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Access to mental health services is a concern for many healthcare organizations, and was identified recently as a top priority at San Diego-based Sharp HealthCare. Patient access and clinical leaders worked together to address this important issue.
“The objective was to decrease the number of patients not participating in therapy as a result of their inability to pay for services,” says Perla Pace, manager of patient financial services. The organization’s Community Health Needs Assessment unveiled that access to mental health services was a priority. The same report revealed that access to care or insurance were strongly linked to good healthcare outcomes. “Previously, lack of information about a patient’s financial responsibility resulted in surprise bills months after a patient’s registration had taken place,” Pace explains. Leadership in patient access and the intensive outpatient program at Sharp Mesa Vista Hospital formed a team tasked with improving the admissions process for patients. The goal: Give patients greater clarity about their financial responsibility. “Each decision was scrutinized under the same test: Is this the best we can do to serve the patient?’” Pace says. After analyzing the current process, the team implemented these changes:
These are used as a communication mechanism between the admissions office and program leads. The card is presented to patients after they have met with the hospital’s business office to understand their financial responsibility for care.
After, the program therapist asks the patient to share their affirmation with the group during their session. “The affirmation card validates to the program therapist that necessary financial education has taken place,” Pace notes.
Patient access contributed to the new process by streamlining pre-verification. “This was done by consolidating benefit check requests to one central form and process owner,” Pace recalls. The form was updated to provide patients with details about their designated program, available benefits, and payment arrangements — all in one document.
“This was paramount to the overall project, given that the program and length of stay information is the foundation for any estimate,” Pace says.
Patient access also empowered its staff to provide solutions for patients who say they’re unable to pay. The entire team was trained in a new “financial responsibility visit process.”
“Staff were encouraged to improve the patient’s financial verification experience,” Pace says.
Two real-time solutions have made this possible: prompt pay discount and auto-withdrawal tools. Many patients take advantage of these new options, who previously would have declined services due to their inability to pay.
“Patient access services was able to increase transparency of the financial responsibility for patients participating in therapy for long periods of time,” Pace adds. The previous admission process included an intake interview by a program therapist during which basic demographic information was captured.
The program therapist submitted a benefit check to patient access services for insurance verification. Once the verification took place, patient access services would respond to the program therapist with the patient’s benefit information.
Next, the program therapist would inform the patient about his or her available benefits and schedule a mental health assessment, which he or she would need to complete prior to their admittance to a program. On the day of admission, the patient would visit the hospital’s business office to complete the registration process and begin therapy.
“The project team walked the process from a patient’s perspective,” Pace notes. “We identified what initial steps delayed treatment for someone who could be in a crisis.”
The improved process includes immediate scheduling of a mental health assessment and a financial responsibility visit on the same day. “This allows for more timely access to care, and ensured the business office procedures were expedited,” Pace says.
Along with a detailed estimate for services, patient access provides payment options. These range from the prompt pay discount to full financial assistance awards. “This has increased transparency of patients’ financial responsibility, and reduced the number of visits the patient makes to and from the hospital,” Pace reports.
The new process includes these steps:
Step 1: The patient calls to inquire about the program. A therapist performs an initial interview and recommends a program. A mental health assessment is scheduled, and the pre-verification information is obtained from the patient. A therapist sends the benefit check request to patient access services, who review the benefits and return the completed form to the therapist so it can be added to the patient’s record.
Step 2: The patient visits the hospital for the assessment. The patient receives a tour of the facility and additional information about the program. The nurse gives the patient a welcome card with contact information, and escorts the patient to patient access services.
At this point, the second piece of the admission process is completed — financial responsibility. Patient access explains the patient’s benefits, gives a price estimate, and completes the registration.
Patient access services secures a financial agreement with the patient that explains their responsibility. This ranges from payment in full, a prompt pay discount, auto-withdrawal payments, or another option negotiated with the manager’s approval.
The reverse side of the welcome card is completed by the program therapist and patient access services, and includes the patient’s financial responsibility and patient access office contacts.
Patient access services calls the nurse to inform the patient that their financial responsibility visit is complete. A nurse returns to pick up the patient, addresses any additional concerns, and escorts the patient back to the lobby.
Step 3: The first day of therapy. The nurse meets the patient and escorts him or her to the hospital’s business office. Patient access services confirms the patient has attended the financial responsibility visit, and the visit is activated in the system. Patient access gives the patient an affirmation card, which is shared with the therapist. Under this new process, “we have seen a 30% increase in overall cash collections, and 86% of all new admissions have completed the financial responsibility visit,” Pace reports.