The allied health staff of Retina Associates of Western NY (RAWNY) know retinal disease patient visits require many steps, which can have a negative effect on these patients’ experience with the practice. For this reason, and in their effort to maintain the practice’s mission of “preserving and restoring sight with compassion and innovation,” RAWNY’s allied health staff take specific steps to streamline these processes.

“I think of every patient as my family member,” says Toni Beardsley, revenue cycle manager for the practice. “All allied health staff members here do. And as members of our family, we want RAWNY patients to have as pleasant an experience as possible.”

Here, members of the allied health staff describe these action steps. 

Investing in EMR/ERP interoperability

Sherri White, chief executive officer of the practice, says RAWNY recently replaced its electronic medical records (EMR) and enterprise resource planning (ERP) systems with better interoperative systems that automate data and provide an “overall picture” of the patient’s journey throughout the practice, including an anti-VEGF injection log. While new EMR initially caused some delays while we gained the muscle memory necessary to work effectively, it now allows all areas of the practice to focus more on the patient and their reason for coming to our office rather than the machines … It has allowed us to use other technologies that have the potential to have a more profound impact on the patients the better we get.

“The old systems required a lot of manual processes, which was super time-consuming and, therefore, not conducive to our culture of caring,” she says. “Now, all of our technologies are ‘talking’ with one another, with far less need of allied health staff.”

Triaging for scheduling

RAWNY allied health staff refer to an appointment-type list, consisting of specific retina diagnoses and the timelines for appointments to determine appointment urgency, explains Margaret Whelehan, a medical photographer by trade who recently became the practice’s executive assistant. 

“For example, a retinal detachment or endophthalmitis are scheduled for the day the call comes in,” she points out. “On the other hand, a baseline diabetic exam, as another example, would be scheduled out a few weeks. By knowing when to schedule patients, we are ensuring they are receiving the specific and prompt care they need.”

Obtaining accurate billing information

Ms. Beardsley says she holds billing training sessions for allied health staff. This training helps to ensure, for example, that new hires ask the spelling of a patient’s full name, their birthdate, address, and insurance.

“Let’s say a patient is entered as ‘Stephen Scott,’ but their correct name is ‘Scott Stephens.’ The incorrect information would cause ineligibility when retrieving/confirming information with the insurance. This could cause unnecessary delay in processing or higher cost for the patient,” she illustrates. “Such scenarios result in inefficiencies that contradict the practice’s mission statement.”

To facilitate insurance information acquisition, RAWNY’s allied health staff have a list of insurance carrier electronic portals that contain coverage eligibility, among other pertinent information, so they can avoid phone trees, notes Ms. Beardsley.

Performing a pre-workup

Created due to COVID-19-induced social-distancing requirements, RAWNY re-allocated staff, using remote technicians to confirm information provided during triaging as well as input medical and ocular history into its EHR via patient phone interview, says Ms. White. In realizing this increased practice efficiency and patient satisfaction, in terms of less time spent in the practice, Ms. White says the practice retained two of the remote technicians at the pandemic’s end. 

“Before a patient physically enters the practice, the remote tech documents items, such as current medication use,” she explains. “Specific medications, such as plaquenil, can adversely affect retinal health, so the doctor needs that information.”

She adds that she has overheard patients thank staff for doing this ahead of their visit because it’s easier to locate medications while at home vs. digging through a purse or plastic shopping bag when in the practice.

“The pre-workup has also allowed the doctors to review that patients stated issues and concerns prior to the visit so that they can make any necessary adjustments to our typical workup,” Ms. White says. 

Implementing imaging protocols

Ms. Whelehan says implementing the following protocols has improved both the patient’s experience in this area (minimizing patient discomfort), as well as increased accurate image acquisition (optical coherence tomography (OCT) fundus photography, fluorescein angiography, and ultra-widefield angiography).

• Having a working knowledge of each device. “Understanding the device you’re using and its nuances allows you to maximize the image quality to provide the doctor with the information he needs to determine appropriate intervention,” Ms. Whelehan points out. “Without this understanding, time-consuming re-takes are often required, affecting both the demeanor of the patient and the patient schedule.”

• Practicing regular equipment maintenance. “I think keeping up with basic equipment maintenance, such as making sure no smudges are on a device’s lens to prevent artifacts, can be overlooked. Again, the techs want to give the doctor the best and most accurate image.”

• Preparing for the patient population. It’s not news that retinal conditions tend to be age-related, so these patients can present with mobility issues and dry eye disease (DED), Ms. Whelehan notes. For the former, she says the RAWNY allied health staff have, for example, sometimes transferred (if they are able) wheelchair-bound patients to rolling office chairs that can be raised, lowered, and positioned appropriately at a device. “It is important to have patience and compassion for slower-moving patients, even on a busy day,” she says. 

For the latter, Ms. Whelehan says techs have been educated to remind patients to blink regularly during image acquisition, as DED can reduce resolution, lower device signal strength, and make it difficult to focus, all of which decrease image quality.

“Allied health staff often instill artificial tears prior to device use in DED patients, as doing so can significantly improve the images, which ultimately provides more detailed information to the doctor,” she explains.

Using a J-Code reference sheet

Should one of RAWNY’s doctors decide anti-VEGF injections are warranted, a staff-created “J-Code Authorization Decision Tree” reference sheet is available to facilitate injection access for patients, points out Ms. Beardsley.

“This is essentially a cheat sheet that contains a grid of payors, the insurance groups they fall into, the specific drug, and whether authorization and what kind (e.g., some or full) is required for the patient to get their injection,” she says.

For authorization, the Tree contains a “stop light” color code, with green (no authorization required), yellow (some required), and red (full authorization required and a sample may be needed if treating today), she explains.

Enrolling patients in co-pay assistance

RAWNY allied health staff use a co-pay assistance technology, such as PX Technology, to expedite the enrollment of patients into patient financial assistance programs, so they can get the medication their doctor prescribes, says
Ms. White.

“The technology pre-populates information into patient assistance program enrollment forms and submits the forms electronically,” she explains. “We do this on the patient’s behalf because we never want them to have the burden of choosing between their utilities and their medication.”

To monitor co-pay assistance enrollment, the allied health staff have created a “Co-Pay Assist Programs Grid,” populated with a grid of payor, medication, and corresponding assistance program, adds Ms. Whelehan.

Using an inventory management system

Instead of entering every anti-VEGF drug, every patient’s name, every line number and more into EMR, which was required with RAWNY’s prior EMR system, allied health staff now use a drug inventory management portal that tracks orders from time of order, through billing, payment, and then the payment of the AP for the buy and bill drug, notes Ms. White.

“Now, staff is removing a drug from the practice’s injection refrigerator, and scanning it into the inventory management system,” she explains. “Additionally, it serializes each drug, so we know what drug a specific patient received, as well as when, so patients don’t receive injections any more frequently than every 28 days, at a minimum.”

Utilizing an after-hours call system

RAWNY uses this system, as it automatically populates a dictation of an after-hours call between doctor and patient into the practice’s EMR system. Additionally, the technology enables the doctor to create a related task for staff the following business day, such as scheduling the patient for a specific appointment, explains Ms. White.

“The call system efficiently enables allied health staff, the doctor, and the patient to be on same page, regarding the patient’s needs,” says Ms. White.

Employing patient engagement software

Ms. White says the practice uses patient engagement software comprised of appointment reminders, a text-pay feature, patient history forms, and a staff communication feature to streamline patient communication.

“The staff communication feature, in particular, has allowed us to reach out to local organizations about getting patients transportation to their appointments,” Ms. White notes. She adds that the technology was rolled out after observing that “almost every single patient was using their iPads and iPhones in the reception area.”

Invaluable contributors

Brian Connolly, MD, one of five retina specialists at the practice, says RAWNY’s allied health staff are invaluable to the success of the practice. 

“Because they do so much and came up with all these efficiencies, I can focus on what I went to medical school for: caring for patients who have retinal diseases and discussing their circumstances and a plan of action,” he says. “Their contributions become especially evident when I’m stopped by a patient on almost a daily basis who tells me how kind and organized they are. They truly practice ‘preserving and restoring sight with compassion and innovation.’” OP