Transforming patient check-in: Three key lessons learned

July 31, 2017
By Rob Crabtree, Administrative Director of Orthopedics, UAB Hospital-Highlands

In late 2015, frustration with patient registration reached an all-time high among orthopedic surgeons at University of Alabama at Birmingham (UAB) Hospital-Highlands in Birmingham, Alabama.

Patients weren’t being seen by surgeons until 30 to 45 minutes after their scheduled appointment time due to hold-ups in the registration process—many of which were due to the number of forms patients needed to complete. Problems with delays had become so frequent that it wasn’t uncommon for surgeons to walk into the waiting room to see what was going on.

As leaders of the orthopedic division, we knew we needed to completely change the clinic’s front-end processes. So after a significant amount of research, we chose a digital registration tool that put registration in the hands of their patients, similar to an airport kiosk.

Within two weeks of implementing seven self-registration check-in systems, the best indication of its success was the lack of chatter we heard from surgeons.

Our surgeons no longer walk into waiting rooms, checking on the status of a scheduled patient. Instead, they’re delivering care in a less hurried environment to patients who are pleased to be meeting with a surgeon so soon after their arrival.

By the numbers

For UAB Hospital-Highlands, introduction of self-service check-in has had a profound effect not only on physician and patient satisfaction, but also the financial health of the organization.

Point-of-service collections have risen 54% since the kiosks were installed in March 2016. Patient throughput also has increased, with check-in times reduced from 7 minutes to an average of 1 minute, 49 seconds per patient (and even lower for returning patients: 1 minute, 24 seconds). Surgeons are seeing more patients throughout the day while gaining greater time for one-on-one interaction.

Self-service check-in has had a significant impact on the back-end of the revenue cycle as well. Patient demographic and insurance data is verified in real time, increasing the likelihood of submitting a clean claim for care delivered.

Making the move to digital

The success of self-service check-in technology at UAB Hospital-Highlands’ orthopedic division points to three reasons why putting check-in in the hands of patients provides greater value for physician practices and those they serve.

Digital check-in changes the psychology of patient payment

When the system informs patients that a copayment is due, they are more likely to pay right then, at the point of service, assuming they’ll be unable to see their physician unless the payment is made. This reduces the tendency of patients to delay payment—for instance, by telling staff they’ve forgotten their checkbook or credit card.

Today, in-office payments at UAB’s self-service kiosks total around $30,500 per month—as much as the orthopedics division used to collect at the front desk—with an additional $8,000 to $12,000 in cash and check payments made at the front desk. The impact stretches beyond the orthopedics division: When patients are alerted to a balance due for care delivered by another UAB department, patients tend to pay these balances at time of check-in as well.

Self-service check-in has multigenerational appeal

The average age of patients in UAB Hospital Highlands’ orthopedic clinic is 53. Specialists serve 200 patients a day, many of whom are elderly.

Initially, there was concern that older patients would resist the self-service check-in platform. But a colleague at a specialty clinic in Birmingham said her clinic found the opposite to be true—that seniors take pride in being able to manage the registration process on their own. And certainly, that has proven true at UAB Hospital-Highlands. In fact, some of our older patients have been the quickest to adapt to the new technology.

Our clinic offers a concierge to walk patients through the process, if needed, but our senior patients are likely to decline assistance. They want the satisfaction of mastering the tool on their own.

Staff are more likely to embrace transformation of patient check-in when they see the value it creates for patients and staff alike

Appropriate training and onboarding, both before and during go-live, eased the transition for UAB, but so did the ability of two staff members to serve as concierges for patients as they became accustomed to the digital check-in platforms.

Staff took pride in the reduction in wait times and the ability to help patients get to the heart of their visit sooner. Staff also appreciate the capability of the system to capture updates to patient information more quickly than staff could collect manually—at a rate of 200 updates per day. In March 2017 alone, we captured 3,000 driver’s license updates, 515 new email addresses, 1,000 primary insurance updates, and 475 secondary phone numbers.

The true measure of the system’s value came during a power outage. Staff were quick to say they couldn’t imagine going back to a paper-based process—and hoped they would never have to again.

Multispecialty and multigenerational appeal

Digital check-in holds value not only for private practices, but also academic medical environments such as ours. It’s a solution UAB will expand to other outpatient clinics beginning this summer, with the potential to touch more than 1 million visits per year.

With the right training and approach, self-service check-in technologies have the potential to transform patient check-in, with unexpected benefits not only for patients and staff, but also the revenue cycle. In an era of increasing healthcare costs, transforming patient check-in digitally is not only a value differentiator, but also an important step toward creating a sustainable system.

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