Pre-admission procedures gives a hospital its first opportunity to positively impact hospital financial management. Pre-admission Affects Hospital and Patient Resources From the hospital’s point of view, pre-admission interaction presents the best occasion to schedule hospital resources appropriately in advance. The threshold question from the patient’s perspective is whether the anticipated health care is necessary. Not only is that something that insurance plans require in order for payment to issue, but each patient must consider this question in relation to his own physical condition. Patients in the new health care paradigm have a lot of issues to consider. Health insurance plans have changed significantly over the last few years. Many patients have a high deductible health insurance plan that often leaves them paying a deductible that can mean thousands of dollars laid out before the insurance company pays. One of the services that pre-admission interviews can provide a patient is letting them know up front what the procedure will cost. Questions such as whether the patient has to pay first and then seek reimbursement and who files the claim forms are important logistical issues. The patient may not enjoy hearing the financial news but he will appreciate knowing ahead of time an estimate of what he will owe, rather than going through the procedure only to find out the cost later. If he knows the cost up-front, then his consent to care is that much more informed. The pre-admission interview is the natural time to determine and satisfy insurance qualifications. The worst scenario happens when a patient shows up for admission to the hospital on the day of a procedure only to find out that the insurance coverage he has does not cover the procedure. This can result in surgery cancellations or in the patient having to cover the cost himself. Neither is a good scenario for the hospital. Statistics on Effective Pre-admission Processes In a 2012 case study of one particular hospital, patients who participated in pre-admission processes had shorter hospital stays (10.7 days) than those patients who did not (18.4 days), with 4 days less in pre-op and 4 days less in post-op care. That same case study found that day of surgery cancellations at the subject hospital were 13.9% compared to the national average of 7-8%. The cancellations were due to a failure to do required pre-op testing. The largest number of same-day cancellations were due to test results (28%). The hospital initiated a pre-admission process that required patients to complete pre-testing within 48 hours before surgery. The process required identification of locations for pre-testing within 72 hours before surgery. The hospital integrated the pre-admission process to require follow-up on patient readiness no later than 48 hours before admission. They added a database so everyone involved could check the progress of the pre-admission process. The hospital added a contingency plan for flexible staffing that would permit the hospital HR department to match staffing to the actual workload based on findings of patient readiness for admission. At the end of the six-week study, the most significant finding was that the hospital increased revenue by $1 million. The hospital’s overall cancellation rate fell to 8%, within the national average, and the hospital also realized an 80% reduction in cancellations on day of surgery. To read more about pre-admission process effects, read Kimberly John’s article, “Reducing Avoidable Cancellations on the Day of Surgery” and Jeff Forbes’ article “Why the Pre-Admission Process is a Critical Part of Transitional Care” which were an inspiration for this post. If you would like to discuss how your hospital might integrate a pre-admission process into your customer relations and human resource management systems, or anything else, please contact us. We look forward to helping you improve your hospital’s financial management.
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