About five years ago, Stanford (CA) Children’s Health already had a patient portal in place at a time when most hospitals did not. The problem was patients could not do much with the system. “The only thing we had was some very rudimentary bill pay,” says Andrew Ray, director of professional revenue cycle.

A third-party bill pay solution was used at the time. This caused problems because it was not integrated with any other systems used by the revenue cycle department. “It did a good job of transacting billing and payment information. But that was about it,” recalls Ray of the third-party solution.

The portal wound up frustrating patients instead of helping them. Patients really wanted more control over their care, both clinical and financial. “We wanted to open that up more and didn’t have the capability to do it. That got us moving toward the solution that we currently have,” Ray says.

The organization had multiple electronic medical records (EMRs) and revenue cycle systems, but none of them were integrated. At the time, says Ray, “the level of investment it would have taken to have a single patient portal across all of those was daunting.”

Nonetheless, hospital leaders decided to invest in a fully integrated patient portal. A single revenue cycle system and single EMR are now used across the entire health system. A “portal team” consists of a few IT employees. “The team does an awesome job in making sure we stay up to date on all the features and functionality,” Ray notes.

Patients can pay bills, schedule appointments, and message their providers. “People want a single place to do all of that. They don’t want to have 15 different logins,” Ray says.

The patient access department at Paterson, NJ-based St. Joseph’s Health is updating its payment portal. “Our patients love our portal, and we see it being used more and more,” says Sandra N. Rivera, RN, BSN, CHAM, patient access director for St. Joseph’s Health. The new portal will show outstanding balances and allow patients to set up their own payment plans.

At Stanford Children’s Health, the portal experience continues to evolve; however, patients maintain ever-higher, even unrealistic, expectations. “People want their healthcare experience to be like making a restaurant reservation or checking into a hotel,” Ray says.

Considering the complexities of a hospital bill, no portal can achieve this today. For now, Ray says the answer is a combination of portals and great customer service. Patient access staff and financial counselors field complex questions, either by phone or in person. Currently, about 5% of patients use the portal to schedule their own appointments. “But this percentage is expected to grow as we expand,” Ray adds.

New and existing patients can schedule primary care and obstetric appointments. Still, portals cannot answer all the questions patients ask about their hospital bills. “The way insurance benefits work have changed a lot in the past five years. I don’t think patients are fully aware of what that means,” Ray offers.

Some progress has been made with the level of detail provided in the portal. Initially, patients saw only a dollar amount. This did not work since there was no explanation about what the bill was for. Patients could not separate portions of the hospital bill to pay, either. Some just wanted to quickly take care of copays, but not the whole bill. In the first version of the portal, there was no way to do this. This meant the patient had to call in before any part of the bill could be paid.

“We started looking at the reasons patients were calling with questions,” Ray says. Many calls involved setting up payment plans or recurrent billing, such as paying off a $5,000 balance over 12 months. Today, patients can do this themselves through the portal, which has eliminated about 15% of calls.

Overall, about 40% of patients are paying bills online. User-friendly graphics show how much insurance has paid already. “It helps patients to see why they have a balance in a way that’s understandable to someone who doesn’t work in medical billing all day,” Ray says.

Lots of calls and frustration still come from bills that were not expected. “This is one of the biggest issues plaguing healthcare,” Ray laments. Staff members are tweaking the portal to send more information to patients earlier. The goal is that when someone schedules an appointment, he or she also receives a good idea of what it will cost with their insurance factored in. “The big thing is trying to figure out how to use portals to take out the transactional part of the visit,” Ray notes. “People appreciate doing some things in advance.”

Many patients welcome the chance to sign consent forms or update addresses and phone numbers in the comfort of their homes. This also is a huge help to patient access in terms of productivity. “The more we are able to do that, the more we can open up time for the front desk personal relationship to become more interactive,” Ray suggests.

Asking patients to sign multiple forms and correct outdated demographic or insurance information took up most of employees’ time. Now, staff can offer price estimates and financial counseling. From the patient’s perspective, this is much more important. “The biggest sign of improvement has been decreased complaints,” Ray reports.

Shifting rote tasks to portals is a way to keep up with outpatient volumes, which are growing about 10% annually. “Self-service tools are a way to expand our capacity without increasing staffing,” Ray says.