Physician referral system reboot improves patient access

Two years ago, University Hospitals of Cleveland set out to solve problems within its patient access operations. The 2,000-bed academic medical center historically had challenges related to its call center operations, scheduling and referral guidelines and provider information visibility. The result was a less-than-perfect patient experience, high operation costs and lost revenue.

As part of a comprehensive restructuring of its access services--made in parallel with a physician referral initiative to match patients with the correct specialists--the organization invested in a software upgrade. Six months after the new system was put in place, the organization saw a 20 percent decrease in the number of patients who hang up while on hold with the call center, as well as a 25 percent decrease in the number of patients who are referred to out-of-network providers instead of in-network specialists.

The main problem patients had was accessing specialists and finding the correct physicians for their specific problems, explained Michael Nochomovitz, M.D., president of University Hospitals Physician Services, (pictured) during an exclusive interview with FierceHealthcare. The organization's goal, he said, is to provide seamless access in the Internet age to help connect patients with healthcare services.

"We had a number of issues," he said. "First, patients want ease of access to the services they require and pay for. Second, with increased complexity of medical care, particularly with specialists and subspecialists in an acute care medical center and servicing other hospitals, they want to make sure they get the right doctor, at the right time, at the right place with their preferences, such as gender, training or expertise."

Furthermore, he said, the organization wants frontline staff answering telephone inquiries to provide patients with the correct answers in the shortest amount of time possible.

To solve the problem, University Hospitals of Cleveland first tackled the logistical side of access by centralizing its scheduling systems. Staff who answer the phone or review electronic requests for appointments are now housed in one department and all receive the same training. In addition, the organization upgraded its scheduling system to cover all physicians in the enterprise, including community-based or subspecialists at major hospitals.

"This gave us the opportunity to have more fluid scheduling across the enterprise at the point of the service," he said. "For example, after you see your family doctor for a shoulder problem, and you need a follow-up appointment with an orthopedic surgeon, you are given an appointment with someone who is an expert in the shoulder as opposed to seeing a spine surgeon."

Once the organization dealt with the infrastructure, it worked with Kyruus to invest in software to enable physician selection with a big data approach. It took the physician referral system to the next level, Nochomovitz said, allowing patients to select their own doctors and schedule appointments.

The system also provides schedulers with access to information previously unavailable to them. If a patient has a problem with psoriasis, for example, and the scheduler misspells it, the program will still list external and internal physicians who specialize in treating the condition. The system includes a comprehensive inventory of conditions, including medical and lay terms, to allow schedulers to respond to patient questions. Schedulers can also put in additional information to filter the list, such as patient's gender preference, language and time preference. The aggregated data is sent directly to the scheduling system so the scheduler can set up the patient with the right appointment at the right location. The entire process takes just minutes, he said.

The result is improved staff efficiency, as schedulers no longer need to consult books, manuals and spreadsheets to find the information. It also optimized the use of physicians, Nochomovitz said,

The process leverages technology and big data so the organization is more efficient. Patients expect booking a doctor's appointment to be as easy as booking an airline ticket, according to Nochomovitz.

"What it comes down to is, how many people would buy a product online without knowing whether they were getting the correct product?" he said. "How many would order a repair for a refrigerator and get someone in-house to fix a television? As we try to reduce healthcare costs and improve efficiency, we are taking steps to avoid unnecessary encounters in healthcare, avoid duplication, and do the right thing, for the right patient at the right price."

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