working toward a seamless patient financial...
TRANSCRIPT
Working Toward a Seamless Patient
Financial Experience
March 9th, 2017
Miguel Vigo, Revenue Cycle System Director, Patient Access and
Pre-Service Center, Edward-Elmhurst Health
Suzanne Lestina, VP Revenue Cycle Innovation, Avadyne Health
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The Industry Challenges
81 percent of patients report anger or frustration related to
medical bills
Two thirds of Americans would struggle to fund a $1,000 medical emergency
42.9 million Americans have a
medical bill in collections
Patients who don’t understand their bills, what they owe and why they owe it tend to give lower scores on patient satisfaction surveys
Negative Patient Financial Experiences
3
Historical approaches
to self pay and bad debt
LEAVE GAPS Collecting
money earlier
in the process
The Provider Challenges
Siloed Approaches to Patient Liability Resolution
3
Navigating
estimates,
billing and
insurance
Providing
complete
financial
clearance
Building
greater
financial
transparency
Delivering patient
communications
Empowering
patients with
information
earlier
Ensuring
financial
screening and
counseling
4
Why Align the Patient Financial
Experience Differently?
Market Trends
Consumer payments to healthcare providers have
increased 193%
If collections fail, hospitals take on bad debt. Hospitals
have provided more than $502 billion in uncompensated
care since 2000
35% of hospitals collect at the point-of-service
34% of patients were able to pay the full amount
requested at the point-of-service
In 2017 hospitals expect to collect upfront fees from 31%
of patients
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5
How Would Patients Describe Their Perfect
Financial Experience?
The #1 reason consumers would
switch hospitals AND the top factor
when asked what they’d pay more for
• “It was simple”
• “Staff was knowledgeable &
compassionate”
• “Payment options were flexible”
• “I had no surprises”
• “Great self service options”
“Keep me
informed before,
during and after a
visit”
would choose a hospital that shares its prices upfront over a hospital that does not
57%
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Unify all patient
financial touchpoints
across a healthcare
organization to drive
superior financial
benefits and foster
patient loyalty
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Pillars of the PFX
Delivering to the patient a seamless and consistent experience across the entire health system
Ensuring patient expectations of payment are set early, and refreshed often
Contacting the patient only when necessary, and resolving as many outstanding items in a single interaction as possible.
Enhancing patient loyalty through thoughtful interaction while facilitating maximum customer reimbursement
8
Outcomes of the PFX
Interacting in an entirely patient- centric approach
Increasing patient satisfaction
Increasing levels of financial and clinical screening
Communicating clear financial expectations for patients
Reducing levels of re-work in post treatment revenue cycle functions
Reducing payer denials
Increasing cash recoveries
Reducing net operating expenses
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EEH PFX Impact Analysis
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Who is Edward-Elmhurst Health?
Edward-Elmhurst Health (EEH) is one of the larger integrated
health systems in Illinois
Edward-Elmhurst Health was created by a merger of Edward Hospital
and Elmhurst Memorial Healthcare in 2013
Compromised of 3 hospitals, Edward, Elmhurst and Linden Oaks
Edward has been named a Top 100 Community Hospital by Becker
and by Truven
Elmhurst has been named #1 (2014) & #2 (2015) Most Beautiful
Hospital and Most Wired
11
Who is Edward-Elmhurst Health
Some key statistics of Edward-Elmhurst Health
Annual revenues of more than $1 billion
More than 50 outpatient locations across a service area of 1.7
million residents in the west and southwest suburbs of Chicago
Nearly 7,700 employees and 1,700 volunteers
More than 1,900 physicians on staff (98% are board certified)
Nearly 100 medical and surgical specialties and subspecialties
Edward-Elmhurst has achieved Magnet recognition and became the
first hospital to achieve this in the DuPage and Will county area
Elmhurst is one of the few hospitals in the world to receive Planetree
Distinction
Planetree recognizes hospital’s achievement and innovation in
the delivery of patient-centered care
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Current PFX Initiatives
Increase pricing transparency and respond to consumerism
Improve up-front and POS collections
Advance scheduling processes & interactions
Improve patient experience & satisfaction
Improve front end staff financial communications skills
Future Considerations:
Improve financial/billing skill set and move dialogues prior to and on the date of service
Forecast financial considerations and become proactive rather than reactive
13
Developing PFX
Barriers:
Lack of tools to support process
Accurate patient estimates
Contractual issues
No unified systems to support process or workflow
Cultural change for employees (recent hospital merger)
Lack of clear and consistent procedures
Cultural change for patients
New name, brand, color schemes, policy & regulatory changes
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PFX Impact Analysis
Where are we today?
Evaluate EEH PFX to identify possible gaps in their
process as well as identify opportunities to optimize and/or
tweak their current PFX
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Benefits of Analysis
As Edward-Elmhurst Health continues to integrate and
standardize their process, this analysis will provide the
following supporting information:
Confirm those processes that are yielding successful
results
Align findings with future considerations
Ensure that technology (current and new) will support
standardized processes
Resource to leverage additional conversation with key
stakeholders regarding patient financial experience
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PFX Impact Analysis
Step 1: PFX Survey
A short (15 questions) online survey related to their patient
financial experience process
Step 2: Analysis
Evaluate the systems PFX compared to survey results
Step 3: Feedback
Report of findings:
Processes
Volumes
Quality standards
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Opportunities
Limited conversations with patients regarding financial
obligations, primarily focused on basic out of pocket expenses
Little contact with patient prior to service regarding out-of-pocket
expense
Self pay patients that are not able to pay and are not considered
urgent are rescheduled
Patients that do not have a valid authorization are rescheduled
While patients are encouraged to make payments a time of
service, there is little to no incentive for patients to actually do so
Staff were not adequately equipped to answer all patient
questions
Staff did not appear comfortable dealing with patients that
pushed back regarding a request for payment
CONFIDENTIAL
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Accountability
CONFIDENTIAL
Revenue Cycle revisited our POS and any patient facing financial scripting to help ensure that we had a balance of education to the patient while asking the account balance/price estimate
Pre-Service Financial Specialist team was created to provide price estimates and have financial conversations with patients when patients requested it and for appointments prior to the date of service
We aggressively pursue deposits and down payments for all Self pay patients and without them, no elective services are scheduled
The Hospital teams worked with the Ambulatory/Physician groups to ensure that authorization was started within 1 hour of the test being ordered in our EHR system
EEH now provides prompt pay discounts upfront when objections are made or presented by patients
We have retrained all front end users, i.e. Registration, Scheduling, Insurance Verification, and our Pre-Service Financial Specialists to have a unified script to use for each and every price estimate or pricing inquiry
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Results – POS Collections
CONFIDENTIAL
$-
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
FY2016
FY2017
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Results - Continued
CONFIDENTIAL
Registration staff are more comfortable asking for OOP
amounts from patients as their interaction is not the first
Pre-Service Financial Specialists use a more accurate price
estimation tool and are able establish 1 point of contact:
To provide the price estimate
Negotiate price (as needed)
Provide education
Schedule appointment(s)
Perform the insurance verification functions
All in 1 phone call
Patient Complaints have decreased dramatically
Patient Experience scores are increasing each month
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Patient Experience
CONFIDENTIAL
Patient centricity and generating a great patient experience
is not solely on the clinical team(s)
Non-clinical staff play a HUGE role in the patient
experience
It starts from the moment we encounter the patient, i.e.
scheduling. All the way through to their bill being fully paid.
Making sure EEH has the easiest and most open patient
access points and confirming that we have met any and all
needs of the patient is everyone’s job
The patient financial experience plays a critical role in
keeping your patients…your patients, and growing your
market share and your patient volumes
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Questions