It’s no surprise that payment models in healthcare are transforming. What may come as a surprise, though, is how quickly these models are transforming. Healthcare is rapidly moving to incorporate measures of value into payment models, with more than two-thirds of payments expected to be based on value measurement in five years, up from just one-third today, according to a study conducted by ORC International.1

The study goes on to state that most of the key obstacles that need to be overcome during this shift are technology-related, with one of the biggest technology problem areas being data collection, access, and analytics. Hospitals and health systems’ financial health have now come to depend on getting and accessing accurate and current data, documenting data and, ultimately, delivering good clinical outcomes.


Defining the mid-cycle

The mid-cycle occurs where the revenue cycle meets clinical interactions and patient access. A value-based reimbursement system requires tighter integration of clinical records and other systems with providers’ financial systems. Today, however, a key bottleneck for many hospital revenue cycles occurs in the link with the clinical side. Identifying this bottleneck area, and learning how to optimize it is critical for healthy financial performance, solid clinical performance and for patient satisfaction and engagement.

Now, how can we optimize it? Start small.


Capturing data before the appointment

There is an opportunity to engage patients in a pre-registration workflow, pre-service before they have even stepped foot on premise, on a personal device, such as a laptop, smartphone or tablet. Several items go into a pre-registration workflow, some of which can include a confirmation/update of a patient’s demographics and insurance information, completion of forms and/or questionnaires, and bill payment. Capturing that information beforehand has a great impact when it comes to anything that needs to be sent to the patient, such as appointment reminders, billing, mail order prescriptions, and lab results.

In addition to asking for demographic information confirmation, you have the opportunity to ask clinical screening and clinical intake questionnaires relevant to a patient’s appointment as part of the pre-registration process. These questionnaires can help you determine any number of issues (e.g., the patient is scheduled for the wrong appointment) before they ever show up on-site. Another example is when a patient is scheduled to receive a procedure at a certain location, but, based on his/her answers to a questionnaire, it turns out the patient is in a wheelchair and the original appointment location wouldn’t be appropriate because the spacing and equipment don’t allow for the size of a wheelchair.

It could have been a disaster for the patient to actually go to his/her appointment, not only because it would have been a waste of time for the patient, but also because the hospital would have wasted an appointment time slot with expensive equipment, and would have to spend time finding a new appointment time and location for the patient. But, through a questionnaire given pre-service, this can be found out and flagged in advance.


Facilitating data capture on-site

Just like the airline industry, where travelers can check in for a flight on a kiosk at the airport, patients can do the same at a hospital or health system. The big advantage to having an on-site registration and check-in solution is healthcare facilities can capture data on patients who they were not expecting to arrive, like a walk-in.

Instead of registering and checking in face-to-face with a member of the hospital staff, kiosks, whether they’re free-standing, wall-mounted, table-top or tablet kiosks, can be designed for a quick 2-minute interaction. They are an effective way to identify patients on-site, give them questionnaires, take them through relevant workflows, and triage them.

Even the most basic question, “Are you here for a scheduled appointment or are you here as a walk-in?,” can allow healthcare facilities to optimize their patient flow. Now, if you take it a step further and ask questions like, “What are your symptoms? What is your pain level?,” healthcare facilities really have the opportunity to prioritize patients and get them to the right place in a timely fashion.

Kiosks also can be used to educate or inform patients; for example, if healthcare facilities want to encourage their patient population to get flu shots or to think about getting tested for a certain disease, they could display notifications or reminders on these kiosks.


Automating clinical intake documentation on the front-end

There is a lot of clinical intake documentation that is based on simple interviews of patients that can be pulled out of the clinician workflow and handled electronically. This information can then be feed directly into the EMR. We call this concept of patient-directed digital questionnaires a “virtual clipboard,” a tablet or kiosk with the same questionnaires patients would have been given in paper form, but are now just automated.

The virtual clipboard is a practical, low-cost way to save time and start providing relief to clinicians during their clinical workflow. Specific areas that can be automated using a virtual clipboard include:

  • History of Present Illness
  • Medication reconciliation
  • Chief complaint
  • HIV, drug, alcohol screening
  • Behavioral and mental health screening
  • Antibiotic overprescription screening


Identifying and optimizing the mid-cycle

These results are certainly within reach. By taking a small step in extending patients the ability to enter their own data, healthcare systems can strengthen their documentation initiatives, which will ultimately optimize their revenue cycle and bolster their bottom line.

  • The 2014 State of Value-Based Reimbursement, ORC International, 2014.
Janie Tremlett
Janie Tremlett is GM of Patient Solutions for Vecna. Responsible for more than 50 successful technology implementations in healthcare, Janie has held numerous positions including Sr. VP & Chief Marketing Officer at Concordant, CIO/CTO at Commercialware and Commonwealth Financial Network, and Director of Information Delivery at Blue Cross/Blue Shield where she managed the development of one of the first practice management applications. She has also been a key contributor to the electronic insurance claims and EDI standards committees, MGH’s Internet Health Care Forum, and a number of national technology initiatives. Janie holds a B.S. in Mathematics from Union College and a MBA from Syracuse.



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