Patient experience is one component of value-based reimbursement, and hospital finance staff are aware of the connection.
Since the advent of the Affordable Care Act, hospitals have shown increased interest in consumer perceptions of the healthcare delivery experience. A key reason for this concern is that patient experience is one component of value-based reimbursement, and hospital finance staff are aware of the connection.
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys, which measure patient evaluation of the services they receive, are a key component in the calculation of value-based incentive payments to providers under the ACA.
Questions in the HCAHPS survey put the biggest spotlight on the quality of care patients receive from medical staff and the quality of the hospital environment itself. But consumers also are asked to give an overall rating of the hospital and whether they’d recommend it to others. Their answers to these queries may draw not only upon their in-hospital experience, but also reflect how they are treated by the hospital, or its outsourcing partners, during the billing and collections process.
“Encounters at touch points related to the revenue cycle, which can be one of the encounters furthest down the chain for healthcare organizations, are significant,” said Jason A. Wolf, president of The Beryl Institute, a community of practice and thought leadership organization focused on improving the patient experience in healthcare. These interactions probably occur in very close proximity to when patients will be filling out surveys.
[See also: 4 areas to watch to reduce billing costs.]
Wolf recently co-authored a paper, The Revenue Cycle: An Essential Component In Improving Patient Experience, that discusses the importance of positive interactions between patient and revenue cycle representatives in contributing to strong patient experience scores, and thus to healthy reimbursement levels in value-based purchasing (VBP) programs. “You could perform well in the four walls of the clinical experience, but if the revenue cycle process fails or the bill comes in and the patient or his family members feel they are treated with disrespect by revenue cycle representatives, that ultimately reflects on the institution overall,” he said. (Not only that, but Wolf says people are more apt to pay when they feel they are treated with dignity.)
Given that the level of reimbursement hospitals receive from their largest payer, Medicare, will be directly tied to the HCAHPS survey, it’s critical that backend billing and collections be aware of the broader patient experience effort of the organization, Wolf recommends. “They must be cognizant of the fact that they have a role in contributing to the overall patient experience,” he said – not just see their job as getting the last dollar owed out of a patient.
Just because you outsource this doesn’t mean you can bury your head in the sand.
Organizations that use third-party services to partially or entirely handle patient collections should understand how those outsourcers work, to be sure they can conform to the behavior standards they want to encourage. “There are all kinds of collections agencies, and you should interview them to understand their philosophy,” said Zac Stillerman, executive director and general manager of Revenue Cycle Solutions at healthcare industry technology, research and consulting firm The Advisory Board Company. And, he adds, healthcare organizations should follow up with patients after the process. “Just because you outsource this doesn’t mean you can bury your head in the sand. You have to survey the patients and make sure their interactions with [outsourcers] weren’t unnecessarily coarse,” he said.
Wolf believes, in fact, that outsourcers who “put skin in the game to ensure patients are satisfied with their encounters with them” should position themselves to potential clients as expert patient experience partners. “They would be well-served to present themselves [that way],” he said.
The front-end experience is part of the revenue cycle
Both Stillerman and Wolf urge healthcare organizations to build their front-end experiences with patients such that they pave the way to a satisfactory close of engagement for all parties concerned. Wolf, for instance, points out that registration workers who help patients fill out paperwork represent these consumers’ first encounter with a facility. If these frontline caregivers are trained to bring empathy and patience to the job, they’re setting the stage to create lasting and loyal relationships with those in need of care. “That’s a critical role in the ongoing revenue cycle,” he said.
[See also: Billing and Collections.]
Additionally, as hospitals become more savvy about using technology and data as a way of honing in on what a patient will truly owe for certain treatments – elective procedures like knee replacements, for example – they can guide and counsel the patient about his responsibilities before he receives care, Stillerman said. They even can direct him in advance to sources that could help supplement the surgery’s costs.
“Telling someone he’ll owe $1,300 out of pocket and asking for a down payment on that before he arrives for the procedure might feel like an iffy interaction to have,” he said. “But if hospitals and healthcare systems can accurately and confidently tell patients what they’ll owe, patients generally see it as a positive interaction. They start to view it like any other [buying] experience, whether it’s going to the auto mechanic or the coffee shop.”