: FOR BABER MAKAYLA-NO HANDSHAKES PLEASE

P A G E11

H E A L T H C A R E R E G I S T R A T I O N A P R I L 2 0 0 2

Putting the positive in change creates an inspired work team Tips to succeed in ever-changing health care environ- ment

C hange may be constant, but itdoesn’t get any easier. Changetypically generates the same response: fear and resistance. The challenge, then, is to emphasize the positive in change.

In patient access, change occurs daily. It may be as simple as incorporating a new contract requirement into the registration process for patients covered under that health plan. Or, may be the facility has a new contract with another health plan. Or, perhaps a new employee has joined the ranks, placing increased responsibilities upon existing staff, as he or she gets up to speed.

A restructuring or redesign of the patient access process is change of a greater magnitude, and the corresponding fear and resistance response increases with the immensity of the change.

To effectively manage change, it is important to approach it from the position that change presents an opportunity rather than a problem. If change leaders focus on the positive and opportunity in change, the employees charged with implementing the change are more likely to view it as an opportunity rather than a problem.

Be open To effectively manage change requires that leaders be open, honest and proactive in addressing the need for change and how it will be accomplished.

Involve employees as much as possible, as this builds interest, understanding and enthusiasm for the change.

To involve employees, present the issue in need of change at a staff meeting to alert them to the problem in need of a solution. Invite employees to make suggestions on how to remedy a problem. This serves to: 1. encourage the people most affected by

the change to present their ideas, 2. involve those charged with carrying out

the change to come up with solutions that work, and

3. generate enthusiasm and buy-in, as employees are coauthors of the change.

Employees who are knowledgeable and involved in change will be most inclined and best able to adapt to the change.

Emphasis on the positive helps employees to embrace change No matter the type of change that challeng- es patient access, emphasize the positive to effectively incorporate change into the work environment. If employees see the benefit of the change—for them personally, and for the organization—they will be more likely to embrace change.

For example, a change on the horizon may be to preregister a greater percentage of scheduled patients, requiring a change in job responsibilities and requirements, or even job assignments.

In presenting the change to employees, emphasize the positive by noting the benefits derived from the change. Start with the “What’s in it for me?” perspective, and then move on to big picture issues, such as providing better service to patients, improving department performance and enhancing the organization’s ability to meet its goals and objectives in terms of service and financial performance.

In presenting the positive, be certain to provide details that cover: ■■■■■ The change process

Share with employees how the change will occur. • What is the timeframe? • Is change urgently needed, or is there

time to designate an employee task force to brainstorm and develop a solution?

• Who will be affected by the change, and how?

■■■■■ The goals Outline what goals will be accom-

plished due to the change. Again using the preregistration example, goals might include a higher percentage of sched- uled patients to be preregistered and a corresponding higher percentage of patient records for which insurance verification is completed prior to service.

Be specific in outlining the goals so employees know and understand what is expected of them.

■■■■■ Benefits to be realized As noted above, outlining the

benefits realized should begin with the “What’s in it for me?” perspective.

Change presents an opportunity rather than poses a problem.

Be open, honest and proactive in addressing the need for change and how it will be accomplished.

See Change, page 12…

P A G E12

H E A L T H C A R E R E G I S T R A T I O NA P R I L 2 0 0 2

Change—Continued from page 11…

Aspen Publishers, Inc. 7201 McKinney Circle Frederick, MD 21704

Periodicals Postage Paid at

Frederick, MD

Benefits under an improved preregistra- tion process might include: • a more complete and integrated

registration data collection flow, as the focus moves from simply scheduling patients to collecting complete patient demographic and insurance data prior to service;

• a smoother hand-off of more complete patient records to patient access employees who work with patients at the time of service;

• increased job satisfaction as employees are able to better meet performance standards;

• a new opportunity to ensure accuracy and completeness of patient demo- graphic and insurance data, as front- end employees can fill data gaps when patients present for care;

• improved job performance and an improved ability to meet or exceed performance standards;

• happier patients at the time of service as they are relieved of what is per- ceived as an onerous administrative barrier (i.e., on-site registration) to receiving care; and

• improved billing and collection on patient accounts, as claims processing delays caused by the need to complete missing registration data elements are eliminated.

■■■■■ Why realizing those benefits is important While similar to outlining the benefits

of change, explaining the why puts it all in

perspective by presenting a more global view. If it is a compliance issue, for instance, note that the change is impor- tant to ensure the facility retains its status as a Medicare provider because 45 percent of patients served are Medicare patients.

Encourage change agents Although the common response to change is fear and resistance, there are people who constantly seek ways to improve. These people also recognize that the only way to improve is to change. This does not necessarily mean that the old ways of doing things were flawed. Rather, it means that change is required to improve those processes and take accomplishments under the old ways to a higher level.

To generate higher levels of achieve- ment and performance, it is important to identify the change agents among employ- ees and encourage their input.

The reason: Change becomes more palatable and accepted if it is viewed as a value and comes from within.

A tip-off to a possible change agent is an employee who constantly asks, “What if we…?” or, “Why don’t we …?” or who states, “If only …”

These curious employees who want to know the reason behind a process often are employees who will push the envelope and seek to find a better way.

To encourage and nurture change agents: • Create an environment in which employ-

ee suggestions and ideas are welcome and valued.

Be specific in outlining the goals so employees know and understand what is expected of them.

Explaining the why puts it all in perspective by presenting a more global view.

Change becomes more palatable and accepted if it is viewed as a value and comes from within.

See Change, page 10…

P A G E10

H E A L T H C A R E R E G I S T R A T I O NA P R I L 2 0 0 2

Registration accuracy—Continued from page 9…

With a renewed focus on accuracy and supportive training, patient access employ- ees gain another important benefit: an understanding of the important role they play in the organization’s success.

Multiple benefits, by-products of improved accuracy As outpatient registration accuracy im- proved, several other benefits were real- ized. Hare emphasizes that the benefits realized were not solely due to improved accuracy as the MSO takes a team approach to improvement.

“Just as we were focusing on our approach on the front end, we did the same on the back end, in the third party area, the billing, the coding,” Hare ex- plains. “We also look at their individual productivity [in the business office]. We look at their quality every month, so that contributes to…our overall performance.”

Some key financial indicators that reveal the success of this team effort include: ■■■■■ A nearly 45 percent reduction in the num-

ber of days in accounts receivable (A/R) Days in A/R dropped from 89 at the

beginning of the improved accuracy initiative to 49 days.

■■■■■ A 20 percent improvement in net collections

The net collection percentage improved from 80 percent to 96 percent.

Net collection percentage is the dollars actually collected as a percent of what could be collected. In other words, once contractuals are applied, a health plan may pay only $50 of a $100 bill. If the entire $50 is collected, the net collection percentage is 100 percent.

■■■■■ Improved cash collections The improved registration accuracy

that fueled better financial perfor- mance—a reduction in days in A/R and increased net collection percentage— translates into a nearly $15 million bump in cash collections. ■

Figure 5

Sample accuracy report for quality of insurance information Patient access—Patient registration

Performance Improvement Summary Report For the period of 12/01/2001 to 12/31/2001

Division: Dermatology Insurance QA Benchmark accuracy rate: 95%

Divisional accuracy rate: 93% Variance: –2%

Total Total appointments appointments Accuracy Total no.

Employee arrived with errors rate of errors Jseebot 19 2 89% 2 Rbuehl 17 2 88% 2 Dsentar 18 0 100% 0 Mtremai 20 1 95% 1 Lwiggin 20 2 90% 2 Total 94 7 93% 7

ERROR TYPE SUMMARY Error Number Primary insurance not in system 1 Wrong insurance company address 1 Wrong insurance company name 3 Wrong insurance FSC 1 Wrong insurance subscriber name 1 TOTAL 7

Source: UAHSF Management Services Organization

Reader’s resource For more information, contact Andy Hare, associate director with the Univer- sity of Alabama Health Services Founda- tion Management Services Organization. Address: 500 22nd Street South, Suite 200, Birmingham, AL, 35255-5407. Telephone: 205/731-9274. Fax: 205/ 731-5302. E-mail: sahare@ uabmc.edu.

Reader’s resource

Focus on accuracy and supportive training.

Change—Continued from page 12… • Put employee suggestions into practice

when appropriate and possible. This will go a long way to ease the

change process, as employees see their contributions are valued and thus will be on the lookout for better ways of doing things.

Cultivate change agents By encouraging employee participation in meeting goals and achieving excel- lence, employees evolve to become the

instigators of change. The workplace then takes on a new

tenor. Change is less feared, as employees collaborate and challenge each other to find new ways of doing things.

Indeed, by nurturing change agents it is likely new change agents will be cultivat- ed, creating a more inspired and motivated team working together toward common goals. ■