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HIMSS18 revenue cycle recap: Patient-centric approach takes communication, flexibility and motivated staff

A new philosophy is emerging around the hospital revenue cycle that it bookends episodes of care.

Beth Jones Sanborn, Managing Editor

Rebecca Kaul speaks at the HIMSS18 Revenue Cycle Summit

When it comes to revenue cycle, a patient-centric culture is the future. By the way, make sure you include your employees in that philosophy and understand how technology can help get there.

The dominant themes emerging from HIMSS18 when it comes to revenue cycle were all about putting the patient first and recognizing that it's people driving your revenue cycle operations.

Hospital executives must recognize what will be driving the healthcare industry from a patient and employee standpoint in the coming years and acknowledge the consumer-centric experience taking hold just about everywhere -- and, increasingly, that includes healthcare. The emerging philosophy around revenue cycle is that not only is it part of the overall care experience, but that it will bookend most episodes of care, with pre-authorizations, registration and taking of POS payments at the front-end and then post-care billing on the back end.

The policies and procedures surrounding this front-to-back operation should be built on personalization of patient interactions, knowledge of consumer preferences, flexibility, and clear communication where the patient understands what they will be responsible for and will have options to fulfill their obligation that suit their particular situation. It's the experience they have come to expect, and it's something that may be present in other areas of care delivery but that has been lost a little in the realm of revenue cycle.

Consumers also welcome digital options for registration and billing. Sharp Healthcare in San Diego created a self-serve billing portal where patients can view statements, pay bills, download statements and view current invoices broken down by hospital clinic. 

"Patients can pay their full balance or for a specific visit. There is a document repository as well so they can see any forms provided to them at the hospital," said Gerilynn Sevenikar, vice president at Sharp. 

Since its launch in 2017, patients have paid more than 10,000 invoices online.

Patient communication of the high- or low-tech variety can play a pivotal role in increasing collections across the various stages of revenue cycle, but is likely most effective when frontloaded. Having focused, clear and personal conversations with patients at the beginning of their care experience made all the difference for stand-alone system Goshen Health in Indiana. Their former CFO Amy Floria addressed the audience at the HIMSS18 Revenue Cycle Solutions Summit and told listeners that bad communication equals bad debt, and that lack of communication and standard procedures for financial aid qualification hurt them badly. 

"We had everyone apply and just charged off bad debt when they didn't end up qualifying," Floria said.

Goshen redesigned its website, met with every patient while they were in the facility to address issues and questions, and expanded payment plan options, especially for consumers with high deductible health plans. The system also started offering all patients financial informational material in english and spanish to accommodate their hispanic community.

All that resulted in a whopping 7,200 percent increase in monthly POS collections from $2,500 a month before the changes three years ago to $240,000 a month in 2017.

Flexibility and creativity in creating an adequate array of payment plans and options for patients will be even more crucial moving forward, as healthcare costs show no sign of shrinking. On the contrary, a recent Transunion study showed that out-of-pocket costs spiked 11 percent in 2017, while at the same time 35 percent of American adults would struggle with, or be unable to pay, a $400 bill. If the care isn't going to get any cheaper, than something has to give when it comes to how patients are allowed to pay.

Revenue cycle leaders also can't forget that while new technology can help refine operations and expand capabilities, if the people who staff your department don't understand it or hate using it, you've wasted your investment. Choosing software that is intuitive and creates efficiencies will inspire more productivity in your staff. So it might not hurt to get their feedback or even give them a say in what technologies gets selected -- and do so as early in the procurement process as possible. 

Finally, driving a successful revenue cycle department requires motivating and rewarding the staff who do the work. Since over the course of the next decade, consumerism will constitute a bigger piece of all industries, healthcare included, creating a system of performance monitoring, real-time feedback and employee rewards can inspire your rev cycle staff to work smarter and, in turn, that will benefit your system's bottom line.

"That's what makes a difference to that next generation healthcare consumer and employee," Sevenikar said.

Twitter: @BethJSanborn
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