Digital transformation initiatives that focus on improving the patient experience are high priorities for many healthcare providers. One journey that patients take when initially engaging with a provider is the processes of scheduling and registration. At many facilities, these processes are still done manually, with as high as 88% of appointments in the US being scheduled by phone, and registration processes done in person or on paper. Besides the inconvenience this presents to a population that is accustomed to online experiences, it also leads to potential data collection errors that may have downstream impacts such as missed appointments, as well as lengthened insurance claims processes.
This post is a part of our Revenue Cycle Management Optimization blog series. Here, we dive into registration and scheduling to show how Intelligent Automation can be incorporated into many parts of the process. In doing so, healthcare providers drive streamlined customer experiences, higher revenue, as well as lower costs by reducing administrative workload and eliminating errors.
In the US, depending on the type of visit, between 5% and 30% of patients miss their appointment. Each one of these missed visits drives much more lost time than simply what is scheduled with the physician. There are follow-up phone calls to validate that the patient is a no-show, the lost time spent when scheduling the patient originally, the time spent in re-scheduling the patient for a future appointment, not to mention the time the physician spent in review of past history and preparation of notes for the missed appointment. When these factors are combined, it’s easy to see how no-shows alone cost the US healthcare system $150 billion per year! What this figure doesn’t account for is the lost opportunity cost of that unused timeslot where a provider is still paying for administrative staff time without generating revenue.
Some of the reasons for the high rate of missed appointments include:
A 2019 study by Athena Health1 also found that when a patient misses a single appointment with their primary care physician, there is a 70% chance that they will not return for follow-up within a year and a half period!
Besides the financial implications of no-show appointments, there is, of course, a clinical implication. Missed appointments drive gaps in continuity of care, such as preventative screenings that are missed, medication monitoring that can’t be conducted, and acute illnesses that may evolve to chronic conditions. This has a direct impact on an individual’s health, but also drives up the cost of healthcare overall as preventative medicine now turns into reactive or diagnostic care.
Another impact of manual scheduling and registration processes can manifest later in the appointment lifecycle in the form of extended claims processes. While electronic patient registration solutions are available, many providers still require patients to fill out forms manually. The data is then entered into electronic systems, while also manually keying in demographics and insurance information based on ID cards. Any time data is entered manually, not only is administrative time being spent on a low value activity, but there is a high probability of data entry error. This data entry error up front can cause additional steps later in the process, such as return denials which must then be corrected.Not only does this increase the time to revenue for the provider, but also inconveniences a patient who may be notified to pay out of pocket or re-provide their eligibility information for claims resubmission.
While it’s easy to understand the costs of unused scheduling capacity and no-show appointments, there are many ways that Intelligent Automation can be used to drive down the number of missed appointments while also improving patient experience. In fact, when thinking about automating patient-facing interactions, our recommendations to our clients are to ensure those efforts are combined with patient experience programs that map end-to-end patient journeys. In this way, the right technologies, including automation but in many cases additional tools to drive omni channel and personalized communication, can be applied in the most effective way. When looking at automation’s role as part of a patient experience program, these are some of the ways it can be used to drive improvement:
One of the most straightforward uses for automation is in sending automated appointment reminders. While many providers do communicate with a patient prior to an appointment, this communication is often missed by the patient, or forgotten by a provider in the case of manual phone call. Significant reductions in no-shows can be driven through communication that continues 4-5 days prior to appointment, through to the day of appointment. This is especially true if responses are not received to initial communications. Automation can be used as the glue to drive communication via automated phone, SMS text, or tools that provide personalized communications feeds with patients. Two-way communication also means that automation can receive a response from the patient, and automatically update appointment status within the EMR or scheduling system to give the maximum lead time possible in filling that slot with another scheduled or same-day appointment.
Automated Scheduling and Rescheduling
Automation is often used to support automated scheduling workflows, as well as rescheduling, when a patient indicates that they are going to miss an appointment. Intelligent Automation forms the glue between web, chat or SMS based scheduling workflows, and EMR or scheduling systems. For example, automation can be used to query for available timeslots to present this information to patients through these various communications channels. Once the patient selects their desired time, automation can not only schedule the appointment, but also begin to initiate any type of prior authorization process. If a patient indicates that they are going to miss an appointment, automation can be used to present a patient with future appointment options to allow immediate rescheduling. This can help mitigate situations where patients miss appointments and do not reschedule for a year or more.
Coordination of Transportation
Because lack of transportation is a concern for many, especially older, patients, through the automated appointment confirmation process, additional questions can be asked if a patient requests cancellation. In this case, if the patient indicates a lack of transportation, automation can be used to coordinate ride-share services like Uber or Lyft.
Pre-Appointment Patient Instruction
Once an appointment is scheduled, automation can be used in conjunction with omni channel communications tools to ensure patient education is being sent proactively. For example, special arrival instruction and procedures, as well as directions, can be communicated. Automation can also be used to drive communication of educational procedure information or reinforce pre-appointment instructions that a provider may have given (what can/can’t be eaten, etc.).
In many cases, using known data about a patient such as past history, appointment times, demographics, holidays and more can be used to predict no-show appointments or reschedule requests with a high degree of accuracy. Automation can be used to create the dataset necessary for machine learning to identify patterns in data and make these predictions. Prediction of future no-show appointments can allow even higher levels of appointment confirmation, or allow additional appointments to be booked with other patients when there is high confidence of a no-show occurring.
Outside of the scheduling process, automation is often employed during registration. This can be useful even prior to a patient arriving for an appointment. For example, as a convenience feature, patients can be allowed to upload identification or insurance card photos through a smartphone registration application, or even an online check-in or chatbot. Automation can use intelligent OCR (Optical Character Recognition) techniques as well as machine learning to extract necessary data from those ID cards to complete registration processes with a higher degree of accuracy than manually entering this information. In doing so, automated insurance verification can begin well before appointment time to give ample time for follow-up with a patient should it be needed. Because of the higher accuracy of automated registration, the likelihood of insurance claims errors is also reduced, leading to fewer denials to follow up on, and decreased time to revenue.
While there are many additional applications of Intelligent Automation to registration and scheduling, the examples above demonstrate immediate actions that can be taken to reduce no-show appointment numbers while streamlining processes and improving customer experience. By keeping patients from missing appointments, a positive cycle is reinforced: time slots for physicians remain filled in the short term while overall retention numbers are improved long term!
pureIntegration has been partnering with our customers to automate their most challenging business and technical processes for over 15 years. We offer flexible engagement models and a factory approach to automation development—from building and maintaining automation long term as a managed service, or by building internal development expertise and an operations model (Center of Excellence) to drive automation initiatives, our team can get you off the ground quickly. Engage with us today to find out how to put 80,000 hours of automation experience to work for you!