Patient Pre-Registration Tips for a Quality Consumer Experience

How pre-registration streamlines patient onboarding

Pre-registration can simplify the onboarding process by collecting patient information prior to the appointment wherever possible, according to a module from the AMA Steps Forward project.

The module, authored by practice leaders at Asante Physician Partners, explained how pre-registration can benefit a practice’s patient flow.

“Pre-registration is conducted by a new patient coordinator (NPC) over the phone or in person prior to the initial visit,” the guide explained.

“This conversation enables the NPC to capture all of the required demographic and payment information in the registration software and enter medical information, including medication list, allergies and medical history, directly into the electronic health record (EHR) to reduce the data entry work required of clinicians at the patient’s initial visit.”

Pre-registration requires significant coordination between several moving parts, says the Healthcare Financial Management Association (HFMA). A high-functioning pre-registration system usually includes:

• A dedicated unit, team, or staff member depending on practice size
• Integrated systems and processes between scheduling and pre-registration
• A policy of postponing services if the patient is not preauthorized or pre-registration is incomplete
• Available financial counseling

Financial counseling includes informing patients about their financial responsibility and copayments, organizational policy about point-of-service payments, and reminders for patients to bring any necessary information about their health insurance benefits.

Pre-registration can save time for staff as well as patients, according to a study from Baylor Medical Center. After implementing a pre-registration system at Baylor Jack and Jane Hamilton Heart and Vascular Hospital, staff members saw improved patient flow and more complete patient health information.

“Nurses frequently spend time waiting for patients to think through their surgical and medical histories, and they often find that the patients have forgotten important elements,” the researchers recalled. “Time is lost during this process and, more importantly, information is missed because patients cannot recall their history during the interview.”

The hospital experimented with maining mailed out pre-registration packets to patients. These materials were sealed in bright pink envelopes with large print to ensure patients could not miss them or mistake them for spam mail.

The pre-registration packets included instructions, admission forms, patient safety, allergy, and comorbidity checklists, procedure preparation checklists, facility maps and information packets, and letters from practice administrators and patients’ physicians.

Pre-registration packets can also include other materials, depending on an individual facility’s unique needs and goals.

All patients included in Baylor’s pre-registration rollout completed at least some of the forms. Fifty-one percent arrived with fully completed forms.

Despite some pre-registration forms not being entirely complete, the practice still improved patient wait times and patient flow. Other system benefits included:

• Patients had ample information about what to expect during their hospital stay, usually decreasing patient anxiety and increasing patient education
• Patients can complete the pre-registration forms at home, where they may be more at ease can readily consult their medical histories
• Nurses have access to patient information that helps facilitate individualized, patient-centered care that taps specialty consults
• Clinicians can focus more on patient-provider relationships and personal patient care, driving both patient and provider satisfaction

Designing a patient pre-registration process

Healthcare organizations should begin designing their pre-registration processes with a careful self-assessment. Which current elements are working? Which ones are not? Where are patients left with questions, and where is patient flow slowing down?

For example, identifying unanswered questions about patient billing will reveal that NPCs should review payment processes and insurance policies more thoroughly.

Organizations should also consider electronic methods, such as specific onboarding systems or systems within the EHR.

At Mentis Neuro Health, the Texas-based rehabilitation center, Porter and his team tapped automation to condense registration processing time.

“We drop everything into the system starting with the first contact with the patient and then automated each step of the process,” Porter explained.

“We set service level agreements and time limits for each step of the process, doing everything in parallel when we can. We escalate our efforts whenever those time limits are exceeded. That’s how we squeezed several weeks down to just a couple of days at this point.”

Increasing the speed with which Mentis enrolled patients improved satisfaction and increased the likelihood that the patient would choose to rehab at Mentis instead of another clinic or at home.

“Patients and families are trying to get information as quickly as possible because that is something that lowers their stress,” Porter pointed out. “They make a commitment to say that they are going to Mentis and here is what they have to gain from us. Getting them through that period of uncertainty very quickly has raised satisfaction.”

Organizations without the capital or the same complex needs as Mentis may consider implementing a more manual pre-registration process. Improvements can be as simple as pre-appointment phone calls to new patients or mailed registration letters, such as in the Baylor example.

“You can send patients a welcome letter with pre-registration prompts, asking them to prepare a list of their medications, and allergies, and their medical history,” AMA advised. “This will save time and improve accuracy whether the pre-registration occurs over the phone or in person.”

Regardless of the medium, organizations will need to work together to determine which data points they will need to collect from a new patient. A primary care practice will often takehave a more prescriptive approach, usually collecting patient histories, information about other specialists, health insurance information, and other demographic data.

Some specialists won’t need every single patient detail, but should consult with administrative and clinical staff to determine what will be appropriate.

This should be a team effort, according to the AMA guidelines. Front-end staff, patient-facing staff, physicians, and health IT workers will be important for designing the system. Additionally, organizations with a patient-advisory council should tap that resource for this collaborative process.

Developing a pre-registration script

After determining practice-wide goals and protocols, organizations should create a pre-registration script. The NPC will use this script when talking with patients to ensure the staff member does not miss a certain prompt or forget to ask the patient an important question.

“The NPC will save time and make fewer errors if he or she can enter the information in the same order and in the same fields during the pre-registration discussion with each new patient,” the AMA pointed out.

The pre-registration script will be a key training tool. AMA recommended posting the script in areas where NPCs can reference the text as needed.

It is likewise important to emphasize positive communications with patients. Pre-registration is often the first impression patients receive of a clinic. While organization is critical for facilitating a positive experience, as is patience, friendliness, and respect during patient communications.

Organizations can embed some of those positive communication habits within the script. A standardized greeting, for example, can help start NPCs on the right foot. However, organizations must supplement the script with customer satisfaction training, thus giving a more authentic and agile skillset to NPCs.

Identifying and training staff partners

It is also integral that practices select the right staffers to take on NPC roles. This is a patient-facing role that demands strong customer service skills.

“NPCs should have exceptional customer service and telephone skills, as well as competency with your practice registration software and EHR,” AMA stated.

“The NPC should be trained to enter patient information directly into your practice’s systems during the conversation with the new patient so he or she is not filling out a paper form then re-entering or scanning the information into the record,” the organization added.

In some cases, nurses will be best suited as NPCs because they have the clinical expertise alongside the administrative and interpersonal skills necessary to create a positive patient experience.

Healthcare organizations should look for NPCs who can fulfill the following responsibilities:

• Guiding patients through the pre-registration process
• Informing the patient about any items to bring to the appointment
• Obtaining accurate and complete demographic, insurance and medical information
• Checking patient insurance eligibility and informing the patient of any co-pay amounts that will be due at the time of service
• Scheduling the patient’s appointment, giving the patient a copy of the appointment date/time and directions to your practice
• Scheduling any laboratory or other tests based on your practice’s protocols
• Answering questions about the registration process, practice and medical team

Organizations should also be prepared to offer training on some medical terminology, procedures, and workflow. Having new-hires shadow a seasoned NPC is one of the most effective strategies for NPC training, AMA recommended.

In addition to training, organizations must ensure NPCs have adequate workspace to complete their tasks. If NPCs are registering patients by phone, they will need their own private offices because NPCs will likely be required to share or repeat protected health information (PHI) out loud. If PHI is audible to unauthorized individuals, it could lead to a HIPAA violation, AMA cautioned.

The NPC staff size will depend upon the practice size, but experts recommend having more than one team member assigned to the task. Staffing at least two NPCs will allow for lunch break coverage and can also handle walk-in patients where applicable.

Rolling out the new pre-registration process

As with any major practice overhaul, pre-registration rollout should be an incremental process, AMA said.

“Start implementing the pre-registration process with new patients who still need to be scheduled,” the group recommended. “As time permits, reach out to new patients who have already been scheduled.”

Throughout the implementation process, practice leaders should collect feedback from patients and staff quarterly. Physicians can speak to the quality of clinical information collected, while patients can speak to overall experiences. This feedback will be critical to making further improvements.

Onboarding should take approximately 10 or 20 minutes, AMA offered as a benchmark. As NPCs become more comfortable with the process, patient registration will likely become more streamlined.

Optimal results should include quality clinical information for physicians and a positive patient experience. When done correctly, patient onboarding should leave patients satisfied with the practice, understanding how their care encounter will proceed, and comfortable with fulfilling their patient financial responsibility.

“Results of using pre-registration may include increased patient satisfaction, increased provider and staff satisfaction, reduced new patient appointment times, reduced new patient check-in times and more efficient use of resources,” AMA said.

Being organized and customer service oriented will go a long way in improving the patient experience. Additionally, a streamlined patient registration process can reduce patient wait times and make accessing the provider easier for patients.

Patient registration ultimately boils down to making a good first impression on the patient, and hitting each of these pre-registration goals will ensure the process is a positive experience.

This article was originally published on October 27, 2017.