By Pete Thompson, Sr. Revenue Cycle Strategist, ClearBalance
Twitter: @ClearBalance
This year’s Healthcare Financial Management Association (HFMA) Annual Conference achieved its goal of providing a forum to highlight the need for industry transformation along with progress toward improved reimbursement accuracy for hospitals, health systems and medical groups. Across the four-day convention, I noted three themes: revenue integrity, patient financial journey and price transparency. The latter came under specific focus with the signing of President Trump’s executive order aimed at healthcare price transparency on Monday during the event.
Price transparency confidence builds
Although the topic isn’t new in revenue cycle discussions, recent national headlines made price transparency to improve patient satisfaction a top priority for HFMA attendees. Hospitals have become more comfortable with the accuracy of their cost estimates. Therefore, they are also more confident in asking for payment up front, linking patient financial advisors with clinical navigators, and offering patient financing programs. The call for greater healthcare price transparency is here to stay and continually increasing the accuracy and availability of cost information was common fodder for many attendee conversations.
In one panel session, Gerilynn Sevenikar, VP Revenue Cycle, Sharp Healthcare, reiterated the need for providers to give patients a price estimate and stick to it. Sevenikar predicts that soon providers will be required to provide an exact service cost, not just an estimate: “tolerance for cost estimates will end by 2025, if not sooner based on regulatory action.” To improve customer service during patient-pay conversations, Sharp Healthcare hired a patient experience coordinator to manage all patient pricing, communication and even focus groups on the topic.
Sharp’s focus groups revealed a need to improve patient communications during price-sharing conversations. For instance, patients who arrived by ambulance were offended to receive a letter saying “Thank you for choosing Sharp.” Learning from their patient consumers has allowed Sharp to change the message and ultimately improve customer service when discussing payments.
Advanced technologies boost revenue integrity
HFMA’s newly designed exhibit hall was also busy with dozens of upstart technology exhibitors. Artificial intelligence (AI) and deep data analytics companies were prevalent amid established revenue cycle services vendors. What was the focus for these new inductees to HFMA? The use of progressive technology to address evolving revenue cycle integrity challenges. Interest in AI and analytics was expressed not only by large health systems’ representatives, but also by attendees from smaller, rural organizations that need to catch up by delivering similar levels of service and positive patient experiences.
For example, many AI and analytics vendors apply tech tools they’ve sharpened in other industries to streamline revenue cycle workflow, proactively reduce payer denials and better compete under risk-based contracts. Attendees spent time with these vendors learning how advanced technology can improve their revenue cycle processes.
Sevenikar provided sage advice for these up-and-coming vendors. “Providers are really feeling pain to validate their use of technology tools. I need to share return on investment with my boss. If you can help me get there, great. But you need to help me articulate it.” This was just one example of traditional wisdom balancing healthcare innovation. Moving revenue cycle focus from back-end process management to a front-end focus intent on improving the patient’s financial journey is another.
Proactive planning becomes keystone for better patient journey
Provider organizations continue to see lower inpatient volumes and loss of patients to stand-alone clinics, retailers and same-day-surgery centers. Patients should be directed to the most appropriate, cost-effective care setting, whether it’s inpatient or outpatient. However, the steady stream of outgoing patients fuels another common topic at every HFMA conference: the need to shift revenue cycle focus, staffing and investments from retrospective management to planning with an eye toward facilitating a better, holistic patient experience. At the forefront of this experience is managing the patient as a key payer in the reimbursement mix.
To that end, common questions we were asked about patient financing in our ClearBalance® booth were:
- Where does long-term patient financing fit into the patient financial journey?
- Should we incorporate patient financing conversations into our current front-end systems and workflow?
By conducting the patient financial conversation up front during pre-service and Access/Registration, several ClearBalance organizations were recognized for remarkable results and awarded top performer designations during #HFMAAnnual. The annual Top Performer awards program is based on the ClearBalance ROI Value Model™, an HFMA Peer Reviewed* tool that sets national standards for measuring patient financing performance. Among this year’s winners:
CentraCare Health, a not-for-profit integrated health system in Minnesota, won the rookie Top Performer ROI Award with 487 percent ROI using long-term patient financing. “We’re in a competitive market in Minnesota,” says Kathy Parsons, VP Revenue Cycle. “It’s been important to engage patients in a way that enables them to affordably repay their cost of care while also contributing to a strong bottom line.”
MaineGeneral Health, a nonprofit hospital serving the Kennebec Valley region in Maine, was recognized for providing the greatest positive impact to patients through its financing program. In seven months, the program was used to help patients cover their medical costs for nearly 16,000 care episodes. “We don’t want cost to be a barrier to receiving care. Giving consumers an option to pay their out-of-pocket costs over time definitely improves satisfaction and loyalty,” says Buffy Higgins, Sr. Director, Revenue Cycle. “It’s been a positive experience for our patients and also helped us reduce bad debt nearly 10 percent.”
Ounce of prevention still good advice
An ounce of prevention has always been worth a pound of cure. This adage holds true in the healthcare revenue cycle. Patient financing programs, team metrics, up-front collections, prior authorizations, insurance discovery and patient scoring all play an important role in improving revenue reimbursement while boosting positive patient experiences.