Kathy Peterson, FHFMA Director of Patient Financial Services
October 11, 2015
Self-Pay in an ACA World:
Optimizing Resources with
Soarian Tools, Workflows
and Partners
Our focus today
Marketplace changes
New skills needed in patient access
Creation of patient advocate role
Challenge in back-end self-pay collections
Extended business office solution
ResultsAbout us
Located in Plattsburgh, NY
Now part of the University of VT Health Network
Licensed 341 Acute Beds
54 SNF Beds
Inpatient Behavioral Health
Live on Soarian Clinicals in 2010
Live on Soarian Financials December 2013A changed healthcare landscape
Meaningful Use
Drove the need for new Electronic Health Records (EHRs)
New EHR’s drove the selection of new health information systems
New health information systems necessitatedo Long installation periods
o New processes
A changed healthcare landscape
Affordable Care Act (PPACA)
Individual insurance mandateo Increase in high-deductible plans and out-of-pocket expenses
both in the marketplace and through employer plans
Pricing transparency
501r regulationsPhase 1 - new IT system / new skills
Our Journey begins with
Soarian Financials – live December 1, 2013
11 month install – launch was January 2013
New skill set needed in patient access
Created new titles
Wrote new job descriptions
Nobody grandfatheredo All had to meet requirements or face layoff
Patient access -new job titles
Healthcare Access Associate
Certified Healthcare Access Associate
Certification through NAHAM*
Must become a Certified Healthcare Access Associatewithin 15 months of hire
New job description
Associates Degree in Healthcare or business preferred
Medical Terminology Certificate requirement or anatomyphysiology as evidenced by transcript
Microsoft Word and Excel Certificates required
Data Entry test (moved away from typing test)
Basic Coding Course certificate required
One year customer service experience with specificexperience asking for payments/money required
New job description
Same as Healthcare Access Associate except:
Within 15 months of hire must become a CertifiedHealthcare Access Associate through NAHAM –
www.naham.org
Recruiting note—a little more difficult but partnered with local technical college and they teach to our requirements and are a major source of employees for usNew requirements – higher pay
Pay Scale for Healthcare Access Associate
•
Step 0 -- $14.31/hour (old wage was $12.07)•
Step 10 - $18.60/hour (old wage was $17.43)New requirements – higher pay
•
Step 0 – $15.64/hour (old wage was $12.88)•
Step 10 -- $20.33/hour (old wage was $18.60)•
Step 20 -- $22.68/hour (old wage was $20.75)Coding at the time of registration
Require walk-in ancillary tests (labs & straight x-rays) be coded at registration
Convert worded diagnoses to coded diagnoses asnecessary (skill also needed for ABN’s)
Bills can go out within 2 days - lowers DNFB and improvesManagement structure change
Previously had two patient registration managers Changed their titles and roles to:
o Patient Registration Operations Manager
o Patient Registration Training Manager
• Increased skill set requirement and complex system justified need for focus on training
Result – drop in error rate
0 200 400 600 800 1000 1200 1400 1600 1800January-14 May-14 September-14 January-15 May-15 Subscriber Data Insurance Data Admission Data Patient Data
Result – faster turnaround of bills
One of our Vice Presidents came in for lab services.
The bill was sent electronically through clearing house to the insurance, processed, electronic remittance received and
posted, balance transferred to patient and statement went out to patient 8 days later for the patient responsibility.
Phase 2 -the next set of challenges
Fragmented financial clearance process Missing authorizations
Not meeting with scheduled patients early enough
Not asking for out-of-pocket before day of procedure
Point of service collections Primarily asking for co-pays
Not asking for deductibles or larger out-of-pockets
Need for ACA up-front pricing and transparency bestpractices
Self-pay unit unable to manage incoming/outgoingcollection calls
Addressing the challenge
Create a new job description called Financial Advocates
Change the financial counselors and self pay team to thenew financial advocate role
Move self pay team to the front into new job role
Create a financial advocate supervisor (promoted seniorself pay staff person to this role and eliminated that position—net FTE impact 0)
Partner with an external company as an extended businessoffice to answer all of our incoming calls and make outgoing collection calls (better customer service – we had high
New job description
AA degree in business, finance or healthcare preferred
Medical terminology required or Anatomy and Physiology
3 years healthcare experience with a focus on finance andcustomer service
Microsoft Excel and Word course certificates
Must become a certified application counselor for theHealthcare Marketplace within 6 months of entering position
Must become a notary public within one year into thisposition
Must take a basic coding course within 3 months of hireGoals of financial advocate
Review all scheduled surgical, cardiology and radiologyprocedures for:
Insurance information
Authorizations
Out-of-pocket responsibility
Meet with all patients who have out-of-pocket responsibilityprior to scheduled procedure
Review payment optionsGoals of financial advocate
Embed the financial advocate in other departments andprocesses to make this seamless and well coordinated for the patient Examples – joint program, cancer center
Reduce bad debt
Increase price transparency to patientsStaged implementation
Rewrote new job descriptions and cleared through union
Created Financial Advocate Supervisor position and filledfrom within
Implemented extended business office
Had to have in place before staff could be moved from back end to front end - EBO live on November 10, 2014
Worked with facilities to build 4 new offices for financial advocatesStaged implementation
Eliminated cashier positions to improve patient flow
Financial advocates now handle all payment
transactions after making financial arrangements with
patients
All other cashier functions deployed elsewhere – i.e.
foundation, etc.
One cashier became financial advocate and one
absorbed into general accounting
Used vacated space to build new financial advocate
offices
Staged implementation
Had to fill vacant financial advocate positions out of the gate
Surgical implementation started roll out - Jan 2015
First financial advocate placed in Emergency Room - Feb 2015
Financial advocate as part of “joint program” - May 2015Additional technology needs
In final selection of vendors and contract for:
Prior authorization software
Patient estimation software
Cashiering/credit card integration/balancing softwareExtended business office services
Chose two of our existing vendors to review for possiblepartnership
Went on site to both companies
Toured
Talked with staff
Observed
Reviewed proposals
Went live November 10, 2014 with outside vendor answeringEBO – stage 1
Implement in a 30 day timeframe
Answer all incoming phone calls/take insurance
Transition from CVPH to partner transparent to patients
Same phone number on statements - forwarded to EBO
Answer phone as CVPH
Staff trained on CVPH Soarian system
Reduce abandoned calls
Improve customer serviceEBO – stage 2
Initiate effective collection campaigns
Interactive voice response (IVR) technology
Live conversations in between patient statementso Using dialer system
Careful analysis of patient population (AR) to determine efficient approach and maximum performance
Propensity to pay scoring*
Segmentation strategy*Results – POS collections 91%
$50,000.00 $100,000.00 $150,000.00 $200,000.00 $250,000.00Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
POS Collections
Results – Self Pay Collections 78%
$100,000.00 $200,000.00 $300,000.00 $400,000.00 $500,000.00 $600,000.00 $700,000.00 $800,000.00 $900,000.00 $1,000,000.00Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
Self Pay Collections
Results
Improved patient satisfaction – patient complaints regardingwait times on phones have been eliminated
On-line e-payments collections - $1.8M in past 12 months
Bad debt expense has been reduced
Bad Debt is at 1.2% of the gross revenue per audited financial statements
In the 3Q of 2013, HARA* reported that hospitals across the country wrote off 3.30% of their gross revenue as bad debt
Self Pay receivables are now lower than pre-conversionlevels
Take-aways
Possibilities for new skill sets in patient access
Patient access job descriptions
How to shift resources from back-end to front-end forproactive collections
How to partner with your existing vendor or new vendor forextended business office
