Front-End Financing

How can we most profitably liquidate your assets so you can pay for your care?" That's not the question Columbus Regional Hospital's financial counselors were asking when they talked with patients, but that's what patients were hearing, says Marlene Weatherwax, the 240-staffed-bed hospital's chief financial officer. That is, until the hospital implemented a system for qualifying patients for assistance before they received care. "The conversations were difficult because there was a fear there that we were going to force them into liquidating assets," she says. "That's not what we're trying to do."

What this hospital 35 miles south of Indianapolis is trying to do is line up payment sources for patients prior to care. The county safety-net hospital counts self-pay patients at about 5% of its payer mix, with about 55% Medicare and the balance commercial. But that 5%, as well as the growing number of insured patients who pay part of their bill out of pocket, can mean the difference between a positive and negative net margin.

Information is key, says Weatherwax. Since Columbus Regional started using a revenue cycle software program from TransUnion, frontline workers have access to credit information that helps the hospital determine whether to talk with self-pay patients about payment sources or to seek financial assistance for the patient prior to care. Patients who have good payment histories are treated like they have insurance, Weatherwax says. For people who have few resources, the information allows staff to try to qualify them for a sliding fee scale that starts at 400% of the federal poverty level.

The software is vitally important in the ED, where Weatherwax says clinicians always triage and treat the patient prior to financial conversations. After treatment, patients stop at the financial counseling desk. If they have the ability to pay, an appointment is made to arrange a loan or qualify the patient for Medicaid. The system also helps determine when a patient is using invalid data.

"They might use a social security number of someone who has died five years ago," says Weatherwax. "Before we implemented this, we might have registered two different people under one name, and that was a nightmare to get the medical record straightened out. This allows us to manage our work toward individuals we will really collect something from.

—Philip Betbeze