The good news about healthcare scheduling and revenue cycle management

Published: Wednesday, February 19th, 2020

They’re not complex. They’re just complicated.

Here’s a distinction that offers hope to harried healthcare executives: “Complex” and “complicated” are two different things. Why does it matter?

Recognizing the difference between complex problems and complicated problems leads to their solutions. Theodore Kinni, a contributing editor for the MIT Sloan Management Review, says complicated problems are problems that follow rules. Complex problems, on the other hand, involve unknowns. Kinni describes the difference this way:

Complicated problems can be hard to solve, but they are addressable with rules and recipes, like the algorithms that place ads on your Twitter feed. They also can be resolved with systems and processes, like the hierarchical structure that most companies use to command and control employees.

The solutions to complicated problems don’t work as well with complex problems, however. Complex problems involve too many unknowns and too many interrelated factors to reduce to rules and processes.

A website commenter going by “ACARREIRA” posted this example: A car is complicated, traffic is complex. You can build a car or repair it, but you have to manage traffic, especially when you drive! You can achieve full visibility of a complicated system but not of a complex one. That’s why rules can be used with the former but not with the latter. [Emphases added.]

Healthcare scheduling and revenue cycle management are only complicated.

The issue is easy to spot.

Scheduling and revenue cycle are crazy complicated, it’s true, but being merely complicated, and not complex, is what makes it possible to set up systems to manage them. For example, consider the first step in the revenue cycle, registration:

The challenges of registration and scheduling

Registration requires a long list of inputs that are easy to screw up, so you need a system that guards against simple mistakes and omissions. But registration becomes especially complicated when your personnel are dealing with symptom-based calls. Some need emergency care!

A multi-location clinic system poses lots of challenges:

• Symptom-based scheduling is critical.

• Physicians often change their scheduling rules, and the system needs to adapt quickly and easily.

• Information needs to be accurate, current, and easy to find.

Failure to meet these challenges and more demoralizes staff and worsens the problems.

Managing registration complicatedness

An integrated healthcare provider in Urbana, Ill., has implemented a knowledge ecosystem that guides call center personnel through the delicate process of routing symptom-based calls in the course of scheduling routine care.

The Carle Foundation has more than 7,000 employees in its hospitals, physician group, health plan, and associated healthcare businesses. Its director of patient care says 55 schedulers are handling patient appointments for a network of 265-plus doctors, residents, advanced practice providers, and nurse practitioners.

As you can imagine, appointments for such a vast network of different providers can be very complicated. But their knowledge ecosystem guides them through all the various processes.

A mentor beside you all day

Schedulers follow a decision tree developed with clinical leadership. The workflow allows schedulers to ask specific questions about callers’ symptoms. The decision trees enable people with no medical training to confidently schedule patients or transfer them to nurses for triage.

“It’s the equivalent of having an electronic mentor sitting beside you every day,” the patient care director said. “It’s been lifesaving. These decision trees allow our scheduling staff to get our patients to the right level of care. We feel like we are saving lives, literally, every day,” said the director of patient care.

Because the process is merely complicated—in other words, it is not fraught with lots of unknowns, but instead can conform to an orderly process—Carle’s knowledge ecosystem can simplify registration and scheduling processes.

2 steps to implementation

At Carle, the first step to mastering the complications of hundreds of providers and thousands of patients was to put all their scheduling rules into their knowledge ecosystem, which in this case is the Panviva platform.

Just this first step of putting all information into a single source of truth provided doctors and schedulers a record of what and when changes were made, eliminating confusion.

The second step was creating the structure and workflow process. Getting the process done right meant starting from the beginning: tearing down Carle’s old processes and building them back up using workflow rules and decision trees.

Despite the complicatedness, the Panviva platform was up and running within four months.

The new system is much easier and faster to maintain than its predecessor systems. A scheduling specialist said, “In the old system it took about 20 minutes to update changes. Now it’s about 5 to 10 minutes.”

Now, the people of Carle are saving 50 percent to 75 percent of the time they used to spend updating the knowledgebase. And that’s on top of more reliable information!

Revenue cycle challenges

The scheduling example above is complicated, but to get really complicated, we need to talk about your revenue cycle.

Your revenue cycle combines the complicatedness of government regulations, insurance, multiple providers, coding, billing and more.

We’ve run out of room in this blog post to penetrate all the complications of revenue cycle management. Suffice to say, a robust knowledge ecosystem platform can deconstruct the complications and develop a practical guidance system for everyone who contributes to the revenue cycle, from registrars to doctors to accounts receivable personnel.

• Accelerate time to cash.

• Slash denials due to compliance errors.

• Raise patient satisfaction and HCAHPS scores.

A final word about ways to make work less complicated

A knowledge ecosystem such as the Panviva platform uses contextual awareness to know exactly where people are in their workflows. That way, it provides just the right information, just as it’s needed, which keeps the work flowing.

• Searches are unnecessary because the software links to the resources related to that specific stage of the workflow.

• The software pulls from one knowledgebase, ensuring a single source of truth.

• It eliminates the need to interrupt coworkers and liberates managers to coach and raise performance.

The Panviva platform is also notable for the way it makes it easy to harvest best practices and incorporate them in the process.

Summary

With its 100 billion neurons firing along one quadrillion possible routes, the human brain appears to be the most complicated system in the universe. The No. 2 most-complicated thing in the universe has to be a large healthcare organization’s revenue cycle and scheduling.

Fortunately, the elements of scheduling and revenue cycle management lend themselves to processes that can be mapped, organized, and served up to the people who need that information as they need it. They’re not complex. They’re merely complicated. The key is to use a knowledge ecosystem platform that makes the task practical and sustainable.

Revenue Cycle Coalition recommends the Panviva platform

As a healthcare revenue cycle consultant, I’ve helped organizations develop hundreds of operational policies and training materials over the years. I’ve also, all too often, been disappointed to see all of the effort that went into creating this much needed content wasted when the content is difficult to access. Even the most concise quick-reference guide or job aid won’t be used if it’s hard to access or buried somewhere on an intranet pathway. Moreover, we’ve all seen multiple versions of out-of-date printed instructions floating around an organization. While I’ve always had the best-practice instructions that my clients needed, what they needed even more was a knowledge delivery method that provided the answers users needed, quickly and easily at their fingertips. Panviva is the only solution I’ve found that addresses that need. It’s uncluttered, easy search functionality enables a user to quickly access the answers they need in the moment, along with the ability to drill down deeper for additional answers if needed. After all these years, Panviva is the first solution that delivers my content even better than I do! —John A. Thompson Jr., PMP, CHAM, CRCE-I, CHFP, CRCR, CHAA, Revenue Cycle Coalition


Tags: Health, Employee Experience, Compliance