There’s a raging debate going on in the Advisory Board offices right now between the people who think "patient access" is a critically important issue for health systems, and other people who think "patient access" is a critically important issue for health systems.
Yes, you read that right.
At least in our corner of the industry, “patient access” is a leading contender for Health Care Buzzword of the Year. It’s coming up in many of our conversations with executives, policymakers, and physicians. But, like so many jargon phrases, everyone seems to mean something different by it.
The hospital's front door
For some, “patient access” refers to the hospital department that’s in charge of registration, insurance verification, cash collections, and so forth.
The patient access department has always been an integral piece of how hospitals work, because the department touches every patient who comes through the hospital’s doors. If it’s possible, though, patient access has become even more important recently, for two reasons.
First, our researchers have found that many patient access departments could do even better at their core functions. Across the past several years, Advisory Board studies have identified best practices for patient access departments that, if adopted, would result in meaningful improvements. Many of these practices work best with technologies that support patient access workflow, but we have found examples of tactics that all providers could pursue, regardless of their IT infrastructure.
Second, the shift in the insurance market toward high-deductible health plans means that an ever-larger portion of the overall hospital bill will be the patient’s responsibility to pay. The Advisory Board expects that the development of public and private exchanges will accelerate this trend. So, how well patient access departments manage patients’ financial obligations is going to have a growing impact on hospitals’ bottom line in the years to come.
The health system's front line
As important as the patient access department is, though, the people who focus on health system strategy define patient access quite differently. To them, “patient access” represents everything that affects a patient’s ability to get the right care at the right time, in the right place.
The narrowest definition here focuses on centralized scheduling for ambulatory care sites, but as Advisory Board Consulting President John Deane wrote a few months ago, access is much more than scheduling: it encompasses operations, staffing, IT systems, facility design, and coordination between sites of care across the full continuum.
For instance, if a health care system has an effective centralized call center, but it doesn’t offer the hours or geographic location that meet a patient’s needs, its centralized scheduling abilities still won’t result in great access. Likewise, if the system doesn’t have the right mix of specialists, or enough providers to meet the demand for care, patient access will suffer.
One of the reasons that patient access has become such an important health system issue of late is that today’s patients are expecting a higher service standard with regard to access, with primary care in particular pushed to be a 24/7 offering, in person and virtual. Our 2014 Primary Care Consumer Choice Survey found that six of the top ten clinic attributes that primary patients value are related to access and convenience.
So in some ways, “patient access” is practically a synonym for health care delivery strategy—and it’s no wonder that Deane made the case that patient access is a CEO issue.
The health care delivery model
If that’s not enough to convince you of how important patient access is, improving access to care was a stated goal of the Affordable Care Act’s Medicaid eligibility expansion and health insurance exchanges. But the ACA took it a step further. To make care accessible, patients—and the country as a whole—need to be able to afford to purchase health care.
And for the nation to be able to afford high-quality care, many observers believe that we will have to reconsider our physician-heavy care delivery model. Thus, we will need to rely more on nurses and mid-level providers to deliver the full range of services they are qualified to provide—working at the “top of their licenses,” as leaders in health care education and policy describe it.
Not sure what we mean by “top-of-license nursing practice?" Let Katherine Virkstis explain:
No matter how you define it, though, patient access is sure to be one of the most important issues for health care providers in the years to come.
Access to Care,
Service Line Growth