By Paul Shorrosh
Patients expect a consumer-grade healthcare experience, but overwhelmingly, they're not getting it. This shortcoming can overshadow even best clinical patient experience. Long waiting room times, clunky, manual registration processes and poor visibility into financial responsibility are all common headaches for patients. But what if navigating healthcare was as easy as online shopping, banking and booking travel?
The healthcare industry lags at least a decade behind e-commerce giants like Amazon, travel industry leaders like Expedia and large financial institutions that set the standard for intuitive, consumer-friendly online engagement. Like them, healthcare organizations have spent millions over the past two decades to digitize; however, most of that money was spent on installing and integrating electronic health record systems, not on improving patient access or financial experience.
While EHRs provide a wide array of clinical capabilities, hospitals are often disappointed to find significant gaps in patient access and digital engagement functionality. This is a growing problem, because as tasks historically handled by staff are transitioned to patients, the registration and financial experience is becoming a bigger factor in patient satisfaction. Increasingly, the financial experience is intertwined with the clinical patient experience, so much so that 93% of consumers say the quality of their billing experience is an important factor in whether they will return to a provider.
Most forward-thinking hospitals and health systems recognize the importance of the non-clinical customer experience as a differentiator and an increasingly important factor in retaining and attracting patient volume. They realize their EHR alone can’t deliver the market-leading, digital patient experience patients expect. It requires the right technology partner and an investment in a platform that complements their EHR. Combining the EHR’s capabilities in clinical data management with the right digital patient access, intake and engagement solution fills EHR gaps and increases the value and interaction with the EHR by providing insights into the following:
- Financial and administrative data integrity: EHRs lack the comprehensive automation to ensure the accurate financial and administrative data to protect the revenue cycle from rework, denials and write-offs. Hospitals need a customized and continuously updated and maintained rules engine to automatically audit all accounts for errors and save staff time by providing how-to-correct instructions in an exception-based workflow.
- Advanced real-time eligibility: To ensure claims will not be rejected or denied, and to provide trustworthy price estimates, hospitals need to automatically verify, extract and audit targeted benefit data along with patient demographic data. EHRs do not do this, and only the most advanced complementary solutions prevent denials while also using this information to drive guaranteed price estimates.
- Embedded training, reporting and benchmarks: Though many EHRs provide staff training on how to use the EHR system, few provide training on patient access, revenue cycle and insurance clearance. Patient access management needs tools to track and improve individual and team productivity, accuracy and competency with performance reports, trainings and testing that is auto assigned based on individual error patterns, scorecards and industry standard benchmarks.
- Improved throughput management: EHRs lack centralized, integrated solutions that allow staff to view patient information and flow, communicate and collaborate in real time across departments and eliminate the bottlenecks that frustrate both patients and staff. Comprehensive patient tracking and dashboards improve interdepartmental interaction and coordination while bi-directional texting improves patient communication and adoption of your patient portal by encouraging engagement.
- Digital financial and administrative engagement: Opening a useful “digital front door” requires much more than just communicating by text with patients about when and where their appointments will occur. Providing the tools for patients to self-register, create trustworthy price estimates and make payments helps transition financial and administrative tasks to patients and allows hospitals and health systems to redeploy staff resources to higher-value activities. Most EHRs aren’t equipped for that and choosing the right complementary partner will result in higher utilization of your EHR.
- Guaranteed accurate price estimates: EHRs require a technology partner to deliver the real-time eligibility transactions required to create cost estimates, but most do not provide the benefit-level targeted responses, automation and predictive analysis that is required to generate highly accurate estimates. Contracted and chargemaster rates are constantly changing; these need to be integrated with service-specific benefit information, real-time deductible balances and claims and remit analysis to create trusted patient estimates.
- Rules engine maintained by experts: EHRs have basic capability around patient access functions, but they do not have robust, customizable rules. Hospitals can reduce staff burden and identify and prevent avoidable denials with an intelligent rules engine constantly updated with remit denials analytics and experts who track regulatory and payer requirements.
- Automated prior authorization processes: Prior authorization processes are manual, and most EHRs provide work queues that still rely heavily on human intervention—putting a strain on already short staff. Hospitals need intelligent automation integrated into their EHRs to automate determination, submission and retrieval. Automating these three steps not only saves valuable staff time and resources but prevents no-auth denials and care delays.
Often providers have a disjointed patchwork of vendors and systems trying to provide an optimal patient access and financial experience. Besides the EHR vendor, one vendor typically provides online scheduling, while another delivers pre-registration and registration services. Yet another offers communication tools, such as automated appointment reminders, digital front door and virtual waiting room, while a fourth vendor provides eligibility, basic patient cost estimates and point-of-service payment processing. This list can go on and on, creating an ever-greater mishmash of vendors that adds to complexity, rework, dissatisfaction and higher costs.
It’s past time for piecemeal solutions that don’t fully solve the healthcare consumerism challenge. Today, it’s imperative for healthcare organizations to fully commit to improving the consumer experience. Adopting a single-source digital solution that empowers patients and healthcare organizations will help hospitals and health systems provide the convenient, flexible digital experience patients now expect so the next time they need healthcare services, they’ll come back.
Paul Shorrosh is the CEO and founder of AccuReg, a healthcare technology company that integrates with electronic health record systems to increase patient engagement by enabling digital intake, patient registration and price transparency across health systems, hospitals, ambulatory settings and telehealth applications. A solutions-oriented healthcare thought leader and entrepreneur, he has nearly 30 years of revenue cycle experience.