8 initiatives for overhauling the patient financial experience

Consumers increasingly expect healthcare organizations to provide the type of convenience and efficiency that they are accustomed to receiving from retail and other industry sectors. Moving from “the way it’s always been done” to a customer-centered financial operation requires a major overhaul of processes and protocols, as illustrated by the effort at Atlanta-based Piedmont Healthcare.

Brian Unell, vice president-revenue cycle transformation and integration; Allyson Keller, executive director of the Patient Connection Center; and Andrea Mejia, executive director-patient financial care, will be at HFMA’s 2019 Annual Conference, June 23-26 in Orlando, to present on the health system’s “8 Initiatives to Support Patient Financial Care” (part of the Patient Accessibility, Engagement and Experience track). The eight initiatives are:

• Patient Financial Responsibility Policy: Develop, implement and administer a policy to address the growth of self-pay balances
• Price Estimator Tool: Implement and enhance the use of a vendor partner’s pricing estimator to generate a patient estimate for physician and hospital services.
• Patient Payment Processing: Replace the current patient-payment processing solution to ensure compliance and enhance electronic payment processes, tools and accuracy.
• Third-Party Financing: Provide better options for patients to meet their financial obligations for physician and hospital services.
• Patient Financial Communications: Optimize notifications (statements, estimates, receipts, etc.) to make them easy to understand. Optimize communication mechanisms (paper, web, chat, email, phone, text etc.) to meet patients’ preferences.
• Customer Solutions Center Optimization: Define and execute core competencies for customer service and collection activities. Leverage technology to enhance efficiency and effectiveness.
• Patient Connection Center Optimization: Align operations to more effectively perform financial preservice activities and help create a hassle-free experience.
• Job Description Redesign: Revise job descriptions, incorporating talent enhancement and skill development, to support the move to self-service technologies and align to the concept of staff as owners of the patient’s financial experience.

In this Q&A, Unell (pictured) provides an overview of the organization’s progress to date.

What does your job title — vice president of revenue cycle transformation and integration — mean? How is Piedmont Healthcare transforming its revenue cycle?

Historically, our revenue cycle operations operated with a disparate, decentralized model. While our revenue cycle performed well by many metrics, we knew we needed changes to accommodate our growth — we have doubled in size in the last four years — and position us for greater success in the future.

I see revenue cycle as a strategic, value-added function, not a cost-focused transactional function. For us, that has meant launching eight initiatives — each of which is a big undertaking — with the goal of moving the business in a significant way. 

Too often people say, “I’m going to do point-of-service cash, and if I can collect $3 more from 10,000 patients a month, then I’ve got $30,000 a month and $360,000 a year, and in five years that’s a $1.5 million initiative.” In my view, if you focus on moving an individual metric, you can do it in the short term, but it’s not sustainable. 

We set the goal of trying to collect $10 million more in patient collections over three years because we know just focusing on any single metric isn’t going to be enough. We’ve already achieved $5.4 million in benefit in the first year, and I believe there are more dollars out there that we’re going to be able to collect as well.

How are your revenue cycle initiatives organized?

One initiative is working on our patient financial responsibility policy. We are now in Phase 3 of that initiative. In the first phase, we started off with a select group of nonemergent services — walk-in services like “I got sent over from my doctor’s office for an X-ray or a lab test” —  and focused solely on trying to collect at least 15% of the patient’s responsibility up front. In Phase 2, we included some scheduled services like surgeries and other invasive procedures. 

In the third phase, we’re going to focus on patients who are responsible for the entire cost of their services because they either are self-pay or have high-deductible insurance plans. We see that those patient balances are where we still have a big opportunity to improve collections. 

What kind of infrastructure changes are you making?

One of our biggest initiatives was a complete overhaul of our entire patient-payment processing system — including point-of-service, preservice and post-discharge payments that are made via the web, phone calls from patients to a staff member, or an interactive voice-response system where patients can type in their credit card number and pay a bill. We needed to be able to accept chip-embedded credit cards, so we deployed nearly 900 new credit card machines. As you can imagine, that was a pretty significant change for the 1,500-plus team members who take payments.

Another initiative was to introduce a third-party financing option. We had historically done in-house payment plans, but we are changing so that patients who need a payment plan longer than 12 months will work through this third-party arrangement. 

What are you doing in the area of patient financial communications?

That initiative involves refining our estimates, statements and receipts so our patients can understand them better. Although we have come a long way in improving the patient financial experience, this is a journey we are continuing to focus on.

It used to be that patients in our physician offices would get two different receipts — one from the credit card system and one from our electronic health record system — so we have cleaned that up. The larger focus has been on our consolidated physician-and-hospital patient statement.  

In fact, a few months ago our CEO was at a Rotary Club meeting and during the Q&A someone stood up and said, “I have a comment about my bill.” At this point our CEO was thinking, “Oh boy, here it comes.” But instead of complaining, the person said, “I don’t know what you all did, but for the first time I can understand my bill.”  

Additionally, patients can now opt in to receive email or text notifications about statements. We went live with this option in September, and by January we had over 10,000 patients opting for email or text notifications.

What is your Patient Connection Center? And what are you doing to enhance that?

Our Patient Connection Center handles our scheduling as well as our preregistration and authorization functions. Working on this was one of the first initiatives we undertook. 

Historically we were aligned by facility, and we moved to a consolidated model centered on service lines. Then we also went from what we called “days out” — if you are coming in for an appointment, we want to make sure you’re preregistered 72 hours in advance, or three days out — to notifying patients of their liability and completing preregistration during the scheduling call. If you have an appointment four weeks from now, why should we be scrambling just a few days ahead of that?

We had another initiative related to that, which was redoing the job descriptions for staff in the Patient Connection Center to support the service-line model.

What’s next for your revenue cycle transformation?

Our next initiative is to optimize our scheduling and customer service calls. We have implemented workforce management to understand how our teams should be staffed to answer calls from our patients. We want to use speech analytics to understand why our patients are calling and how we can meet their needs without a phone call. 

For example, if 30% of calls are because patients don’t understand their bill, how could we make it easier for them to understand? People calling us is not good use of their time, and it’s really not good for us either.

The game-changing initiative is the opening of a $600 million expansion at our quaternary facility, Piedmont Atlanta Hospital. There will be no traditional registration area. This is a major effort that we are partnering on with our patient experience and hospital leadership teams to ensure our people, processes and technology are ready to support self-service to complete the preregistration function, given that there will be no place to perform this function — in the traditional way — when the building opens in late 2020.

Interviewed for this article: Brian Unell, vice president-revenue cycle transformation and integration, Piedmont Healthcare, Atlanta.