Improving Patient Collections in Fast-Paced, High-Volume Clinical Environments
Whitepaper | Kristen Coletto
Vice President Financial Counseling, Change Healthcare
Kristen leads the Change Healthcare Financial Counseling solutions to help providers manage patient obligations. With 15 years’ experience in a variety of healthcare roles, she served in director and executive positions for new business development at Aetna. She is a graduate of Duke University and has a MBA from The Wharton School at the University of Pennsylvania.
Although traditionally reliant on reimbursement from insurance carriers, today’s hospitals are now looking to patients for a much higher percentage of revenue for healthcare services. One recent Kaiser Family Foundation survey1 found that out-of-pocket healthcare costs rose by nearly 230% from 2006 to 2015.
This revenue shift represents a big change for hospitals and consumers alike. Consequently, many patients need help understanding how greater financial responsibility fits within the broader scope of their care delivery options. Without this help, some patients may find it difficult to navigate their care costs.
Hospitals, in turn, must contend with the fact that the probability of collecting patient balances drops significantly after services are rendered. Research conducted by the Advisory Board suggests that providers who fail to make point-of-service collections on a $150 patient-responsible balance only have a 36% chance of collecting fully.2
In response to this new reality, some providers are prioritizing front-end financial counseling strategies to elevate both the revenue cycle and the patient experience at the same time. Workflows supported by a solid infrastructure of automation and analytics can improve upfront payments, while also enhancing the overall patient financial experience.
Many hospitals have deployed financial counseling in patient access processes associated with scheduled inpatient and outpatient services. However, forward-looking organizations also recognize that these tactics are especially important in the emergency department (ED), where complex patient situations and workflows can increase the challenges associated with pointof-service collection
Five Steps to Building the ED Patient Access Strategy
Improving the ED revenue cycle and the patient financial experience starts with developing processes to address patient needs, patient access efficiency, and clinical team collaboration. Hospitals and health systems should consider these 5 elements:
1. Recognize the Point-Of-Service Opportunity
The first step to better patient collections is identifying and acting on point-of-service opportunities specific to the ED. Examining patient volumes and patient mix can help healthcare providers determine opportunities specific to their organizations. While the basic premise for expanding point-of-service collections is the same in the ED as elsewhere, the clinical intricacies of this highly acute, fast-paced environment are unique. Therefore, patients in the ED require a more collaborative approach to financial conversations. Patient conditions need to be considered in determining whether financial counseling should take place in the ED, or in a different hospital care setting.
2. Determine Appropriate Resource Allocation
Hospitals must also consider resource allocation needs, both from the staffing and training standpoints. As patient volumes increase, many EDs are grappling with fluctuating administrative staff-to-patient3 ratios, which have a direct effect on front-end registration responsibilities. As a result, hospitals have a good reason to dedicate resources to financial counseling and ensure all patients can be reached to have their financial questions and concerns addressed.
Importantly, a balance of proactive engagement and compassion must exist to ensure collections occur for a positive patient experience. Healthcare organizations are wise to train financial counselors on specific workflows and scripting that address the nuances of counseling patients in emergent situations.
Although some hospitals are bolstering the ED patient access experience by adding staff, those facing lean budgets may have difficulty getting approval for this approach. When added internal resources are not an option, healthcare organizations increasingly find a viable and effective alternative in partnering with a third party to outsource the ED financial counseling function.