“Cutting waste while preserving critically important treatment is the holy grail of healthcare policy,” according to a recent New York Times article. Healthcare waste has been widely reported in recent years, and a primary target is administrative overhead. According to the Council for Affordable Quality Healthcare (CAQH), of the $372 billion spent on administrative complexity in the US healthcare system, $39 billion is spent conducting administrative transactions.
While there are some administrative transactions, such as claims, that have largely become electronic, significant additional savings are possible. One typically manual transaction that often starts a care episode is when a physician places an order or referral for their patient for a diagnostic procedure, an imaging study or a specialist consultation. Surprisingly, 90% of providers still rely on fax communications, and each fax or phone call requires an average of eight minutes to handle. Equally concerning, when the order isn’t sent by fax, the patient is frequently handed a paper order – leaving them on their own to navigate next steps, if they follow through at all.
By focusing on that critical step – when a physician orders care for their patient – healthcare organizations can cut waste and create a dramatically different care journey. An electronic order-first process, enabled by R1 Entri™, the intelligent patient experience solution, helps organizations streamline revenue cycle processes and improve financial performance, while delivering the best patient experience.
Manual, paper-based order and referral processes are just the tip of the iceberg. The entire journey from receiving an order to scheduling care to making payment can by disjointed and confusing for patients. In many cases, patients delay care or avoid it altogether when faced with multiple calls and a lack of transparency about insurance coverage and costs. Providers are just as frustrated when their patients are not able to easily receive recommended care. Add to that the burden on providers from laborious prior authorization processes that too often cause care delays for their patients.
For the health systems seeking to reduce patient leakage and attract referrals from the employed and independent providers in their market, there are many points where the process breaks down. When the faxed order is missing critical information required for the insurance prior authorization or the patient is incorrectly scheduled at a location not covered by their plan or the patient arrives for their appointment without the proper preparation, care delivery is interrupted, and valuable resources are wasted.
In addition to frustration on everyone’s part, the costs are significant. Denials, often caused by eligibility and prior authorization issues, have increased for 89% of hospitals and health systems, according to a recent AHA survey. Add to that utilization costs – one leading health system reports that 18% of imaging appointments go unfilled, often because of last-minute cancellations due to lack of authorization, incorrect scheduling or no-shows.
In an order-first process, the referring provider submits an electronic order that is instantly received by the rendering health system. Up-front checks at order entry eliminate errors and omissions, so the fully compliant digital order can trigger automated, streamlined revenue cycle and patient access processes. Simply put, orders reach a “schedule-ready” status much faster and with less administrative work.
Underlying this streamlined process is standardization that enables rules-based automation for financial clearance, scheduling, registration and payment. By standardizing requirements and processes across locations, best practices can be defined and embedded within technology-enabled workflows. This makes it possible for any user to be guided step-by-step through even complex processes with speed and accuracy. This drives out friction, while creating a consistent experience.
For the referring providers, submitting accurate orders quickly and efficiently is facilitated by easy-to-use tools. For providers using an EMR, background integration seamlessly delivers orders to the health system. For providers who currently fax or give patients paper orders, a simple online form with built-in short cuts for common procedures enables fast and easy electronic ordering. In either scenario, the process automatically ensures the order contains all required information, appropriate documentation is included, and the physician’s electronic signature is affixed. On the health system side, orders are ingested into a single repository for easy management by the patient registration and access teams. Plus, this repository gives referring providers visibility to patient order and scheduling status.
Once a complete, compliant digital order is in hand, the rest of the care process proceeds more smoothly. Automatic checks can immediately confirm the patient’s in-network participation, member benefit eligibility and health plan authorizations prior to scheduling. This speeds up financial clearance, obtaining prior authorizations, if needed, and scheduling. Ultimately, by eliminating the common errors and delays up-front, patients receive more timely care, and the health system prevents downstream denials and payment delays.
Adding to the inherent revenue cycle benefits of starting a care episode with a digital order is the new opportunity for deeper patient engagement. Digital orders progress to the schedule-ready status faster and open the door for inviting patients to access their care setting more efficiently while eliminating the obstacles that commonly get in the way. In short, it removes all the guesswork. The health system can proactively invite patients via an email or text message that includes a unique scheduling link. Patients can easily self-schedule even the most complex appointments using the link that already includes all the critical information: the exact exam/procedure ordered, ordering provider and reason for the visit. All the patient needs to do is follow the step-by-step guidance to select the location, time, and date that’s best for them. They can even be offered options to select a location closer to home or one that has earlier availability.
Once scheduled, the patient receives a link to complete all their paperwork before they arrive. They can complete their pre-registration and intake – starting by confirming or updating information given at prior visits – to provide insurance, fill out screening forms, sign consents, etc., all at their convenience. The patient can even pay their co-pay online before their appointment. They also receive preparation and arrival instructions in advance, so they can be well prepared for their appointment.
A digital order-first approach eliminates many of the common missteps that waste time and cause care delays and denials. Patients appreciate the flexibility and convenience of being in control of their own care. Providers welcome closed-loop communication that assures them their patient is following through, so diagnosis and treatment can proceed. And health systems can be more confident about driving adoption of self-service through their digital marketplace for a broader range of services and procedures, which further reduces waste and administrative overhead.
Working with R1, clients use Entri's rules-based processes to make up-front clinical and financial clearance steps more reliable. This approach assures the right patient is scheduled for the right procedure at the right location with all the right resources – every time.
To learn more, download our eBook, Build High-Value Service Line Volume – 3 Strategies for Confidently Expanding Consumer Self-Service.
Shawn Dennis is the Regional Vice President of Patient Experience Solutions at R1 RCM.