From readmissions to no-shows, factors like addiction and food insecurity have an impact on billing, collections, and the bottom line.
Social determinants of health has been one of the hottest topics over the past few years, as everyone from HHS to health plansto health systems try to tackle the issue.
That's why it's notable that a new surveyof consumers shows that 68% respondents said they have challenges in at least one social determinants of health (SDoH) risk category. This is also bad news for revenue cycle departments as SDoHs can affect patients' payments.
"Addressing SDoH challenges for patients can have overwhelmingly positive effects on the patient’s health and the country’s overall healthcare system," Matthew Hawkins, CEO and board member of Waystar, tells HealthLeaders via email.
"But, in an era of health system transformation, providers, healthcare organizations and payers still lack the tools, programs and community partnerships required to identify and address patient needs," he says.
The risk categories included in the survey, which was conducted by Waystar, include financial security, food insecurity, social isolation, housing insecurity, addiction, transportation access and health literacy.
The survey found that 25% had a “moderate risk” (elevated stress in one to two categories) and 27% were “high risk” (elevated stress in three or more categories).
Despite the prevalence of these risks, only 22% of consumers with SDoH stress have discussed these issues with their physician. Also, of all patients in the “high risk” segment, 60% have never discussed their issues with a provider or their insurance company.
We asked Hawkins to break down the survey's findings and the implications for the revenue cycle. The email conversation has been lightly edited for clarity.
HealthLeaders Media: What are some key findings from the survey as related to revenue/revenue cycle?
Matthew Hawkins: SDoH risk is present across payer classes, and no payer group is without high-risk segments.
Patients with high SDoH risk are over three times more likely to miss multiple medical appointments per year. No-shows impact patient health (missing necessary care), and financial health (missed appointments means no reimbursement and lost utilization).
SDoH risk profiles inform collection follow-up strategies and customer segmentation: For example, patients with health literacy issues may receive more simplified communication/documents than those without.
Payers and providers need to be strategic about how they bring up SDoH: Patients with SDoH issues are 2.5 times more willing to talk about those issues with clinicians compared to payers. Additionally, most of the SDoH conversations that are occurring are with patients that are least likely to have health issues and least likely to utilize available support services.
HLM: Can you please explain how social determinants of health affect the revenue cycle?
MH: SDoH issues and risk are present across all revenue classes (not just Medicare and Medicaid). No payer group is without high-risk segments.
SDoH factors can be viewed as a common thread that underlies a patient’s clinical and financial experience. No matter if a patient is talking to a doctor, nurse, financial counselor, registration clerk or billing rep, the patient’s social determinants will influence their decisions as a healthcare recipient and consumer.
There are many points of intersection between SDoH and RCM:
No-shows: SDoH risk correlates to risk of appointment no-shows and can be used to inform prevention strategies. No-shows impact patient health (missing necessary care), and financial health (missed appointments means no reimbursement and lost utilization).
Bundled payments: With multiple events in the delivery routine, risk factors at home and in the community can make it harder to adhere to the sequence (therapy, medications, follow-up appointments, dietary plans) leading to leakage in revenue and reimbursement, and poor health outcomes.
Readmissions:Readmission management can be improved by 20% or more when the SDoH elements are integrated to the clinical routines. This means penalty reduction as well as improved health.
SDoH risk profilesinform collection follow-up strategies and customer segmentation. For example, patients with health literacy issues may receive more simplified communication/documents than those without.
The combination of clinical, claims, and SDoH dataenables a future of consolidated follow-up calls to improve care coordination and patient experience. A single representative can follow up on outstanding balances, appointment scheduling, simple health status checks and getting the patient connected to appropriate home and community-based services.
HLM: Can you give any real-world examples of hospitals/health systems that have addressed social determinants of health and experienced an improvement to their bottom line?
MH: Geisinger used SDoH to sub-segment their diabetic population looking at food insecurity. They then deployed a nutrition program targeted at those individuals and saw [significant clinical and cost improvements].
In January 2018, the University of Illinois hospital invested $250,000 to extend its pilot program in partnership with the Center for Housing and Health in Chicago to provide chronically homeless patients permanent housing to improve their health and reduce their costly emergency room visits.
Results from the 2015 pilot showed that [the average monthly healthcare cost per patient dropped 18% from $5,879 per month before being placed into housing to $4,785 after being placed in housing.]
HLM: What practical actions should readers take after learning this information?
MH: Figuring out how to engage patients in their SDoH challenges is core to successful, cost-effective and high-value population health management. However, current efforts are still limited and have inefficacies, such as unevenly applied targeting, or done in a way that consumers choose to reject today.
As a first step, RCM leaders need to talk with their care teams on the front lines to close the gap they have in understanding the SDoH needs of their patients. Then they must figure out how best to gather that information at scale across their full population.
A promising solution to this is technology utilizing predictive data analysis, which can segment patient populations without manual survey efforts, enable pre-arrival preparations and suggest more appealing methods for program uptake.
This allows organizations to modify workflow to leverage these analytics in support of more accurate targeting of high risk patients, more effective methods of engagement and more efficient allocation of human and financial resources.
Continuing with a traditional, 'billing-as-usual' approach isn't going to cut it as more responsibility shifts to patients.
A study released last week showed that just 30% of self-pay accounts, comprised primarily of patients who are uninsured, have generated 80% of self-pay revenue for hospitals.
That's certainly a lopsided statistic, one made especially significant by the ballooning uninsured rate.
But what should revenue cycle executives do—in a practical sense—with that finding?
HealthLeaders posed that question to Dave Wojczynski, president of TransUnion Healthcare, which conducted the analysis.
"Assuming all patients have the same ability and willingness to pay their bills is no longer an effective collections strategy," he said via email.
Instead, revenue cycle leaders need to work hard at figuring out which patients are most likely to pay their bill and which will toss their bill into the trash repeatedly.
"Propensity to pay and charity scoring are tools to stratify the bad debt portfolio into the appropriate payment categories," Wojczynski says. "Providers must identify those accounts with an ability and willingness to pay accurately and efficiently to drive collections and, ultimately, revenue yield."
The analysis also yielded other findings, including one that Wojczynski believes is especially relevant for revenue cycle leaders: An increase in PBAI (patient balances after insurance) from 8% to 12% over a five-year period.
This finding is "compelling" because it "points to the growing trend of the patient as the payer," Wojczynski says.
However, continuing with "billing-as-usual" isn't going to cut it.
"Traditional billing on a disengaged patient, after discharge, will result in continued challenges in uncompensated care," he says.
There are lots of ways to shift away from traditional billing and boost engagement.
For instance, an increasing number of providers are offering text-based billing options and and giving patients a "retail-like experience" for point-of-service payments. They're also taking steps to improve front-end collections.
Others are learning that by making billing easier and more convenient by allowing patients to choose what kind of communication they prefer (text, email, or paper, for instance), they can actually boost collections in the long run.
"Engaging patients early to protect earned revenue will be critical in providers' patient experience and loyalty initiatives to drive volume and revenue from positive patient payment experiences," Wojczynski says.
In giving patients a more convenient billing experience, Westmed Medical Group also increased collections and reduced time to collect.
There's just no way around it. Medical bills stink.
"People don’t like to get billed," says Vicki McKinney, COO and chief revenue officer of Westmed Practice Partners.
"When you charge your credit card for something that you're wearing, it's much more satisfying than getting the bill from a doctor's office for something that you had to do—and you probably thought was covered to begin with," McKinney tells HealthLeaders.
Westmed's patient relations hotline was tracking lots of complaints and questions about the billing process, McKinney says.
That's why Westmed Medical Group, which is managed by Westmed Practice Partners and that has locations in New York and Connecticut, wanted to improve the patient billing experience. To do that, the group invested in technology that allows for simple, user-friendly bill pay.
In an era where patient satisfaction is prioritized for everything from the clinical experience to the cleanliness of the waiting room, the billing experience has largely been left behind.
"No one really thinks about this piece of it," she says.
Patient satisfaction focus reaps many benefits
Research shows that ignoring patient satisfaction in the area of billing is a mistake, since billing has the potential to drag down patient satisfaction and ratings. That's why Westmed set out to improve its billing experience.
The medical group accomplished that and more. Not only is patient satisfaction up, Westmed also increased collections and reduced their time to collect.
"Initially, my objective was to increase patient satisfaction and give them a better experience," McKinney says. "I'm getting other benefits that were not necessarily my intention."
Westmed Medical Group is several months into working with the patient payment and engagement platform Cedar, which has provided a process for streamlining the billing process.
Specifically, Westmed has experienced:
36% increase in dollars collected
59% reduction in time to collect from 39 days to 16 days
23% increase in patient satisfaction to reach 97% overall patient satisfaction
A deliberate rollout
Westmed added patients to the new platform slowly and deliberately. Initially, it only enrolled patients without outstanding accounts. Those with outstanding accounts were not enrolled to avoid confusing those who were in the middle of the invoicing cycle.
Eventually, the rest of the patients were added, and as of August, all patients were migrated onto the Cedar platform.
When asked about costs for the project, McKinney says she believes they'll see a return on investment thanks to increased and quicker collections. She says she'll see results in January, when she pulls numbers from the project's first few months.
She explains the benefits of three key elements of the technology that she thinks have helped with patient satisfaction of the billing process:
1. Electronic patient notifications
Once a claim is processed and the patient balance is identified, patients receive notification about what they owe via their preferred method—email, text, or a traditional paper statement—which they choose when they register for their visit.
"We keep them engaged, and that's important because a lot of times people don’t even consider the fact that they might have a patient responsibility," she says.
These electronic notifications also link directly to the bill-pay platform, and patients receive periodic reminders about their bill thereafter.
"When you send paper statements, [patients] throw them in the garbage until the fourth [notice]," McKinney says. "So, getting paid took a long time."
Westmed not only experienced a reduction in time to collect, but it also saved on staffing costs, since it was able to reallocate the employees assigned to printing and mailing statements at its internal print center, McKinney said via email.
2. Online bill pay
Once patients are on the online bill-pay platform, they're able to see their visits or episodes of care, allowing them to view anything associated with their visit all in one place.
They're also able to view information for any other family members associated with their account.
Patients can use the platform to pay their bills online via electronic check, credit card, and Apple Pay; save their payment information for next time; and set up payment plans. There's also a "guest check-out" feature.
3. Online chat feature
Before implementing the new platform, the billing office experienced a back-up of phone calls related to billing questions. Now, patients are able to use the platform's click-to-chat feature to ask billing questions, which McKinney says has made a "huge difference" in how efficiently patient questions are handled.
"You can only answer one call at a time, [but] you can do six, seven, eight [click-to-chats]—depending on how good you are—simultaneously," she points out.
The Cedar team worked with Westmed's call center (which didn’t add any additional employees) to onboard them onto the patient chat function and has also provided training and ongoing support as they learn the new system.
McKinney also notes that the call center team members can see what the patient is looking at via the portal, making it easier to understand their specific questions.
"We can actually talk to them about what they're looking at and explain to them [what the information on the screen] means," McKinney says. "It's really cool. It's been very, very helpful to us."
And while no one can likely ever claim to make the medical bill-pay process a fun experience, Westmed hopes its efforts will soften the edges for patients a little bit.
"We're trying to make them a little happier about it," McKinney says.
More than a quarter of survey respondents also said they plan to adopt text notifications for bill payment/notifications within the next 12 months.
More than one in four healthcare providers and healthcare collection agencies are offering text-related payment options to patients, finds a new survey.
"A substantial saving in postage, plus faster payments, can be expected because patients can enroll at the point of care and providers can then send notices via text as soon as the claim is adjudicated from insurance," David Yohe, vice president of marketing for BillingTree, which fielded the survey, tells HealthLeaders via email. "This also offers benefits to the patient and is the trend in how younger consumers prefer to communicate."
According to the survey authors, this is the first year that text-related payment options have ranked so prominently in the results. In fact, it's tied with offering payment via an interactive voice response (IVR) system.
When asked about plans to add to their their payment collection options in the next 12 months, survey responses were equally enthusiastic about text-related payments.
More than a quarter (27.3%) said they planned on adopting text notifications for bill payment/notifications, compared to just 18.2% that said they planned to add IVR payments.
Yohe also points to data from BillingTree partner firm Authvia showing that 20 million texts are sent out every minute in the United States, and 65% consumers pay their bill on first text notification. It's also popular with consumers: 80% of people who are given this payment option use it.
However, text payments still lag behind accepting payments over the phone via a live agent (72.7% of respondents) and through a Web portal (63.6%).
Web portal payments are also the option respondents said they're most likely to add within the next year (54.5%).
Other survey results showed:
HIPAA compliance and the price of payment processing are top priorities when it comes to factors determining payment processes choices
Other important factors are integration within the patient management system, customer support, and compliance challenges
Collecting once a patient has left the facility and a patient's inability to pay are the top challenges related to collecting payments
According to a survey 107 hospital and health system revenue cycle executives and chief financial officers, 56% of respondents said their organizations can't keep up with EHR upgrades or underuse available EHR functions, up from 51% last year.
"Hospitals are having a hard time keeping up with the EHR upgrade process post-implementation," Timothy Kinney, Navigant managing director, told HealthLeaders via email. "They need to continue to review the upgrade offerings in detail and prioritize them by those that will increase patient safety and satisfaction and drive financial results."
In addition, 56% of executives suggested EHR adoption challenges have been equal to or outweighed benefits specific to their organization's revenue cycle performance.
In Kinney's opinion, the concern around the EHR upgrade process is among the survey's most intriguing findings.
"The work is continuous, and each upgrade must be approached as a small-scale implementation with appropriate planning, testing, and results measurement," he said.
The survey also revealed executives' attitudes about consumer self-pay, with 81% of executives believing the increase in consumer responsibility for costs will continue to affect their organizations, down from 92% last year.
"While consumer self-pay was not as often cited as last year, it's clear the issue is still front and center," Kinney said. "Hospitals are turning to advanced technology to help drive financial improvement, including payment plan optimization, patient engagement via text and smartphones, etc."
Other survey results showed:
68% of respondents said their revenue cycle technology budgets will increase over the next year, down from 74%
76% said technology-related capabilities is the revenue cycle capability their organization is most focused on for improvement over the next year
24% said revenue integrity is a top focus for next year
EHR optimization as an improvement priority rose from 15% last year to 21% this year
Physician documentation as an improvement priority fell from 18% last year to 12% this year
One health system provides a look at its decadelong experience with price transparency.
Hospitals and health systems are seeing the value in guiding consumers through their financial responsibilities not only to give patients a better experience, but to increase the healthcare organizations' front-end collections and revenue. Because of this, hospital price transparency is becoming more widespread, from publishing prices online to calling patients pre-visit.
Sharing prices with consumers isn't just a trend, as Memphis-based Baptist Memorial Health Care has realized. The health system has been using price transparency with its consumers for more than a decade using its Expense Navigator, an out-of-pocket medical cost estimator tool that Baptist Memorial developed and built in-house over the course of many months, using existing resources and employee hours.
When Baptist Memorial first launched the Expense Navigator 10–12 years ago, Baptist Memorial Health Care Executive Vice President and CFO Bill Griffin says the health system aimed to accomplish three main goals: Helping patients understand their out-of-pocket liability; streamlining the electronic registration process; and improving electronic patient bill pay.
"That's been very successful for us over this period of time," Griffin tells HealthLeaders.
The health system has learned a lot over the years, he says, and he shares how it achieved the three goals.
Goal 1: Help patients understand their out-of-pocket liability
Using price transparency to help patients avoid surprise medical bills only works if the estimates are accurate.
That's why the online data that the Expense Navigator pulls from is as detailed as possible. Griffin says they've expanded the estimator over the years to include about 90% of the procedures the hospitals perform, and certainly all the ones they perform regularly.
"We're going to take a look at that going forward, just to see if we need to fill in those gaps, but by far the majority of everything is in the navigator right now," he says.
In addition, the tool generates cost estimates that are specific to each hospital in their system, with the exception of those that were newly added after a recent merger and a newly built hospital that will open December; those new hospitals will be added soon, Griffin says.
"The pricing is unique to each of our hospitals," Griffin says.
Instead of generating an average for entire system, which includes more than 20 hospitals across three states—the price estimates are hospital-specific, taking into account each hospital's specific charge structure.
A team of employees also updates all the charge information annually and test frequently for accuracy by running sample procedures and insurances through the tool to ensure that it's as close to the actual price as possible.
Griffin also says the team continues to innovate by brainstorming ways that the tool can be as helpful and accurate as possible for patients.
One of these brainstorming sessions resulted in a feature on the tool that was inspired by the virtual "shopping carts" on websites like Amazon. After searching for a procedure, Baptist's Expense Navigator displays other possible expenses that may accompany it.
For instance, a search for outpatient miscarriage care at Baptist Memorial Hospital-Golden Triangle not only yields an average charge for the procedure itself, but also a note that there may be additional charges related to supplies, medications, and lab tests.
Griffin says it gives patients a heads up about other possible costs and opens the door for patients to have conversations with their healthcare provider to make sure they fully understand the procedure they're about to have.
Goal 2: Streamline the electronic registration process
Although the Expense Navigator is consumer-facing and lives on Baptist Memorial Health Care's website, patients aren't the only ones who use it. The tool has also helped the system to improve the electronic registration process, allowing staff to use the tool to let patients know what they owe during pre-registration.
"After we implemented it, we realized not only was it good for the patients but it's a good tool for us to use internally," Griffin says.
So, they trained existing staff members on using the tool during the patient registration process.
During this training, they ran regular feedback sessions with staffers who were using the tool to make sure they knew how to use it, says Liz Tucker, system director of patient access services. The health system used that feedback to make the tool easier to use, such as by adding keywords to refine the search function.
Now, the Expense Navigator allows staff to provide patients with an estimate for their care, and registration staff can also help set patients up with a payment plan if needed.
Pre-registration staff can also check to see whether a patient qualifies for any third-party insurance, like Medicaid, says Tucker.
"Anytime someone is scheduled we're calling to get them pre-registered by telephone," she says. "Part of the pre-registration process is to complete everything we can prior to the patients' arrival."
Goal 3: Improve electronic patient bill pay
Baptist Memorial Health Care wants its online patient financial experience to be as easy, smooth, and non-frustrating as possible, Griffin says.
For instance, the Expense Navigator is searchable by procedure name, keyword, or DRG code. Users can specify whether they're looking for information about an inpatient or outpatient procedure and which hospital within the system they'll be visiting. Results first display the average charge for a procedure; users can then use the tool to generate their out-of-pocket estimate based on their insurance information.
There's a link to the Expense Navigator right on the health system's homepage, and the tool also links directly to its financial assistance information and policy.
"We've just tried to make it as patient-friendly as possible," Griffin says.
For instance, the Expense Navigator site links to Baptist OneCare MyChart, the patient portal for its EHR system, where patients can pay their bills online. The site also includes contact information for the business office, which can help with payments and payment plans, too.
Data also shows that the tool is easy to find and use. The system's web marketing team notes that in 2018, the system averaged about 2,500 visitors a month to the site, and they've seen an 87% correlation between unique events and page views; in other words, if you land on the page, there's an 87% chance you'll actually use the tool.
Hospitals should keep an eye on state and federal efforts to ramp up consumer protections against surprise medical bills.
As the national conversation about surprise medical bills gets louder, the Senate is taking notice, introducing two new bills over the past several months that aim to limit surprise charges from out-of-network providers.
The latest, Maggie Hassan's (D-NH) "No More Surprise Medical Bills Act of 2018," says that providers can only charge a patient an in-network amount, unless the patient has been properly notified about the charge and has consented to it.
The legislation would also use a "binding arbitration" approach to resolve payment disputes without the patient being caught in the middle. In this scenario, a provider and insurer would each submit their best and final offer to an independent entity that would choose one of the offers.
The other draft legislation is a bipartisan effort from Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO).
It would protect patients from out-of-network billing, set payment standards, and prevent balance billing.
Adler co-authored analyses of each of the bills for Health Affairs. He believes that there's currently a "big appetite" for tackling surprise medical bills.
"Even since 2016, this issue has just sort of skyrocketed into the national attention, from just a couple states having acted on it beforehand," he says. "Clearly there's a pretty broad interest from members of the Senate, Bill Cassidy in particular."
But how might such efforts impact hospitals and health systems? Adler outlined a few things to consider:
1. Action could be imminent on the state level
"I think there will definitely be action in the states this year," Adler says.
In the absence of federal protection against balance billing, several states have acted to curb the practice.
"We've seen over the past two years, five or six states pass legislation, and I assume that trend will continue," he says, pointing to Washington and New Mexico as states to watch.
Federal rules would help consumers the most, however, writes the Commonwealth Fund, " since most individuals with private insurance are in employer-sponsored self-insured plans, which are regulated primarily under federal law."
2. Hospitals may soon need to speak up
In state debates on this issue, Adler says hospitals and health systems haven’t been very vocal. Instead, it's mostly been a fight between insurers and specialist groups, he says.
That may change with increased attention on the topic.
"I'm somewhat curious how much the national attention, and maybe consumers starting to learn about this, forces hospitals to be a bit more proactive on stopping it," he says. "Because right now there's a little bit of a look-the-other-way approach at times."
3. The bottom line may be affected
Despite the potential for new federal balance billing rules, "it's unclear that it would have much impact on the hospitals' bottom line," Adler says.
But that doesn’t mean that it wouldn’t have any impact at all.
"It's not like the hospital has no role here. Hospitals have some financial incentive to try to get their hospital-based physicians to accept and join the same insurer networks that they're in, and some of them do try to push this," he says.
He also says that stipends are an area where hospitals may see a financial impact, particularity with the Maggie Hassan bill.
"If the payment to these physicians went down significantly, it is possible, especially in certain markets, that these doctors might be able to demand higher stipends from the hospital as a condition of practicing in their facility," he says.
A system that integrates practice management, revenue cycle management, and EHR functions can increase collections, help develop new payment models, and more.
Technology platforms that fully integrated practice management, revenue cycle management, and EHR systems are the way of the future, according to Black Book Research’s annual practice management satisfaction survey.
Integrated systems offer a range of benefits, from increasing collections to designing alternate reimbursement and payment methodologies, the survey shows.
"With over fifty percent of US doctors receiving their pay directly or indirectly from a hospital system organization, CFOs and CIOs are seeing the value-based care model potential, reimbursement improvements and resources expenditure savings to be gained by implementing a fully integrated healthcare information technology system," Doug Brown, managing partner of Black Book Research, said in a statement.
They survey included respondents more than 3,000 hospital-owned or employed physician practice organizations. It found that:
85% of integrated delivery network (IDN) executives believe that aligning hospital and physician IT can help meet the challenges of changing model of accountable care and value-based payments
89% of hospital executive respondents say non-integrated EHR and current practice management systems do not allow leaders to strategically design alternative reimbursement and payment methodologies
Hospital-owned and employed physician practices on an integrated EHR/practice management/revenue cycle management platform collect an average of 29% more on billed charges than independent practice physicians with non-integrated or unconnected EHR/RCM platforms
92% of respondents seek integrated EHR solutions to allow IDN administrators and clinical team leaders to monitor and analyze provider performance across the system
Many systems are already moving toward integration.
They survey showed that 40% of large hospital systems respondents are budgeting to replace multiple existing medical practice systems with consolidated and integrated ambulatory technologies that complement and interoperate with the EHR and revenue cycle management systems by the end of 2020.
Three years ago, the scheduling, registration, and arrivals process for patients at Northeast Alabama Regional Medical Center, headquartered in Anniston, Alabama, wasn’t bringing in sufficient front-end collections.
In 2015, they were collecting less than $5,000 a month at point-of-service collections, and during a "big month" they might have collected $10,000, says Bruce Turner, director of the business office and admissions.
"We were a little bit lax in terms of our front-end collections compared to our peers that are nearby in Birmingham or Atlanta, and we knew we needed to do a better job," he says.
Although they'd made attempts in the past to improve front-end collections—mostly by asking unprepared patients for their co-pays or deductibles on the day they arrived and were met with resistance—those efforts quickly fizzled out.
It was time for a change, and over the past three years, the organization has transformed its traditional scheduling functions into a pre-access department that has increased patient satisfaction and has seen a 2,400% increase in point-of-service collections that went from less than $5,000 per month to more than $120,000 per month.
Here are the 3 things they did to change their front-end collections process and get paid:
1. Create a pre-access department
"We had to take the schedulers and train them on how to register patients like an admitting clerk," Turner says.
Instead of simply scheduling patients, representatives from the pre-access department also pre-register patients and call them ahead of their appointments with tailored estimates based on their insurance and the physician who's providing the service.
During these pre-access phone calls, patients are asked for the estimated patient balance that is due. If they are not able to pay in full, they are asked what type of deposit they can make that day.
Sometimes the patient pays the entire balance in full on the phone; others might ask to pay on the day of service or set up a payment plan, which the pre-access rep can also calculate and arrange using technology tools from PatientMatters, a patient financial management and experience system.
Rather than being scared away from treatment or being surprised by a huge bill after receiving their service, patients are usually grateful for the heads up.
"It's been very beneficial," Turner says. "We have seen comments on our patient satisfaction surveys where they appreciated knowing upfront what they owed and what options we had available for them to take care of that balance."
Because of that additional call volume and length of time on the phone, the organization added additional scheduling staff and also extended the department's hours to 6:00 pm. Eventually they may extend the hours to 7:00 pm.
2. Implement technology for front-end collection efficiency
Northeast Alabama Regional Medical Center invested in technology that provided the functionality to schedule patient services, run patient estimates, generate patient-specific payment options, and obtain financial clearance before patients arrive.
3. Use a three-tiered patient arrival system
The organization is in the final stretch of completing a transformation that will culminate in a patient arrivals process that's tailored to their pre-registration and financial status.
"Our goal is to have the patients know what they owe beforehand," Turner says. "Eventually what we're moving toward is a three-tiered approach to when patients present at the facility: We would have a no-stop, a quick-stop, or a full-stop" approach.
The three tiers will function like this:
No-Stop: No-stop patients have been scheduled, pre-registered, financially cleared, and can proceed directly to the department where they're having their service, without first stopping at the admitting area. They have either paid in full or agreed to a payment plan for their outstanding balance prior to their arrival at the hospital.
Although the organization is still working out logistical issues for no-stop patients, such as electronic signature forms, their eventual goal is for 70%–80% of patients to be a "no-stop."
Quick-Stop: Quick-stop patients have completed everything except their payment. For example, they've been scheduled, pre-registered and notified of their balance, but may not want to pay over the phone or online ahead of the appointment.
When they arrive, they make a "quick-stop" at the admitting area to make their payment and then get directed to the appropriate department for their service.
The pre-access center aims to be flexible with patients and understands that different patients have different preferences, Turner says. For instance, younger patients like to use the online portal to pay their bills online (which they can do through the PatientMatters tool), whereas older patients often like to pay in person, rather than on the phone or online, Turner says.
Others may not have the ability to pay large balances all at once.
"We are flexible with how they pay and when they pay," Turner says. "Being community-based like we are, we work with all of our patients to do what we can. We do just ask that you make some type of payment on the day of your service."
Full-Stop: Patients whom the pre-access department can't get in touch with or ones who don't feel comfortable sharing personal information over the phone will require a "full-stop" when they arrive.
These patients will need to go through a more traditional hospital arrival process: Walking in the door and completing a full registration at the admitting desk.
Occasionally, being notified of a balance has prompted patients to reconsider when or whether they need the service or whether a lower-cost option is available. But Turner emphasizes that no patient is ever denied treatment because they're unable to pay. That was an early fear of physicians.
"We just reassure our medical staff that under no circumstances are we going to deny care or treatment to anyone," he says.
"We would just be asking that a good-faith effort be made to make a deposit for the services that are being rendered and that we would be working with the patient as best we could on those payment plans."
Hospitals and health systems are encouraged to include the guide in their pre-procedure communications with patients and post it on the billing and payment page of their websites.
The Healthcare Financial Management Association has published a new consumer guide for avoiding surprises in medical bills and is making the guide available to hospitals and health systems to use in their communications with patients.
"Hospitals and health systems are encouraged to include the guide in their pre-procedure communications with patients and post it on the billing and payment page of their websites—no permission needed," Richard L. Gundling, senior vice president of healthcare financial practices at HFMA, tells HealthLeaders via email.
HFMA says that educating consumers about how to avoid surprise medical bills should be part of a consumer-focused approach to healthcare. This is especially important since patients tend to blame hospitals for high hospital bills.
Still, extending consumer-centric efforts to the basic question of "how much will this cost?" has been a challenge.
The guide puts some of the responsibility for surprise medical bills into patient hands.
"The guide was developed to help consumers understand steps they can take to avoid unexpected out-of-network bills," Gundling says.
The 15-page guide, which is available in English and Spanish, offers a primer on healthcare networks, negotiated rates, balance bills, out-of-pocket maximums, and other pertinent terms, as well as detailed tips for avoiding an unexpected balance bill.
The guide also breaks down treatment, billing, and important insurance and financial questions to ask about three common procedures: Colonoscopy, pregnancy and childbirth, and >hip and knee replacement.
In addition to posting the new surprise medical bills guide on their websites, HFMA also encourages hospitals and health systems to post its consumer guide about understanding healthcare prices and adopt its best practices for financial communications.