Michelle Stewart Way - CAHAM · HCAPS – Value Based Purchasing (VBP) Otani Consulting Group, Inc....

Michelle Stewart‐WayConsultant & Patient Access Specialist

Otani Consulting Group, Inc

1Otani Consulting Group, Inc.

Customer ServiceA Customer

A customer is the most important person on our premises.He is not dependent on us.We are depended on him.

He is not an interruption to our work.He is the purpose of it.

He is not an outsider in our business.He is part of us.

We are not doing him a favor by serving him.He is doing us a favor by giving us the opportunity to do so.

-Mahatma Gandhi


Is Customer Service Important? Yes and here are a few reasons why

It’s just the RIGHT thing to do! Quality Customer Service is a vital ingredient in a company’s ability to maintain profitability and continued success

It raises the bar of competition It effects future reimbursement

HCAPS – Value Based Purchasing (VBP)


Innovation Definition: is the application of new solutions that meet new requirements, inarticulate needs, or existing market needs. This is accomplished through more effective products, processes, services, technologies, or ideas that are readily available to markets, governments and society. The term innovation can be defined as something original and new that "breaks in to" the market or into society. One usually associates to new phenomena that are important in some way.


Innovative Tools Owner’s Manual Waitlist “Queue” Resolution kits

Hospital gift cards or free meal tickets Patient Portal

Ensure that it includes scheduling, pre registration, form requirements, bill payment, etc.

E‐Signature Kiosk Smart Swipe Silent Pagers Technology, Technology, Technology


Can do Attitude

Facts: Japan – 327 people per kilometer USA – 31 people per kilometer

Problem: Japanese markets are small, there is no room for large

melons, Japanese people want watermelon.


Can do AttitudeSolution: Square Watermelons!

How: Can do-attitude!


Is Customer Service Important?Yes It’s just the RIGHT thing to do!

"What's missing in the public discourse about health care is the fact that while medicine has the power to cure, it's humanity that holds the power to heal," said Lloyd H. Dean, President/CEO of Dignity Health“

SAN FRANCISCO, CA‐‐(Marketwired ‐ Jul 15, 2013) ‐ Dignity Health, one of the five largest hospital networks in the country, today kicked off a major national effort to engage and inspire people to promote acts of humankindness within the health care industry and beyond.


Empathy Staff must have Empathy

Yahoo! Answers:Empathy is important for our society because it is what facilitates our interactions and our connections to the other people around us. Empathy is a foundation for building a thriving and supportive community.

Why is it important for individuals to feel empathy? Because with out that sense of connection, with out that ability to consider other peoples views or feelings (or place ourselves in other peoples situations)... we'd all essentially have anti‐social personality disorder


Empathy: The Human Connection to Patient Care – YouTube*Cleveland Clinic

http://www.youtube.com/watch?v=cDDWvj_q‐o8


5 Ways to Improve the Customer Experience Listen to Your Customers Polite Make Promises that you will Keep Make an Extra Effort Build an Efficient Customer Service Team


5 Ways to Improve the Customer Experience Listen to Your Customers

Listening skills are a vital component of good customer service practices. Having empathy and listening to your customers includes, listening to their requirements, to their expectations and to their complaints. Listen to them with concern and believe in what they say. Know what they say. Underestimating the words of your patients will lead the facility nowhere, as, distrust in the customers shall leave them dissatisfied and no facility can consistently retain dissatisfied customers.


5 Ways to Improve the Customer Experience Polite

It is important for any business (healthcare or non) to remember that its customers are its valuable assets. Hurting the customers, being rude to them or disrespecting their opinions can lead to failure in business.

Disney, Nordstrom, Apple


5 Ways to Improve the Customer Experience Make Promises that you will Keep

Making many promises and keeping only a few of them is not a good customer service. Set realistic expectations. To build trust in the minds of your patients, you need to meet the expectations that you set. Moreover, make only those promises that can be kept.

Wait times Forwarding results or paperwork


5 Ways to Improve the Customer Experience Make an Extra Effort

The approach to only “register or collect information” while turning a deaf ear to your patients can prove dangerous. Taking a step or two forward in caring for your customers is bound to build comfort and trust in their minds.

Clinical vs. Clerical


5 Ways to Improve the Customer Experience

Build an Efficient Customer Service Team Know what your staff is doing! For Patient Access success you have build and maintain an effective customer care training program

Make Customer Service the first topic on your agenda for every meeting

Train staff to be polite and courteous with the customers (it’s not always a given)


Results Measure – Monitor ‐ Reward Share satisfaction survey results Act on results ‐ Celebrate the positive & Address the negative

Listen and observe your staff ‐ Hardwire* Develop tools

Suggested dialog / Scripting

Otani Consulting Group, Inc. 17

Scripting Caution with scripting, why? Facilities force their employees – without the least bit of sincerity – to make the same statements over and over and over again to the customer. “Did I deliver great service today?" “I hope I provided excellent customer service.” “I hope you received 5 star service today.”

Customers can sense sincerity and insincerity, communications they trust and mistrust


Scripting cont’d It IS beneficial to have a little bit of scripting andtraining and education with staff that relates to surveys is when the terminology you use to describe the attribute they’re evaluating is not obvious. Maybe you ask on the surveys about “registration process,” but when you talk to the patient in the hospital, you never referenced the phrase “registration process.”

It is beneficial to have a little bit of scripting when asking patients questions using terminology that they may not understand.


Role Play It’s critical that employees practice scripts or suggested dialog in a safe environment. You want to provide scenarios and examples.

When obtaining race and ethnicity an employee may ask “What is your race? What is your ethnicity?”. Implement that they ask with a reason statement, “California law requires that we obtain information regarding race and ethnicity for census reporting. Would you like to provide your race? Is that of any Hispanic decent?”

When unable to answer a questions an employee may say “I don’t know, ask at the department”. Suggest a statement like, “That’s a good question! I don’t know the answer, but I’ll be glad to make a phone call…”.


Facility Campaign Know your facility campaign and ensure it’s activelyimplemented in your department

Example of some facility campaigns:Dignity Health ‐ Hello Human KindnessHoag Hospital – OWN It!St. Joseph Health System – Fostering Sacred Encounters *Every encounter will be experienced as a sacred encounterSHARP HealthCare – AIDET: Five Steps to Achieving Satisfaction & 12 Behavior Standards


Case Study of “ABC Hospital”


GoalWorld Class Breast Care Center

“Dramatically improve patient experience”

Current Status Successful – Clinical Services Improvement Needed – Patient Flow and Process


Actual Patient Comments “Have already recommended the breast center highly” “*** is the best hospital, I’d recommend it to anyone that will listen”

“Only negative would be waiting in the registration line” “Not informed of estimated wait times” “I will return because of my doctor, but I’d prefer another facility because of the cumbersome registration process and the wait”

“Registration was very time consuming and bottleneck” “Why pre‐register if you have to wait in line and register”


Scope of Impact AssessmentOnsite visits at the following locations: ABC Hospital Scheduling, Pre‐Registration ABC Hospital Patient Access

ABC Breast Center

SchedulingPre‐registration

Financial ClearanceRegistrationBreast Center

Breast Surgical CenterTechnology

Areas and Processes Reviewed


Assessment Process Met with management and documented their expectations and

requirements for staff Observed employees in all areas (non‐clinical and

clinical)related to the Breast Center patients. *Included meeting with the volunteers at this facility

Documented every piece of information gathered at each customer “touch point”

Documented technical applications and information required for each application

Shadowed patients Conducted a time study for each step in the process Reviewed all forms and printed material related to Breast Center Conducted “Secret Shopper” calls


Keeping us from our goal• Incomplete pre‐registration process. Complete is defined by: establishing an account, collecting all

required data, insurance benefits verified, and financial counseling (if needed).

• Delays caused by multiple step intake process in Patient Access and Breast Center

• Duplicated work efforts

• Physical layout ‐ location & size

• Segregation of “like” work duties by different departments

• Physician orders (incomplete, inaccurate, missing)

• Multiple systems (not always integrated)

• MagView*

• Technology


Current Patient Interactions

Patient Exam

Completed

Scheduling & Pre‐Reg

Authorization *

Volunteer Patient Access Registration

Breast Center

Registration

Average of 5 Encounters and 21 Minutes


Collaboration

There is strength through collaboration which will transform the patient experience


SolutionImplement a Hybrid Model

Collaboration = The Breast Center Registrar ‐ combine position of Patient Access Rep & Breast Center Front Desk. This position would assume the responsibility for registering the patient, processing orders and

arriving patient in radiology system.


Imperatives for Improvement and Goal AchievementPatient Experience

Concierge DeskOptimize Patient Flow and ExperienceCommunication

Integration with Breast Center Integrate Staff from Patient Access and Breast CenterSeamless information handoffs

Facility ImperativesStake Holder Buy‐in*Approval from AdministrationImprove customer service with patientsImprove customer service with physiciansDecrease patient waitObtain all required patient information & forms ‐ ComplianceEliminate redundant process of reworkOperate within budget constraints


World Class Service Map Patient self schedules or requests an appointment via a patient portal (offer email or text

communication) Decrease the number of employee to patient interactions Check‐in all expedited patients and bypass registration or registration completion Kiosk/tablet includes complete any missing information e‐Forms, MagView questions During scheduling use a script: “Do you have xx minutes to pre‐register your account or

would you like to go on line to the portal? (for all depts., call center and clinical) Top 20 Breast Center Referring Physicians to use HIE for electronic orders or an

equivalent Facility communicate appointment reminders and instructions with patients via

email/text Contact for liability or missing items, if cleared, explain check in process Facility have a concierge desk in lobby to assist visitors and guest Patient Portal with ability for patients to complete Medical Health Screening form

electronically prior to arrival as well as account updates and payment processing


Solution – I of 2 PhasesOne Stop Registration and Arrival

Phase 1 Mirror the Concierge functions from the South Entrance at the Women’s Pavilion Entrance

A proposal for this had been submitted and is pending approval and funding.

Staffing has to be addressed by facility


Solution – I of 2 PhasesOne Stop Registration and Arrival

Phase 1 Occupy the “volunteer” counter space in the Women’s Center Pavilion entrance

Due to the high visibility of this space and patient convince this space is best suited for patient related services.


Breast Center Registration


Work / Process Flow Implement a modified scheduling/pre‐registration process for this patient

population Include required information during the scheduling process (i.e.

race/ethnicity) Develop New Patient pre‐registration requirements (obtain complete

demographics) Morning BC Registrar assembles charts for expected patients for the day and

identifies patients in two categories: Fast Track and Expedite These functions can also be performed prior to the date of service in‐

between patients as time permits Account activation to be performed in Affinity prior to patients arrival

End of day all “no shows” would be identified and accounts noted in Affinity

No Show patients would be contacted and encouraged to reschedule


Work / Process Flow cont’d Patient presents to concierge desk

Pts identified as Fast Track are directed to BC directly Call backs & Re‐checks (patients with no orders & do not require

MagView) Pts identified as Expedite are directed to BC Registration

Limited info obtained on expedite patients (demographic, orders, cards, sigs) BC Rep “pushes” label print to BC Front Desk to notify them of patient arrival

MagView provided to patient Patient escorted to BC Lobby Patient hands in or employee gathers MagView*

As time permits BC Registrar would escort patients to BC Lobby and collect MagViews

Both areas would collaborate efforts to collect MagView and return to BC Registration

Services are provided


Solution – 2 PhaseOne Stop Registration and Arrival

Phase 2 – Renovate front office space of Breast Center to allow for additional employees (dependant on funding and construction)

Move current counter forward and push the lobby area back and utilize overflow lobby if/when needed

Utilize silent pagers if necessary


Phase 2Concept Rendering


Next Steps Obtain approval to occupy real‐estate of workspace in the lobby Concierge Desk – approval and time line Determine FTE’s required

Obtain approval for staffing changes Determine reporting structure Manager & Human Resources

Job Description & Wages Develop new training program for Breast Center Registrars and

Scheduling Staff Identify employees Train employees in both Scheduling and Breast Center

Registration area


Next Steps cont’d Install work stations and equipment Work with Business Development on Marketing and Physician Order Education

Conduct ongoing weekly meeting occur between patient access, breast center, pre‐registration, and business office services

Monitor patient experience surveys, quality audits, regulatory requirements, and AR


CMS Tool used is Hospital Consumer Assessment of Health Plans

Survey (HCAPS)‐Survey asks discharged patients 27 questions about their recent hospital stay. This data is submitted to CMS.

Value Based Purchasing (VBP) – Medicare reimbursement will be adjusted for their core measures and patient satisfaction

www.hospitalcompare.hhs.gov Finalized rules for implementation for FY 2014, 2015, 2016 In the market today there are agencies that assist facilities with avoiding VBP penalties and turning HCAPS into a revenue generator (ex: Press Ganey, Cipher Health, Sound Physicians)

Regulatory Agency


Questions?

How to contact me:Michele Stewart WayOtani Consulting Group, Inc.714‐269‐[email protected]


Michelle Stewart Way - CAHAM · HCAPS – Value Based Purchasing (VBP) Otani Consulting Group, Inc....

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