You should closely watch revenue cycle metrics
Three items you should be tracking
To determine if patient access processes for financial counseling are getting good results, Jen Nichols, senior director of revenue cycle operations at Kaleida Health in Buffalo, NY, keeps a close eye on these metrics:
• The proportion of accounts in bad debt and charity care.
"If you qualify somebody for charity who would otherwise not have paid their bill, you have moved somebody out of the bad debt into the charity bucket," she says.
• The conversion ratio of patients initially classified as self-pay who are converted to a payer source at the point of billing.
"We look to see the self-pay bucket go down and the conversion ratio go up," she says.
The organization's outreach program, which connects financial counselors to patients in the community, is too new to know its effect on hospital revenue. However, Nichols expects to see less bad debt and fewer self-pay patients.
"It's just a delayed presentation. We may be enrolling somebody this year who isn't going to need our services until next year," she explains.
• Patient satisfaction scores.
"Were you happy with the billing process?" A general question such as this on a patient satisfaction survey can give misleading information about patient access processes. Patients who are unhappy about their out-of-pocket responsibility are likely to report dissatisfaction, even if they received excellent service from patient access.
"Department leaders need to ask the types of questions that let them delineate exactly what aspects of the patient experience people are having trouble with," Nichols says.
Good communication and financial counseling processes can prevent patient dissatisfaction even if a large out-of-pocket responsibility is owed, says Nichols. For this reason, it's important that survey questions are worded correctly.
Nichols recommends asking questions such as: "Was the quote process prompt?" "Did you receive a written estimate?" "Did you understand the estimate?" and "Were you treated with courtesy?"
"That is the type of information I want to know about my front end," says Nichols. "The question, 'Were you happy with the dollar amount you were asked to pay?' is not in the purview of my access staff."
Avoid unpleasant surprises
If patient access don't communicate with patients about costs early in the process, patients are likely to be dissatisfied and won't be shy about saying so in a survey, says Nichols.
"When you don't do a good job with those upfront discussions, then any amount owed is an unpleasant surprise at the end," says Nichols. "You run the risk of getting negative patient feedback."
Nichols recommends using focus groups to get feedback specifically about patient access processes: timeliness to care, ease of scheduling, access to information, and preparation prior to the encounter. "One of my favorite things I heard from a focus group was about the transparency of a price quote," she says. "We were often quoting a bottom line number what the patient would owe out of pocket, total."
A patient observed that, in the absence of any context, that number was open to the interpretation of the patient as to whether it was a "good value" or not. "When we showed projected insurance payments, or any discounts offered, or even a payment plan schedule, the patients could put their responsibility in context and understand their contribution," says Nichols.
Kaleida Health's patient access staff are quick to offer patients a prompt pay discount or extended payment plan. "It's certainly not mandated that hospitals have to offer discounts for patient responsibility after insurance," notes Nichols. If you don't offer these options, however, a patient who is shocked to find he or she has a $20,000 deductible might end up paying nothing.
"We can't go back and unwrite a contract that they've signed," says Nichols. "But at least you can take the immediate crisis away from the patient."