Better Results With 5 QA Tips for Epic Patient Access

Part two of a series about optimizing Epic to increase cash and cultivate loyalty in the Patient Access work of every hospital

Every kid dreams of building a treehouse. A place strategically located above the rooftops to see all…to plot neighborhood domination…to hideout from parents and that one mean dog down the street. The vision is there because the end goal is something tangible. The will to get the project done is there because the outcome is meaningful… a super, cool treehouse!

Unfortunately, in this childhood fantasy, there are several critical things missing. Kids (and sometimes even their parents) have no experience in treehouse building. Often, they lack the necessary skills to be able to use the tools safely. Finally, although they may have a design, or a sketch, they haven’t done the engineering quality analysis to make sure their design is sound.

So how is this treehouse-building experience relevant in optimizing Epic for Patient Access work?

Although the desire and vision may exist, these alone are not enough. However, enterprising young builders have created some pretty “Epic” treehouses! And, healthcare organizations have been successfully using their Epic EMR for Patient Access work. It just takes a concerted effort of a combined skill set to bring that vision to life. That’s where we step in to help bring your vision to reality (for your EMR… we know nothing about Treehouses)!

So, let’s pivot to everyone’s favorite word: optimize! To optimize your Epic EMR, you want to ensure engineering quality for everyday use by your Patient Access team. Whether you and your team have a wealth of experience optimizing Patient Access through Epic, or you are relatively new to the field, below are a few tips you may think about when optimizing Patient Access to ensure the best workflow possible.

1. Get the full data picture.

Make sure all modules and workflows within your Epic-based Patient Access toolset are integrated with the right QA solution. A solution is more than technology. It’s empowerment for the user (and your patients sitting in front of them) because it adheres together otherwise disparate data, features, workflows, rules, education, support, and analytics to deliver an accurate and efficient experience for your people. An example is the ability to cross-reference eligibility data to registration data. If an account has a particular insurance on it and the eligibility run returns an invalid or expired policy, those two pieces of information do little for a quality outcome if they are not evaluated together such that the registrar is held accountable for updating the insurance on the registration. A clear and cohesive experience for your staff will also generally lead to a more effective and positive patient experience.

2. Test the Workflow Prototype.

Prototyping is a valuable tool for testing design. You can use it to create a series of simulations, or an onsite simulation environment, designed to test people, workflows, and technology for real-life scenarios. Test your top 80% of scenarios and your top 3 most likely+costly. For example, when pre-authorization for services is required prior to delivery of care, but it is incomplete, is there a clear alert for the user? Is it accompanied by guidance for managing the registration forward to a qualified conclusion? Is there a workflow in place to correct repeated incomplete or inaccurate registrations? Does that workflow include both education and escalation? A prototype is not included in your Epic box. 

3. Set up a Safety Net.

We all want and need some flexibility in the functionality of our tools so we can adjust on the fly to accomplish the right outcome. Still there are some things that require a safety net. With proper prototyping, the net acts as an infrequent failsafe, a measure of protection for everyone involved. Without proper simulation, the net can act and feel like a limitation. An example of a safety net is a holistic QA solution. Leveraging Epic-based, field-level validations is the start, but the QA solution serves as the final validation which looks at a holistic view of the registration and its related data to ensure nothing slips through the cracks unaddressed. Sometimes it’s necessary to eliminate the option to easily bypass things that must not be bypassed considering all the downstream revenue cycle implications.

4. Ensure Real-Time Analytics and Alerts.

Every stakeholder on your team from Registrar to Supervisor to VP to CFO…whoever has a stake in achieving more pre-service cash collection, complex benefit determination, denial prevention, and a patient experience worthy of cultivating loyalty, they all need visibility to performance in their respective key performance indicators. And while the right view includes analytics for post-occurrence review, they also include real-time alerts (proven rules-based) and insights to ensure the right outcome. Your Epic box did come with some of these features. But to achieve true visibility requires real-time visibility.

5. Tap into a Patient-Access-Exclusive Community.

Patient Access is the tip of the spear in so many ways for your healthcare system. Accessing and participating in an active Patient-Access-exclusive community of people beyond your walls will help accelerate your successes, help you manage through payer changes, and ideate on ways to do things better. Patient-Access-exclusive Community did not come in your Epic box.

So, how do you act on these QA Tips for your Epic EMR?

First, make the decision to act. Pause and compare how this “tip of the spear” Patient Access improvement would deliver downstream revenue cycle outcomes. Once you decide to do something about it, you have two options:

  1. Take the DIY route by piecing things together a variety of supplemental technologies and helpers. This approach has pros and cons depending on your resource bandwidth and expertise in doing a QA optimization of Epic for Patient Access.

  2. OR get some help from Patient Access experts. Talk to your peers who’ve engaged the Pelitas team to help them accomplish their priorities with a QA optimization of Epic for Patient Access. I’m happy to put you in touch with them…a great way to tap into our resources right away! Just email me shuddleston@pelitas.com. 

That’s a wrap for today’s post. Stay tuned for our next series on optimizing Patient Access for MEDITECH.

If you could change one thing about your Epic configuration for Patient Access, what would it be? Share in the comments or feel free to email me at shuddleston@pelitas.com. If you found value in this post, share it with your colleagues and peers!