoiding rework later. Stepping up your call center’s role in gathering the data required for registration, completely and accurately, raises your call center’s value and connects you to an integral part of your organization’s survival.

To summarize, there are ample reasons to move toward scheduling services. The following answers to the question “Why?” should provide motivation:

  • Improve patient access and be part of this solution.
  • Tie your center into mainstream revenue flow, thus raising its position within the organization.
  • Establish experience and expertise proactively in preparation for future consolidation.
  • Leverage the customer service skills your staff already has.
  • Growth, through co-location or expansion, brings small centers to an FTE count that can better handle fluctuations in call volume.
  • Similarly, larger FTE budgets better justify the expense of improved infrastructure, such as feature-rich telecom and call management systems.

And in keeping with the title “Surviving and Thriving in a Recession,” we’ve provided answers to the question, “Why now?” These include:

  • Consolidation and process standardization projects are already in high gear.
  • The “barriers” to scheduling are being removed. Healthcare organizations are on the verge of, or have implemented, enterprise master patient indices (EMPIs), EMRs and enterprise scheduling systems.
  • The recession has brought extreme attention to revenue cycle management. If you understand it and your center’s potential contribution, this is a prime opportunity to get involved.
  • All of the above rank high in the priority of funded initiatives.

[Read Part 2 of “Access Management: Appointment Scheduling and Beyond” in the October/November issue of AnswerStat magazine.]

[From the August/September 2009 issue of AnswerStat magazine]