Patient Access and the Revenue Cycle: Insights from Cathy Pallozzi

Catherine Pallozzi, CHAM, CCS is the current President of NAHAM, the National Association of Healthcare Access Management; an organization which supports patient access services across hospitals and other access points, with the purpose of networking, educating, and supporting the patient access position. She also serves as the Director of Patient Access at the Albany Medical Center Hospital, a Level I Trauma Center which serves 25 counties in New York, where she has worked for 30 years. 

In our latest podcast episode, we had the opportunity to speak with Pallozzi and explore the ties between patient access and the medical revenue cycle. Here are our top insights from the conversation.

The Evolution of the Patient Access Associate

“Patient access associates” did not always exist under this job title. When Pallozzi first began work in the healthcare industry 32 years ago, a lot of the work performed by the front line staff was a part of the patient billing department: individuals dedicated to ensuring the flow of the revenue cycle, piecing together claims, and filling in the gaps of missing information. Today, Pallozzi explains, patient access associates are placed at all portals of entry to the hospital and doing work that may have previously been done upstream - collecting and ensuring correctness of demographic information, checking patients into surgery, and troubleshooting issues around insurance. She summarizes the transformation as, “The regulatory requirement that the patient access associate is required to know and execute has also increased significantly. And the revenue cycle knowledge that once was only possessed or known by that patient billing associate is now being transferred and expected by the patient access associate.”

But above all else, patient access associates are the front line in boosting patient experience. Collecting a patient’s health  information, as well as insurance information, PRIOR to service is one focus Pallozzi has noted - and predicts we will see more of in the future. Pre-service might seem insignificant, but it eases the patient experience and prevents patients from being “bogged down” while they’re trying to focus on receiving care.

Customer Service is Engrained in the Model

At Albany Medical Center Hospital, Pallozzi has taken part in her team’s revamp and restructure from a Customer Service Program, to what today is known as the Patient Experience Module. In adapting to healthcare consumerism, Pallozzi and her colleagues stress the “balance [of] making that patient feel welcomed, calm, feeling secure and confident in the person that they're meeting.” As patient access tends to be the first point of contact with a patient, there’s a need to have financial conversations while being sensitive and drawing upon that customer service framework; “be friendly, smile, introduce yourself has really become more scripting. So, that the patient experience is heard and felt during that interfaced encounter.” 

For this reason, hiring patient access team members has become more complex. Not only do you recruit individuals who are knowledgeable in healthcare and the medical collections process, but applicants with hospitality backgrounds can also prove valuable for these positions.

Having an Honest Conversation

Priming patients on the actual costs of service can be difficult, especially as the numbers we see today are becoming larger and larger. Pallozzi explains that the patient access team today bears a greater duty in being educated on various health insurance plans, deductibles, and copays. to better educate and prepare the patient for what their financial obligation will be versus what will be covered. Additionally, the patient access team should be able to discuss knowledgeably and explain why the patient’s financial burden is greater. She provides, “Many times what you'll see is a healthy individual take a high out-of-pocket expense because they don't have a lot of healthcare. Until unfortunately, something happens and now they're left with a $6,000 out of pocket expense because it's after $6,000 that their insurance plan kicks in. So those conversations become more delicate and a little bit more challenging because we're talking about bigger dollars.”

Patient Access: A Numbers Game

While one might not immediately think of improving patient access and patient experience as being quantifiable, Pallozzi believes that it must be; “I think that what many of the patient access professionals will tell you is Chief Financial Officers - they deal with numbers. And as a result, patient access needs to also deal with numbers.” The result of this downstream pressure has led to an extension of the statistics collected around patient access. Productivity and denials of claims have been historically tracked, but now, the bridge between patient access and ROI (Return on Investment) is being analyzed. One example here, is looking at how much patient access employees are doing on the pre-service end to alleviate work later in the “back-end collection process.” Further, average length of stay and number of patients bedden (occupying hospital beds) are key metrics in determining the collection process as, “[the] ability to collect once the patient leaves decreases by about 50% once that patient walks out the door.” It’s looking at: has this department contributed to decreased overhead and administrative costs, and done its part in collecting adequately? 

Finally, NAHAM offers 34 AccessKeys which span the entire field of patient access, such as scheduling of services in advance, denials point of service collection, call abandonment rate, how quickly patients can get in to see their providers (i.e. TNAA) and more. These AccessKeys enable benchmarking and serve as key performance indicators your practice can utilize.

--

As patient financial responsibility rises, we can expect to see more forces devoted to boosting patient experience and patient engagement from the moment a patient steps foot in their hospital or physician office. According to Palozzi, this will likely be in the form of pre-service, price transparency, and financial clearance. To learn more about our guest Cathy Pallozzi, NAHAM’s mission, and the AccessKeys which might be of use to your practice, please visit https://www.naham.org.