Beyond the glaring need for efficiency and streamlining, the siloed existence had a hugely negative impact on communication. Physicians would order what they wanted to order in terms of services. If there was a denial, there was no conversation and the hospital simply ate the costs. This practice put the patient in the middle between the hospital and the physician.
"We didn't want that. We wanted the patient out of the middle. Let's have a convo and then decide the best solution to the patient," Dixon said.
First, they changed their EHR and moved to Epic after years on being on two different EHRs. That was a major catalyst for change. But Dixon said they also looked at other organizations to see what they were doing, and they also talked to patients and did patient forums to understand what they wanted to see happen.
Their vice president of revenue cycle led the charge, but they also had a physician champion. That was crucial.
"To get physicians on board, you need another physician to lead the charge. We had a physician champion helping us as well," she said.
To ensure a nonclinical person wasn't making care suggestions, they also had a nurse lead the financial counseling teams so they could speak the clinical language and communicate with the physician.
"Putting a clinical person in that space helped bridge those conversations with physicians," Dixon said.
They also decided to move as much of the financial conversation as early in the revenue cycle as possible, instead of waiting until the back end to have the conversation about payments and payoffs. The goal was to have those conversations at the time of service or prior to services. They even recorded face-to-face conversations for staff training purposes.
The silos came down. Now, Dixon said, on any given month they have between 40 to 50 percent of all patient money coming in prior to or at the time of service.
"We do a good job of getting that money. The other 50 percent is what we have to work on, on the back end. We have a goal in our office to get to where if we have to send a statement, it's a failure -- that for any scheduled service we should be getting that money up front," she said.
They also have a rev cycle patient experience dashboard with 35 to 40 metrics that provides a glimpse into what the patient's financial experience was through the rev cycle, from pre-registration, time of service, financial counseling and through the back end.
They measure ratio of statements to visits and have seen statements declining because they are collecting more at the time of service. They track statements to customer service phone calls, understanding that if patients trust the statements and if they are accurate and easy to read, they aren't going to call their centralized call center. The same is true for online payments. If the patients are paying online, then they understand the statement. That metric has grown from about 8 percent of total patient collections for a given month to 25 percent of patient collections.
"To be successful, you have to have clinician buy-in and a physician champion. You have to speak their language. You also have to find ways to measure patient financial experience. Find some KPIs and build a dashboard that would give you insight into that," Dixon said.
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