“We’re in the most interesting and dynamic period of healthcare, especially with regards to automation and artificial intelligence” says Hugh King, Chief Financial Officer for Palomar Health. And those words have weight, given King’s more than 5 decades of experience in healthcare. His organization provides comprehensive healthcare to North San Diego County through its two medical centers and more than 900 affiliated medical providers. And despite being recognized as one of America’s 250 Best Hospitals, they too are struggling like many other.
“We have upwards of 350 open positions at any given time,” explains King, “and it’s not just nurses but technologists, registration, and back-office personnel too.” This reality has dramatically shifted the technology, automation, and AI discussions. Whereas these topics were previously weighed down by concerns that these advancements might supplant humans and cause extensive job loss, they’re now being heralded as a necessity. “It’s less about technology replacing labor,” King continues, “and more about it being one of the few means of optimizing the labor you can find in a tight, difficult market.” Where Technology Shines
- Patient Registration
Online registration provides patients with a significantly more positive consumer experience, while simultaneously reducing the number of documentation errors. After all, no one knows the patient’s information better than the patient themselves. In King’s case, they realized a 75% drop in their registration error rate, alongside a reduction in denials, making for a smoother, more timely claims process. Nearly 70% of their patients are using these tools now that they’ve gone live – much more than their original projections of 40-45% -- reducing the need for hospital
clerks and medical assistants who would normally be performing these tasks.
“We can actually take the self-service concept even further,” explains King “Think about when you check into a hotel – you’re handed a key and told which room is yours. We’re talking with a medical group that gives patients a room number when they register, and they see themselves to the exam room. The first person they actually see is the nurse when they come in to take vitals.”
- Prior Authorizations
Prior authorizations require thousands of manual tasks, and with talent shortages what they are, it’s no surprise that errors and incomplete requests are common. This has driven the industry average turnaround time to between 6 and 10 days, and that lag not only interferes with care continuity, but drives staff burnout and patient satisfaction.
Dean Erhardt, President and CEO of D2 Solutions, explains how their UltraTouch™ Verify solution automates that process, eliminating the risk of errors and freeing staff schedules to focus on more mission critical work: “By automating it, our clients are seeing 96% of their auths submitted accepted the first time through, with an average approval time of less than 22 hours.”
- Accreditation & Compliance
Similar to other tasks that are dependent on tracking, managing, and collating large sets of data, Erhardt sees accreditation and compliance as valuable areas to automate: “Healthcare providers have hundreds, if not thousands of licenses to track across staff, their machines, and physician or nursing credentials. Getting that into a single source of truth with a true reporting mechanism moves you away from spreadsheets, and opens up the possibility of automated reminders for renewals and other key events.”
King agrees, adding that they’re using similarly automated tools within their HR department to track compliance training, annual physical, and vaccine statuses. Reminders to staff can also be automated, improving compliance rates and decreasing the provider’s overall risk profile.
- Querying Patient Records
Back in October of last year, the scope of the 21 st Century Cures Act’s Information Blocking Rule was expanded, prohibiting healthcare providers from interfering with patient access to any electronically stored information within their records. This prompted many of them, including Palomar Health, to revisit patient record access. “Timely access to records can be difficult when you have multiple disparate systems across care environments,” explains King, “so we’ve implemented a technology to automate record retrieval following a patient’s request.”
Rather than just pull the entire record, however, the system validates that the patient is who they say they are, and then asks why they’re obtaining the information, such as for insurance, or due to legal action. It then uses algorithms to pull only the data that is relevant to that use case, streamlining the process for patients and helping them become more targeted consumers of their data. “The time to pull records has gone down dramatically,” says King, “and I think that over the next 2 to 3 years, we could be looking at a much leaner records department that only focuses on specialized releases.”
Doing it Right
These are really just a small handful of the ways that automation and technology can help healthcare providers close their labor gaps. The more King’s revenue cycle staff has expanded their usage, the more other departments have begun to see how similar tools could help them: “Now we have people in line to get bots created and approved for their activities, and we expect we’ll find many different ways they can be applied.”
However, King cautions that there are two interrelated pitfalls that can stand in the way of that progress. It’s easy for perfect to become the enemy of the good, and in the process, projects can become so bloated that they become unmanageable. “The more we did, the more people wanted to broaden the scope and it kept growing,” explains King, “and nobody wanted to move forward until it was all defined.” To prevent this, Palomar moved to a phased approach, having their most important projects slated for their first round and less developed ideas tabled until later.
“Start small, start simple, and prioritize well and most importantly, communicate with your people and listen to their needs. Don’t just roll things out and assume people will automatically know what to do with them.”
