The Executive Suite: Optimizing patient access operations

Efficient patient access is paramount for physician practices in today’s evolving health care environment. When patient access and financial clearance processes are outdated, the resulting inefficiencies create delays in the patient’s journey from initial contact to care access – delays that contribute to revenue leakage and can impact patient satisfaction.

Yet many physician groups are struggling to streamline and improve patient access operations, thanks in part to chronic staffing shortages, rising patient volumes, and more complex prior authorization requirements. As a result, they are falling short of core financial clearance benchmarks.

Consider a recent MGMA poll, which found that the percentage of co-payments collected at the time of service was 56%, down from pre-pandemic levels of nearly 90%. In another MGMA Stat poll, just 24% of medical group leaders reported their patient access improved in 2023, while 38% said it had worsened.

A synchronized financial clearance methodology, one centered around a well-designed and efficiently operated patient access team and modernized processes, can streamline operations. This will, in turn, accelerate revenue by decreasing payment delays caused by front-end errors, reducing rescheduled appointments, and improving patient satisfaction. It also aids in greater revenue capture by proactively identifying and resolving patient eligibility and coverage issues before they become denials.

Operational best practices

An effective approach to overhauling patient access leverages new technologies and innovative solutions that streamline operations by engaging people, processes, and technology through collaboration and communication. When combined with several best practices, these technologies help health care organizations effectively enhance patient access processes and improve revenue.

Defining a clear patient access strategy is the first step, which will ensure all processes are aligned with the practice’s goals and objectives. It should clearly define team members’ roles and responsibilities, as well as key performance indicators (KPIs) and metrics to track operational performance, identify trends, patterns, and gaps, and optimize the overall process. KPIs should include:

Scheduling lag time
Insurance verification rate
Prior authorization turnaround time
Financially cleared at time of service
Point-of-service (POS) collection rates
Patient satisfaction scores

Next, invest in technology that supports optimization of patient access operations and contributes to an improved overall patient experience. For example, automating routine tasks such as online insurance verification, prior authorization, and patient liability estimates can lower costs, improve efficiency, and reduce errors. Electronic health record systems, patient portals, and other digital tools can further streamline processes and improve patient satisfaction.

Other best practices to optimize patient access operations include:

Centralize the patient access delivery model to lower costs and create a consistent financial clearance approach to protect net patient revenue and improve overall patient experience through reduction of rescheduled appointments and a consistent experience across care settings

Standardize patient access procedures across the organization to ensure consistency, increase productivity, and minimize mistakes that result in re-work. Standardized workflows should outline each step of the process and the expectations for each team member involved. Future process changes or optimizations are more easily adopted when the processes and underlying training are already standardized.

Foster a patient-centric culture to improving patient satisfaction and loyalty. Staff should be trained to focus on the patient's needs and provide a positive experience throughout the process. Patient feedback should be solicited regularly to identify areas for improvement and address any issues promptly.

Properly train and educate staff on the use of technology and other tools used in the process to improve the performance of patient access operations. Staff should receive ongoing education on changes in regulations and compliance requirements as well as policies related to insurance coverage.

By following these best practices, physician practices can optimize their patient access operations, increase revenue, reduce costs and denials, and improve the overall patient experience.

Best practices in action

An East Coast-based provider was fighting against a rapidly growing patient census that required additional resources to manage the increased volume. Periodic special projects further strained internal resources, exacerbating already overwhelmed patient access operations.

By partnering with an outsourced services and solution vendor to act as an extension of its revenue cycle management team, including patient access operations, the group was able tostreamline patient intake and insurance verification processes and identify and collect additional revenue. Having a partner that offers a flexible service model also means the group can rapidly ramp up resources to manage new projects when they come up.

The relationship has allowed the group to more efficiently handle insurance authorizations, preventing delays in patient care. As a result, they have been able to expand service offerings – increasing patient and billing volume – and payer relationships. All while meeting authorization and monthly close-out goals.

The use of an “intelligent authorization tool” by a radiology practice that operates more than 180 outpatient imaging centers in 14 states, is another demonstration of the impact these best practices can have on patient access operations. By automating and optimizing prior authorizations, the radiology practice realized significant operational efficiencies, reduced denials, and improved overall patient satisfaction.

Specifically, by automating prior authorizations, daily staff production doubled from an average of 60 to 120 cases per associate while the percentage of exams requiring manual intervention fell to just 5-10% of all scheduled exams. The radiology team is also able to work authorizations further in advance from the date of service, improving from an average of 3 days out to 9 days out.

As a result, the practice can provide patients with more timely access to care and allow staff to schedule appointments in advance to fill unexpected gaps in schedules – all without requiring an increase in full time staff.

Optimized patient access

A well-designed patient access strategy that leverages a powerful combination of automation tools and proven best practices enhances efficiencies, streamlines workflows, and established the foundation for optimized patient access operations.

The result is a synchronized financial clearance methodology that eliminates many of the front-end errors that create delays and drag down revenues.