Streamline the Patient Payment Experience With One Bill, One Phone Number

Chris Johnson, vice president of revenue cycle management for Atrium Health, shares two lessons about how the organization made billing easier for its patients.

Hospital bills can be confusing, especially when they involve multiple statements from multiple providers. Throw a couple of different customer service phone numbers into the mix, too, and suddenly what should be a straightforward transaction for patients becomes a guessing game.

That's why North Carolina–based Atrium Health wanted to provide patients with a single statement and single customer service call center to resolve bills, instead of using its historical model of segregating its hospital and physician billing and call center functions.

That involved converting two separate legacy financial systems to Epic and combining two separate call center teams.

"Our conversion to Epic, overall—including moving to a single statement and a single customer service call center—has paid off for us from a cash standpoint because we've had record cash years every year" since 2017, and are on track for another in 2019, says Chris Johnson, vice president of revenue cycle management for Atrium Health.

In addition, in 2018, Atrium Health saved more than $732,000 in statement and postage processing by moving to a consolidated statement. Those savings came purely in raw costs, especially postage, and doesn’t include other factors like labor costs. "I don’t care how big [your organization is], that's a good amount of money," Johnson says.

With these changes, Atrium Health has also experienced increased efficiency in the customer service call center, allowing them to scale the size of the team to meet the new call demands. The organization used to receive 112,000–123,000 calls per month to the hospital (inpatient) and physician (outpatient) call centers combined. Now, after implementing single statements, the new call center receives 53,000–60,000 calls per month.

Johnson shares two lessons that Atrium Health learned on its multiyear journey to make these changes.

1. 'Concept and reality are not always the same thing'

Before converting to Epic, the hospital and physician call centers worked in two separate offices and in two separate financial legacy systems. Consolidating them meant not only combining both teams in one physical location, but also combining their work requirements.

Because Atrium Health implemented the Epic conversion slowly—hospital by hospital—customer service representatives would have to take calls about accounts on both the old and new financial systems during the conversion.

Initially, Johnson says Atrium Health's goal was that every customer service representative would be trained on, be able to work in, and field calls about accounts in any of the financial systems.

"From the outset, we had this goal of whoever answers the phone is able to talk about any account … so we don’t keep bouncing the patients around," Johnson says.

Atrium Health cross-trained its employees, paid them overtime to attend after-hours education sessions, and gave pay increases to employees who were able to proficiently navigate all systems.

However, when the employees started working in all financial systems, Johnson and his team quickly learned that "concept and reality are not always the same thing," he says.

"Conceptually, it sounds like a great idea. The reality is, it's really, really hard," Johnson says. The customer service representatives were bouncing among the systems that didn’t look, feel, or function the same way.

The average speed to answer a call spiked from 1.5–3 minutes to as high as 6.5–7 minutes, and many employees who had been successfully trained in all the financial systems quickly concluded navigating between multiple systems in a live, fast-paced call center created a level of mental stress that wasn’t offset by increases in pay, Johnson says.

"In the real-time environment, [it was] more than they could reasonably handle," he says.

"What started out as a very customer-centered, patient-focused goal … ultimately caused us not to be able to deliver the level of customer service that we really wanted," he says.

Once Atrium Health's leadership and the core teammates realized that just two systems were better for people to work in at one time, the Epic conversion started to go more smoothly. Atrium Health has now completed the system conversion, and time-to-answer, talk time, and abandonment rates are aligned with or better than historical averages and industry norms.

For instance, the average speed to answer a call is now less than one minute; its abandonment rate runs at 3%–5%; and the average talk time is between five and five-and-a-half minutes.

2. Listen to your patients

Johnson says true patient-centered care should be built around what the patient needs, not what clinicians or customer service needs.

"I believe that if we as a healthcare industry do not get better at listening to our patients, we ultimately will not be successful," he says. "The CVS's and the Walmarts … and whoever else is getting into our space today, they're going to win. Because they're going to make it easier for patients to receive what they need." 

That's why Atrium Health leaders decided to ask patient focus groups to redesign the healthcare organization's billing statements.

"What we constantly heard is, 'All I want you to tell me on a statement is, what do I need to do? I don’t want to have to try to figure that out,'" Johnson says. But patients also said they wanted more details about what they owed and why, he says.

The new statement includes a blue box in the right-hand corner of the page with the patient balance and easy instructions for how it can be paid. Page two contains more details, such as an itemized list of all the accounts, charges, dates of service, he says.

Even with these successes, Atrium Health isn't finished making the patient financial experience better. For instance, Johnson says the organization would still like to achieve more on the front end, such as setting up patient payment plans prior to service, and they're working "fast and furiously to get there."