Healthcare providers in today's environment are tasked with two seemingly contradictory goals. On the one hand, they want to cut operational costs to address persistently slim margins. On the other hand, they want to improve clinical outcomes, especially in value-based models that tie reimbursement to clinical quality.
It's a tough balancing act. After all, how does one improve, or even maintain, care quality when the organization is forced to tighten its belt?
As it turns out, leveraging technology in the right way can lead to operational improvements and efficiencies that allow healthcare organizations to actively increase their revenues. And it starts with the patient -- particularly when it comes to addressing their financial obligation.
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It's common nowadays for communication between patient and provider to be lacking. Patients aren't sure how much they'll end up owing the health system, there are no standardized communication protocols, and some patients will even no-show if their interactions with the system are too sporadic or confusing.
While technology can address some of these issues, what's more important than implementing any one tool or approach is to have the conversation internally, and create an organizational culture that emphasizes training, communication and a keen sense of patients' needs.
"When those conversations are taking place, the no-shows and all the other challenges hospitals have are greatly reduced," said David Shelton, CEO of patient advocacy organization PatientMatters. "Given greater efficiencies for their equipment, their manpower, that ultimately drives cuts in operational costs. With the financial conversations that wrap around that, I think a lot of times people miss the additional benefits."
Shelton outlined four main strategies healthcare organizations can implement to make this tough balancing act a reality.
BILL ESTIMATIONS, PERSONALIZED PLANS
First thing's first: There needs to be a system for advanced bill estimations. Perhaps the most important component of the initial process, it gives the patient an opportunity to understand the full extent of their financial obligation. Many providers are using technology to essentially de-emphasize the physician estimates, because each physician arrives at their estimates differently, even if they're performing the same task of procedure.
By projecting the patient's full responsibility, it's much easier to communicate on costs -- not just the initial costs, but any additional costs that may go along with it, whether they be tied to follow-up appointments, ongoing therapy, or any other component of the care journey.
An estimation tool can be one of the most complicated pieces of software to handle internally, said Shelton, because it needs to be continuously maintained. A newly-established tool should have at least 18 months' worth of data to provide a solid informational foundation, and it should be updated with new data on a monthly basis.
"A lot of people do an excellent job of getting started, but in the internal ownership it sometimes gets forgotten," said Shelton.
Estimating financial obligation is one thing, but for the patient, actually fulfilling that obligation can be another matter entirely. That's where personalized payment plans can make it easier for the patient to pay, and thus easier for the healthcare organization to collect.
"When you come in with one-size-fits-all payment solutions, it merely becomes a bargaining piece as opposed to using the technologies available, understanding the patient and being able to make payments," said Shelton.
Equally important is to give the registration team the right tools and education. Their comfort level with technology and the approach needs to be optimal.
"That registration team has a high turnover," said Shelton. "So you end up in a constant training mode with that staff. Whenever you've put tools in place and you have KPIs set -- not what the collection was over the course of the day, but what the opportunity was over the course of the day -- you want to be able to coach that person to be able to communicate based on what was missed."
REGISTRATION AND WORKFLOW DEVELOPMENT
Handling patients' point of entry can lead to additional efficiencies. Patients come into the system through a variety of avenues -- the emergency room, the imaging labs -- and a health system should have a standardized message and means of communication with a given patient. Their response back to the hospital will most often be more favorable as a result.
"If I've got a smooth discharge process, my thoughts upon leaving the hospital may be influenced differently," said Shelton. In an increasingly competitive marketplace, that can pay dividends in the form of patient retention. Consumers are more likely to return and keep their care in the system if they've had a positive experience.
Yet none of that matters if an organization can't get a good handle on data. There needs to be intelligent workflow integrated into the way the system does business, or else it will drown in a sea of information.
"A lot of people are using machine learning, artificial intelligence, big data," Shelton said. "The challenge we see is there's a lot of data floating around. The numbers are interesting, but do they actually bring value to the conversation? It's important to say, 'What's the data we're collecting that's changing our business that allows us to be more effective?' Some of that data might relate to the registration piece -- how fast can we register a patient so they're not frustrated when they receive their services? How does that improve the overall hospital flow? There's a lot of these data components."
Luckily there are a lot of potential benefits to enacting these strategies. One organization, said Shelton, implemented these approaches and saw more than a 300% return on the investment, much of that coming from point of service collections. There were also reductions in no-shows and a reduced registration time.
"When those are all taken into account, the business runs more smoothly," he said. "You can staff based on the volume coming in on different days. Every conversation has to end on patient satisfaction."
With hospitals operating on slimmer and slimmer margins, financial communication both internally and externally is poised to be an increasing necessity, and the right organizational culture and approach to data can bring that a step closer to reality.
"For the most part, the patient has always wanted to pay their bills," said Shelton. "But the healthcare provider hasn't brought them a way to do that. When they do, it's a much more satisfied patient that comes back."