Case Study Background You have just been brought in to manage a portfolio of sev

Question

Case Study

Background

You have just been brought in to manage a portfolio of several specialty clinics in a large multiphysician group practice in an academic medical center. The clinics reside in a multiclinic facility that houses primary care and specialty practices, as well as a satellite laboratory and radiology and pharmacy services. The practice provides the following centralized services for each of its clinics: registration, payer interface (e.g., authorization), and billing. The CEO of the practice has asked you to initially devote your attention to Clinic X to improve its efficiency and patient satisfaction.

Access Process

A primary care physician (or member of the office staff), patient, or family member calls the receptionist at Clinic X to request an appointment. If the receptionist is in the middle of helping a patient in person, the caller is asked to hold. The receptionist then asks the caller, “How may I help you?” If the caller is requesting an appointment within the next month, the appointment date and time are made and given verbally to the caller. If the caller asks additional questions, the receptionist provides answers. The caller is then given the toll-free

preregistration phone number and asked to preregister before the date of the scheduled appointment. If the requested appointment is beyond a 30-day period, the caller’s name and address are put in a “future file” because physician availability is given only one month in advance. Every month, the receptionist reviews the future file and schedules an appointment for each person on the list, and a confirmation is automatically mailed to the caller.

When a patient preregisters, the financial office is automatically notified and performs the necessary insurance checks and authorizations for the appropriate insurance plan. If the patient does not preregister, when the patient arrives at the clinic on the day of the appointment and checks in with the specialty clinic receptionist, she is asked to first go to the central registration area to register. Any obvious problems with authorization are corrected before the patient returns to the specialty clinic waiting room.

Receptionist’s Point of View

The receptionist has determined that the best way not to inconvenience the caller is to keep her on the phone for the shortest period possible. The receptionist expresses frustration with the fact that there are too many tasks in the office to do at once.

Physician’s Point of View

The physician thinks too much of his time is spent on paperwork and chasing down authorizations. The physician senses that appointments are always running behind and that patients are frustrated, no matter how nice he is to them.

Patient’s Point of View

Patients are frustrated when asked to wait in a long line to register, which makes them late for their appointments, and when future appointments are scheduled without their input. As a result of this latter factor, and work or childcare conflicts, patients often do not show up for these scheduled appointments.

Office Nurse’s Point of View

The office nurse feels that he is playing catch up all day long and explaining delays. The office nurse also wishes there was more time for teaching.

Billing Office’s Point of View

The billing office thinks that physicians are giving some care that is not reimbursed because of inaccurate or incomplete insurance or demographic information, and observes that some care is denied authorization after the fact.

Patient Satisfaction Measures

All clinics in the multiphysician group contract with a customer satisfaction measurement firm that administers customer surveys. This survey is sent to a random sample of patients at each clinic to determine their satisfaction ratings for eight dimensions of outpatient and inpatient care for adults and children:

•           Respect for patients’ values, preferences, and expressed needs •      Coordination and integration of care •   Information and education •   Physical comfort

•           Emotional support and alleviation of fear and anxiety •        Involvement of family and friends •            Transition and continuity •     Access to care

Performance Data

The last quarter’s worth of performance data for Clinic X are found in the following table.

Overall satisfaction with visit rated as very good or excellent           82%

Staff courtesy and helpfulness rated as very good or excellent         90%

Waiting room time for patients is less than 15 minutes          64%

Examination room waiting time is less than 15 minutes         63%

Patient no-show rate   20%

Patient appointment cancellation rate 11%

Provider appointment cancellation rate          10%

Rate of initial insurance claim rejections because of inaccurate or     4% incomplete patient record documentation

Patient preregistration rate      16% Average number of patient visits per day           16 Range of patient visits per day            10–23

1. Identify the customers of the process to be improved and their expectations

Explanation / Answer

Customers of the process can be defined as the next person in line to receive the benefit or output of the process improvement.

Access Process Improvement can be broken into the following processes and their customers are mentioned beside them

Patient Appointment Process – patient and receptionist. Improving the patient appointment process (calling the receptionist) will directly benefit the patients and reduce the workload of the receptionists. Patients expect lower wait time during appointment and receptionist expect to reduce parallel workload.

Registration Process – patient, nurses, billing office. Improving registration process will help reduce wait time for the patients. This in turn will help the nurses who spends most of their time in explaining delay. This will also benefit the billing office as quality improvement will help the billing office in collecting proper patient information and billing them accordingly. Patients expect lower registration time, nurses expect less explanation to provide to the patients and billing office expects accurate information.

Insurance authorization Process – patient, physicians, billing office. The insurance authorization process can happen with pre-registration or otherwise. In both way, improving the process provides less wait time for patients. It provides reduced paperwork for the physicians and correct information for the billing office. Patient expect the registration process to be quicker and this includes the insurance authorization. The physicians expect not to run around for paper work and billing office expects the authorization report to be on time.

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