Erlanger Health System, a five-campus, 818-acute care bed system based in Chattanooga, Tenn., implemented a voice-technology system that has reduced the time staff spends on pre-certifications and authorizations mandated by managed care. Additionally, it has saved the hospital real dollars by playing a central role in overturning denied claims.
We led the hospital's selection and implementation of a voice-technology system. Our work included not only evaluation and selection, but implementation and tracking system return on investment (ROI). Because of our role at Erlanger, we witnessed firsthand the time wasted when hospital personnel waited on hold with managed care payer call centers. This unproductive situation led us in 2000 to begin evaluating process alternatives that could reduce time spent on hold by our staff.
Payers engaged in managed care contracts with Erlanger offered several Web-based solutions to this problem. While technically sound, these solutions would have involved installing Web-capable PCs at key points throughout the hospital and on each patient floor.
The staff would have had to be trained to use different systems offered by each payer. They would also be responsible for keying in data for electronic transmission to payers who would then respond electronically. We judged these solutions as unworkable for several reasons.
Web wouldn't work
Floor and desk space are at a premium in most hospitals, and we are no exception. So, installing potentially dozens of new PCs and tying them into the Internet was no simple task. Plus, payers essentially were shifting the data entry responsibility to us. The time needed to key all that data would have eaten up much of the time savings from getting our nurses out of the hold queue with the payer call centers.
In mid-2000, we began to consider a voice-technology system as an alternative. Because the system was phone-based, it avoided many of the problems associated with Internet-based solutions.
Phones are everywhere in the hospital. They're common, and no one is going to say, "I don't know how to use a phone." Phones are simple, and there is no technology fear factor in using them. Because it uses the phone and not a PC, the voice-technology solution involved minimal installation and training, yet it offered the benefits of eliminating hold times while digitally recording and indexing all the calls for later retrieval.
In 2001, we implemented a voice-technology system called VoiCert developed by the White Stone Group (Knoxville, Tenn.) to reduce the time nurses and admissions personnel staff spend on precertifications and authorizations mandated by managed care plans.
What we wanted and what we expected was that VoiCert would cut the amount of time our staff spent on the phone, so we could be more productive. Within six months of implementing the system, we saw phone transaction times drop by more than 50 percent.
While the majority of our payers participate in the VoiCert process, one issue we discovered while implementing the voice-based system was that it was difficult to get 100 percent of our payers directly on the first call. Many times we had to leave voice mails that were never returned and/or acknowledged, resulting in delayed authorizations and even denials. This was solved using the VoiCert feature, Monitored Call (MC), which records any live outbound telephone call to any payer for any type of transaction. It allows the message to be recorded with a date and time stamp for retrieval verification of the notification and clinical information.
Overall, we at Erlanger attribute a total payback of $920,201 and a four-year history of decreased percentages in days denied from May 2001 through March 2005 to the voice-technology system. With the time-savings benefit of the voice-based system achieved, we regard the implementation as a success and are pleased there were additional benefits.
Erlanger realized four unanticipated benefits from using the voice-technology system.
First, the voice-technology system had a measurable and sustained impact on the hospital's denial management efforts, as measured by the percentage of admission-days denied per 1,000 patient days from 14.7 to 4.4.
Second, we realized improved relationships with our major payers, resulting from the system's ability to accurately track authorization and pre-certification information on which both our hospital and payers can rely.
Third, we have seen a reduction in the number of denials it receives, which is attributable to improved recordkeeping and reduced clerical errors made possible by the system.
Finally, efficiencies in the payer communications process driven by the system led us to reassign three full-time equivalent employees to other departments, reducing payroll dedicated to payer communications.
In the four years since implementation of the system, we at Erlanger have achieved our goal of improving staff productivity, measured in terms of the amount of time required to secure information from payers, especially pre-certifications and authorizations.
Rita Bowen, MA, RHIA, CHPS, and Pamela Bassler work at Erlanger Health System, Chattanooga, Tenn. Bowen is director of HIM and resource and reimbursement management; Bassler is manager of resource and reimbursement.