Becker's Hospital Review

38 Revenue Cycle Heard about "patient payment clarity" yet? If not, you'll hear more soon. This new concept is winning fans at forward-thinking hospitals and raising eyebrows with executives as they learn about the term. For hospitals, patient payment clarity is getting visibility into when and how much they will be paid, by whom and the ability to better navigate the ob- stacles to payment. For patients, payment clarity goes beyond transparency to promote satisfaction and instill loyalty. To gain insight into this trend, we tracked down Cathy Dougherty, vice presi- dent of revenue cycle management for Lawrenceville, Ga.-based Gwinnett Medical Center, a 553-bed, two-hospital system serving the Atlanta suburbs. Ms. Dougherty is an unabashed advocate for patient payment clarity and rarely misses an opportunity to point out how it works, how it can improve financial performance and how it promotes positive patient experiences. If you distill her advice, reaping the benefits of patient payment clarity is the result of six essential elements: • An estimation tool at the point of registration • Patient (or consumer) education about insurance coverage • Highly trained financial counselors who act as patient advocates • Crystal-clear billing statements that patients can understand • Multiple convenient payment options, including online bill pay and financing • Direct access to payment services that bypass the usual customer service queue Gwinnett Medical Center has seen great results using this approach, includ- ing online patient payments of $45 million over five years, a 38 percent com- pound annual growth rate for online payments over four years, significantly reduced call center volume and a 10 percent decline in call abandonment. While the tools and processes used at Gwinnett are working well, Ms. Dougherty notes there's still work to be done. Healthcare providers must play an ever-more active role in educating consumers before they be- come patients, marketing use of technology to showcase consumer ben- efits and gathering feedback from patient-facing employees. Here's more of what she has to say about how to give patients payment clar- ity so your hospital can be healthier financially and better able to serve its community. Question: What does the concept of "patient payment clarity" mean to you? Cathy Dougherty: There's nothing more complicated to a patient than healthcare services. To me, clarity is the patient understanding what's in- volved from a financial perspective. There's no shortage of clinical commu- nication, but I want our patients to know what to expect from a financial standpoint. I call this 'the business side of caring.' It goes beyond transparency. It's what to expect when you leave. What kind of bills are there going to be? How will that work? On the way in, we estimate what the patient might owe based on insurance and our contract with the insurance company, using the RelayClearance estimator tool. That gives the patient more insight into what their responsibility will be, because otherwise, most of the time, they just don't know. If they're like me and don't use the healthcare system much, and suddenly need to use it, then they have no idea how it all works and what to expect. They've had things like screening mammograms that are covered 100 per- cent, but when they need real care, suddenly it's a new world and they don't know the impact of the dollar. So, patient payment clarity means ensuring we let them know their financial responsibility upfront, and telling them what to expect on the way out. And along the way, helping them with convenient ways to pay — whether it's an online web portal, phone, check, dropping by, a payment plan or credit card. Q: Does patient payment clarity also mean being able to know who's going to pay, when and how much? CD: Yes, of course we want insight into how likely it is that they will pay for their services and procedures. So if we all are on the same page and know more about what is likely to happen, it sets proper expectations and makes for happier people on both sides of the relationship. Q: What role does the hospital need to play in educating pa- tients? CD: Before the patient is a patient — when they're a consumer — we should be engaged in the community, educating the public about hospital bills and insurance, and answering questions. The lingo we use is not always familiar to patients. What's a pre-auth? What are deductibles? What are co-insuranc- es? When do they apply? What's an EOB? Educating the consumer is crucial. We should also engage employers and work with them to educate their teams. We can reach a lot of people and make a big difference quickly that way. We actually started a community education network through local churches, as part of our parish nurse program. I've been to many health fairs with them. We'll have an open booth, where folks stop by and talk about the business side of healthcare. It's been very well received. We work closely with local charity clinics so they understand our billing practices, how to file for financial assistance, and so on, so those patients are prepared when they come to a hospital. And we started a graduate medical education program in family practice and internal medicine, where newly covered people are often referred after they've been to the ER. That's another population we're educating at point-of-registration. The Business Side of Caring By John Holyoak, Director, Relay Health Financial, a McKesson company SAVE THE DATE learn more & register at beckershospitalreview.com July 20-21, 2015 Ritz Carlton, Chicago, IL Becker's Hospital Review CIO/HIT + Revenue Cycle Summit 80 Speakers, 50 Health System and Hospital CIO & CMIO Speakers, 5 Tracks and 54 Sessions

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