Many decades ago, registering patients created the medical record — taking down a name, address, date of birth and other info and putting it into a manila folder to be handed to a physician.
Yet despite shifting patient expectations and technological improvements, that process has lived on in various iterations as though it were “a beloved tradition,” said Karen Shaffer-Platt, vice president, revenue cycle, patient concierge services, UPMC Corporate Services.
In her work at University of Pittsburgh Medical Center, many of those processes lived on longer than they should have because of a type of “academic arrogance” in which the organization assumed patients would wait and keep using the same processes for check-in, all in the name of seeing the world-class physicians. “These times are changing,” she noted.
Jean Bunyan, executive administrator, physician services, Department of Dermatology, UPMC Corporate Services, points to a GE study that found 81% of healthcare consumers are unsatisfied with their healthcare experience, and that the happiest consumers are those who interact with the system the least.1
“Our physicians always thought that the patient satisfaction was more on their end, but what we are finding since is that our patients are more satisfied when they have a more efficient service experience,” Bunyan said. “It’s basically similar to retail, in the way our consumers are patients. They want the same qualities out of their healthcare.”
“We used to think [our competitors] were Cleveland Clinic and Johns Hopkins and those other big academic medical centers over on the East Coast,” Shaffer-Platt said. “Now, we realize that our competitors are Walmart, Amazon and CVS.”
A new approach
Bunyan said that making patients’ lives easier and the check-in and checkout processes more efficient were necessary transformations to offer better value, in addition to other engagement strategies involving text messaging, online chat and online bill pay.
That value became clear when a UPMC survey found that out of every 100 patients, only seven required any kind of change to information about them already in the system. Shifting that process away from front-desk employees to kiosks with biometric capabilities — in this case, fingerprint scans for identification — for check-in and other services became a way to free up staff for concierge-style duties, Bunyan said. Those changes also extended to clinical workflows, in which nonphysician providers could spend more time coordinating care, but one of the biggest changes was the ability to have staff provide financial counseling to patients.
“As we’ve all seen, more and more of the financial burden is falling onto the patient than ever before, and so that becomes even more important,” Bunyan said. “We must take on new roles. … A huge role is to educate our patients early and often to help them understand, prior to the service, what their expected financial responsibility is going to be.”
A service culture
Self-arrival technology allows the front-desk staff to exemplify the transformation to a true service culture focused on patient advocacy. Bunyan said they even changed the job titles from “patient information coordinator” to “patient service coordinator” to reflect what the organization wanted patients to know about their roles.
The downside to this change was concern from front-desk staff that their jobs would be eliminated by technology, which Shaffer-Platt referred to as the “biggest mistake” in the process. “We needed to tell [the staff] what their next job was” while sunsetting their old roles as patients shifted toward using the kiosks and biometric scanners, Shaffer-Platt noted.
Once those fears were allayed and staff were encouraged to help patients navigate the new technology, kiosk usage rose from 14% of patients at 10 sites in 2015 to 80% in 2019 with kiosks in more than 850 physician office sites at UPMC on every single campus. This allows even more time for staff to communicate with patients about price estimators, payment plans and the shifting financial responsibilities that patients with high-deductible health plans have.
Check-in kiosks are fairly well known in places such as airports, but Shaffer-Platt noted that some people wonder about how technical or expensive the biometric scanner piece of the self-arrival technology is.
“When people say ‘biometrics’ … they think this is some big, sophisticated issue,” she noted. “You can buy that scanner for about $39.” The advantage, as she sees it, is that the biometric identification can be used in numerous iterations, including for remote-site mammograms or even for kiosks in which patients who are enrolled in UPMC’s insurance offering can make coverage selections.
But for all the patient-centric advantages to being able to self-identify with a fingerprint, Shaffer-Platt says the clinical workflows benefit equally. When looking at the opioid crisis and the worry about some patients doctor-shopping to obtain prescriptions, a biometric scan can identify a patient who might otherwise try to use a different name to get around a prescription drug monitoring program (PDMP) check. “We know who you are,” Shaffer-Platt said. “Your DNA comes with you.”
UPMC also standardized its equipment to each of the hundreds of locations where the kiosks are found. “Every single one of them has exactly the same equipment and exactly the same technology,” Shaffer-Platt said.
The downside to that mass implementation was the need to educate 850 service sites that all have only four or five staff members. To meet that need, UPMC opted to build training videos that could be uploaded to a YouTube channel for staffers to watch, and then form a team to help front-desk staff get the hang of things.
Undoing doubt, remodeling staffing
A familiar refrain from doubters of technology is that older patients will be hesitant to use kiosks or other technological advancements, but the UPMC teams studied generational cohort data and have a different story to tell: At one geriatric clinic, kiosk usage is at 82%.
The difference, Shaffer-Platt said, is that practice management and office managers accepted the change, “recognized the value and promoted it” in a way to help patients understand how much easier it would be. The more engaged management was, the higher the rate of usage.
To define an ideal level of service and ensure kiosk usage was optimal, the UPMC team performed time studies, mapped out existing workflows and analyzed volumes in those workflows for a pediatric subspecialty group. All told, about 10.5 full-time-equivalent (FTE) staff were used for check-in and 8.5 for checkout, which helped identify inefficiencies in staffing models and look at daily interval volumes on the hour for when the highest patient volumes occurred, which informed a staffing shift among pods within the group.
While adding the kiosks and scanners was perceived by many in the organization as a great project, Shaffer-Platt said, “it’s not a great project unless it got the results you want.” Assessing that data helped increase self-arrival kiosk utilization by 11%, while biometric check-ins increased by 29% and copay collection increased by 19%. “We didn’t want to just put in the technology — we wanted to achieve these goals,” Shaffer-Platt noted.
Prophet. “The state of consumer healthcare: A study of patient experience.” March 2016. Available from: bit.ly/2NunNbv.