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Hospitals Find Solutions for the No-Pay Self-Pay Patient

Philip Betbeze, for HealthLeaders Media, June 6, 2012

Sharp's case study
In 2009, Gerilynn Sevenikar, the vice president of patient financial services at Sharp Healthcare, a nonprofit integrated delivery system in San Diego, says her team started noticing a sharp decline in self-pay payments (7%) coupled with a sharp increase in self-pay volume (17%). That coincided with a sharp rise in unemployment in San Diego County, from around 5% to 12%. Looking for a way to improve payment through better navigation of federal and state payment sources, she brought in Lebherz to speak to her 25-person collection staff from all the health system's departments. She says that's when the idea of teaming up with FHCE came up. Starting with the ED population, which because of their short stays are particularly hard to help, Sevenikar says her team began integrating use of the site and its tools at patient registration.

"Phil designed a component of [FHCE's] website where it has the Sharp logo and a direct link from my patient registration to the website screening, so I could produce a custom matrix of those funding options they would be eligible for," she says. "Now we have it embedded in our registration process."

She says most self-pay patients, in her experience, don't want to stick the hospital with the bill, but because of the laborious nature of qualifying for assistance on both the patient and hospital end, that's the way it often ended up. 

"Now, not only can I follow up with patients but I can make intelligent decisions about how to settle their balance," she says.

Patients feel better because they're presented with workable options for getting coverage, even if the problems with bureaucracy at the agencies providing assistance are still a big barrier. Sevenikar also says that more than 80% of Sharp's patients classified as uninsured are eligible for some assistance if they follow through with the process.

A better relationship
That's where the relationship between the hospital and the patient has changed markedly, she says. And it's not just the patient's attitude that is changing.

"It's actually changing the mindset of my team that collects from self-pay patients," she says. "We work with them, hear their story, and do what's right as opposed to pushing patients into situations that make them feel uncomfortable. I changed the tone in all my self-pay letters from 'This is a collection effort' to a more of an approach of 'We're here to help you. You're eligible for a discount. Please call us.'"

It turns out that patients are a lot more receptive to the idea of people helping them "versus just trying to get their credit card information," she says. "The more important thing for my team is—because they're asking the five key questions on the eligibility quiz—they go into a really informed discussion with the patient instead of not knowing where they're starting from."

Perhaps best of all, given Sevenikar's position, is that over the three years that Sharp has been partnering with FHCE and through other internal initiatives, it's recovered $4.7 million in revenue that would not have been available otherwise.

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2 comments on "Hospitals Find Solutions for the No-Pay Self-Pay Patient"


Scott Sangster (6/7/2012 at 5:57 PM)
For routine and ambulatory procedures, the best patient experience may be to simply avoid billing. In addition to reducing patient surprise s by posting prices, on HealthInReach providers can offer self-pay patients the option to pre-pay some or all of the cost in exchange for a discount. By taking a deposit, providers manage their risk and patients benefit from whatever fees might otherwise be paid to collection agents. http://HealthInReach.com is free for patients and offers online scheduling 24/7.

Grace DeBold (6/6/2012 at 2:45 PM)
The hospitals could also, in fact, lessen their bad debts line on their P&Ls by simply paying a medical travel facilitator the $15K-$25k to take no-pay hearts, hips, knees,and shoulders off their hands. Local hospitals are losing between $40k and $140k on these cases....