How likely is patient to pay?

Offer patients help upfront

Few registration areas use propensity to pay software to determine a patient’s ability to pay, says Brendan Fitzgerald, research director of HIMSS Analytics, a Chicago-based organization focused on improving health through information technology.

Currently, says Fitzgerald, "it’s usually done on the back end, not so much on the patient access side," he says. If hospitals get this information at the point of registration, however, patient access staff have an opportunity to offer patients some assistance.

"Having that information upfront can certainly offer hospitals a way to help patients if they are at risk in terms of payment, versus hoping to collect money on the back end," he says.

While most patient access areas have automated insurance verification, eligibility, and scheduling processes, propensity to pay and charity screening "haven’t really come into the fold yet," says Fitzgerald.

One reason might be that hospitals are directing significant resources to prepare for the switch to ICD-10, which has put other changes on hold. "Despite the recent pushback of the ICD-10 deadline to 2015, organizations will keep their focus on the coding transition," says Fitzgerald. "Once that transition has happened, we could see hospitals implement some of these lagging solutions."

"Brief snapshot" at registration

Patient access staff at St. Anthony’s Medical Center in St. Louis, MO, ask patients about family size and income, so they can determine whether the patient is likely to be eligible for Medicaid or another type of assistance.

"It is a brief snapshot," says Kim Setlich, patient accounts manager. "This information gives us a quick view earlier in the process. We use it as a tool to capture as much upfront need as possible."

Patient access employees often discover that patients are likely to be eligible for Medicaid. "It allows us to find what assistance the patient needs, so the patient will not decide against treatment based on cost," says Setlich.

The hospital’s Medicaid eligibility department then helps patients with the application process. "We look at all scenarios," says Setlich. "We want to make sure the patient has resources available to pay their bill."

If patients don’t qualify for Medicaid, an effort is made to quality them for charity. "We try to work with them best as we can, to make sure they get the care that they need," Setlich says.