Can you afford not to automate registration?

At the MGMA MPE financial conference, Dr. Muthu Alagappan and Lucy Sumner, Vice President of Revenue Cycle at Austin Regional Clinic, discussed how healthcare got stuck in a complex web of manual tasks, as well as how automating registration — a front-end process — has had far-reaching impact at ARC. The following article outlines the key points made in their joint presentation.

Registration is one example of a manual process that, done incorrectly, leads to further pain points later down the road with claims denials. Unfortunately, mistakes are not uncommon. Because registration has its own language around subscribers, members, and guarantors, there is confusion among both patients and staff. When information is transmitted primarily verbally, it’s easy to make mistakes.

Austin Regional Clinic’s Vice President of Revenue Cycle summarized the pain point, saying, “Front-end staff end up using guesswork as their daily tactic to get through this process, and hand it off to someone later in the revenue cycle to fix.” Automation can help relieve staff from this confusing work and improve accuracy, but there may still be lingering misconceptions about automation. 

“For a while, everyone I talked to about automation in healthcare said automation was only for back-end processes. I always thought that maybe that wasn’t true,” said Dr. Muthu Alagappan. Since then, through experience with automation at Notable, he has found his belief reinforced. Automation can, in fact, be very effective for registration. 

Some of the hesitancy to use automation likely stems from past technology investments missing the mark. Health systems have tried to invest in technological solutions, but many of those solutions have ended up creating additional work or not having as much impact as was hoped for. Why haven’t those approaches worked, and how can health systems choose technology solutions that will actually help?

Healthcare’s people problem

How did we get to where we are now? One key problem is an overly complex web of manual tasks, completed and maintained by a vast network of people. “We keep throwing people at every problem,” Dr. Alagappan said. For any given patient encounter, between 22 and 30 people typically touch that encounter in some way, according to our estimates. 

With so many people involved, processes are complex and confusing. Employees complete the work as best as they can, but often are rushed as they try to keep up with the volume of work they have to complete. Handoffs from person to person can cause communication errors and drop-off. 

Furthermore, health systems are finding that the number of tasks that have to be completed is only continuing to grow. “Between 2013 and 2019, there’s actually been a 52% increase in the number of front-end RCM FTEs per 100 beds in the acute setting. It’s requiring more people to do the same amount of work than it was even 5 to 10 years ago,” said Dr. Alagappan.

Continuing to add staff is increasingly unsustainable in this macroeconomic landscape. Labor wages have been rising 14.6% month over month — twice the rate of inflation. Supply expenses and drug expenses have also contributed to thinning hospital operating margins.

Meanwhile, healthcare burnout has reached epidemic proportions. The Surgeon General has issued an advisory on the urgency of addressing burnout as the workforce shortage grows increasingly dire. As it stands, the healthcare industry is predicted to be 3 million low wage workers short within the next five years, and 139,000 physicians short by 2033. 

Even from a strictly financial standpoint, health systems cannot afford to continue solving workflow problems by adding more people. At the same time, executives have found that not all of their investments in technology have paid off.

Why past technology investments haven’t fixed the issue

Despite the amount of investment in digital technology, progress has almost plateaued. This is because most approaches have too narrow of a focus, without addressing the deeper problem — that web of manual tasks. Dr. Alagappan noted, “Often, medical groups and health systems will make investments in what we call point solutions, like chat bots or scheduling solutions, and that particular vendor is perhaps really skilled in that single area of focus. But despite the investment, we find that the operational reality is that the amount of work that your staff is doing is going up, not down.”

This can occur with technology that introduces a new modality for staff to support. When organizations introduce chat bots, they find that anything exceeding the chat bot’s capabilities gets routed to staff, adding to their workloads. Or with some scheduling solutions, the solution may not integrate directly with the EHR, effectively creating another workqueue for staff.

Even when the point solution is very effective at a singular area of focus, it doesn’t address the overwhelming number of manual workflows that staff have to handle. And maintaining a network of point solutions quickly becomes untenable. “Getting point solutions to talk to one another is difficult,” Dr. Alagappan pointed out. “If you’re using several different point solutions, you then have to devote resources to getting them to integrate with all the different tools you’re using.” 

‍Why automation platforms are going to become as ubiquitous as the EHR

Automating only one workflow at a time provides some lift for staff — but automation is most effective when it can be built into the health system’s overall strategy, adding additional workflow automations over time across the care continuum. Dr. Alagappan predicts that over the next ten years, automation platforms will become as important as the EHR. 

Platforms simply provide more flexibility and extensibility, so organizations can dynamically assess areas of greatest need or which workflows best align with their strategic goals. Since there are over 200 manual workflows that can be automated in healthcare at this point in time, opportunities for automation abound, and automation platforms are best able to partner with organizations across multiple workflows. 

“Our view is, you’re probably not going to want to automate just one or two things, you’re eventually going to automate hundreds of things,” said Dr. Alagappan. It would be difficult to achieve that level of transformation using only point solutions. At the same time, it doesn’t all have to be done at once. Many organizations find it useful to start with a few workflows, and then choose to expand automation into additional workflows over time. ARC is one such example of an organization that took this approach.

‍ARC’s outcomes with workflow automation

ARC had already been using Notable to help with note and order workflows to alleviate providers’ documentation burdens, but as they examined their strategic goals, they decided to expand into registration automation. Lucy Sumner stated, “Getting patient access workflows right really is the key to revenue cycle success. I don’t think anyone here would disagree that optimizing those front-end workflows reduces a huge number of headaches further down the revenue cycle.” 

Registration can be a costly process, traditionally involving a number of people. Staff and patients have to communicate about confusing RCM concepts, and when in doubt, staff may end up resorting to guesswork. As a result of these confusing interactions, ARC found a disproportionate number of their claims denials were related to registration. Sumner noted, “Throwing more staff at the process doesn’t really solve the problems that we have.”  

To automate registration, Notable sends texts or emails to the patient a few days prior to their appointment, asking them to click a link to confirm their information. Once the patient confirms their date of birth, they click through a series of questions, upload their insurance cards or any other important documents that are needed for the visit, and then they are asked to leave feedback on the experience. 

Sumner found that patient engagement rates through this process are higher than they were through ARC’s patient portal. She also looked through patient feedback with Notable and found that patient satisfaction rates were high, across all age groups. The overall patient satisfaction rate for the new automated flow was 94%. In particular, patients were pleased that they could just take a picture of their insurance cards instead of having to type in the information, and they were excited that filling out their paperwork at their own convenience ahead of time could reduce their wait times once they arrived at the clinic.

Automating this workflow was also a meaningful improvement to their RCM processes. Ultimately, by automating registration, ARC was able to reduce their registration related denials by 50%, significantly reducing the cost of managing denials. This change can be attributed to improved accuracy — machines are better than people at selecting the right insurance plan and collecting information without errors. It also opened up bandwidth for staff to focus on higher-value work.

The effects of automating even this one workflow are far-reaching. Automation is a powerful tool that allows improvements to the front-end and the back-end to be made simultaneously, simplifying the complexity of healthcare. By adding registration to their automated flows, ARC made an investment in patient experience, staff experience, and their bottom line — and this investment paid off.

As organizations look to digital technologies to help them get through the staffing shortage, expense escalation, and a more competitive market, they need to assess potential partnerships for how much value the vendor can continue to add over time. Like ARC, health systems may initially seek help from an automation platform for one workflow, and add others as the need arises or to align with their strategic goals. The extensibility of a platform is key to addressing healthcare’s web of hundreds of manual tasks. 

Read more about ARC’s experience automating registration here.