Setting the Right Expectations while Delivering a Positive Patient Experience

By Magan Butler-Coleman | Posted: 06/09/2016

By Magan Butler-Coleman, Vice President, Revenue Cycle Solutions, nThrive

Pressures on the bottom line for healthcare organizations have never been greater. A variety of factors including reduced reimbursement, the mandate for pricing transparency and the shift to value-based care models have CFOs scrambling to create strategies that will protect and enhance the organization’s financial viability while delivering a positive patient experience. Walking this fine line requires keen insight into the opportunities for financial improvement that integrate with and support an organization’s commitment to provide an unparalleled experience for the patient and his or her family.

Recently, I had the honor of teaming with an nThrive partner to present a story that demonstrates how her organization approached this challenge and succeeded. My fellow presenter, Jana R. Mixon, is executive director, Access & Scheduling Services, for the not-for-profit Kettering Health Network in Dayton, Ohio.

I began with an overview of the trends in pricing transparency developing across the country and discussed specific examples, walking attendees through the components of our solution that help members promote transparency across all phases of the access journey.

In 2011, Kettering saw a huge shift toward patients being responsible for a greater portion of the cost of their health care. An internal work team identified two areas of opportunity to improve revenue performance: collect underpaid accounts receivable from government payers and increase point-of-service collections through better patient estimates to mitigate bad debt.

About 55 percent of Kettering’s revenue was from Medicare and Medicaid patients. But, its legacy contract management system focused on commercial payers, preventing the organization from gaining insight into government payer reimbursement rates. Bad debt was growing as the number of unemployed residents increased. Those with health insurance had higher deductibles and co-pays. Sixty percent of patients paid their accounts in full while 40 percent paid only one percent of their bill. Traditional approaches to collecting outstanding balances were becoming more costly and proving ineffective.

Jana explained how the nThrive CarePricer® patient liability estimation solution helped Kettering obtain accurate, patient-friendly estimates at the point of access. The organization combined this solution with nThrive Contract Management® to add definition and clarity to the estimates being provided to the patients.

Kettering recognized that patient billing was an area fraught with opportunities for patient dissatisfaction. It found that, thanks to these nThrive solutions, quoting correct out-of-pocket estimates and billing accurately according to the individual patient’s ability to pay actually improved patient satisfaction. The solutions coupled with extensive communications and training increased awareness among-employees that most patients appreciate the opportunity to discuss financial responsibility before care is provided.

Kettering was convinced that patient financial priority shifts when you educate, estimate and communicate to set the right expectation. All Kettering Access Services personnel completed eight hours of classroom training and additional hands-on training on the new technology and communication techniques. Metrics were developed to gauge improvement and a dedicated manager and support employees was hired to focus solely on revenue cycle strategies. More than 69 tip sheets focused on components of the technology and communications training were produced for front line employees. At-the-elbow support was provided to employees in the workplace.

As Kettering rolled out these initiatives, it found a direct correlation between the number of patient liability estimates provided and the number of successful point-of-service collections completed. Analysis showed that Kettering was achieving its goal of collecting more per patient encounter. In fact, from the time the initiatives were launched in 2011 until 2016, point of service dollars collected increased from $4.7 million to more than $27 million.

For more information on how our revenue cycle management solutions can help, contact an nThrive specialist at 678.323.2500.