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SELF-PAY IN AN ACA WORLD: OPTIMIZING STAFF RESOURCES, WORKFLOWS
AND TECHNOLOGY
June 15, 2016
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INTRODUCTIONS
Kathy Peterson, FHFMA
Director of Patient Financial Services
Champlain Valley Physicians Hospital
Laurie Shoaf, CRCE
Chief Operating Officer
CCI – Computer Credit Inc
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Marketplace changes
New skills needed in patient access
Challenge in back-end self-pay collections
Creation of patient advocate role
Extended business office solution
Results
Take-aways
OUR FOCUS TODAY
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CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
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Located in Plattsburgh, NY
Part of the University of VT Health Network
Licensed
341 Acute Beds
54 SNF Beds
Inpatient Behavioral Health
Sorian Installation
Live on Clinicals in 2010
Live on Financials December 2013
2 unions in place (1199 SEIU and NYSNA)
ABOUT US
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A CATALYST FOR CHANGE
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Meaningful Use
Drove the need for new Electronic Health Records (EHRs)
EHR’s drove the selection of new
health information systems
New health information systems necessitated
o Long installation periods
o New processes
o New workflows in both clinical and financial areas
A CHANGED HEALTHCARE LANDSCAPE
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Affordable Care Act (PPACA)
Individual insurance mandate
o Increase in high-deductible plans and out-of-pocket expenses
both in the marketplace and through employer plans
Improving the patient experience
Pricing transparency
501r regulations
Reductions in Medicare reimbursement
A CHANGED HEALTHCARE LANDSCAPE
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REALIGNMENT OF THE REVENUE CYCLE
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Our Journey begins with
Soarian Financials – live December 1, 2013
11 month install – launch was January 2013
New skill set needed in patient access Created new titles Wrote new job descriptions Nobody grandfathered in
o all had to meet requirements or face layoff
Changed Management Structure
PHASE 1 - NEW IT SYSTEM / NEW SKILLS
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Healthcare Access Associate
Certified Healthcare Access Associate
Certification through NAHAM*
Must become a Certified Healthcare Access Associate within
2 years of hire
*National Association of Healthcare Access Management
PATIENT ACCESS - NEW JOB TITLES
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Associates Degree in Healthcare or business preferred
Medical Terminology Certificate requirement or anatomy
physiology as evidenced by transcript
Microsoft Word and Excel Certificates required
Data Entry test (moved away from typing test)
Basic Coding Course certificate required
One year customer service experience with specific experience
asking for payments/money required
Healthcare Access Associate
NEW JOB DESCRIPTION
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Same as Healthcare Access Associate except:
Within 15 months of hire must become a Certified Healthcare
Access Associate through NAHAM – www.naham.org
Recruiting note—a little more difficult but partnered with local
technical college and they teach to our requirements and are a
major source of employees for us
Certified Healthcare Access Associate
NEW JOB DESCRIPTION
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– Step 0 -- $14.67/hour (old wage was $12.07)
– Step 10 - $19.07/hour (old wage was $17.43)
– Step 20 - $21.27/hour (old wage was $19.44)
Pay Scale for Healthcare Access Associate
NEW REQUIREMENTS – HIGHER PAY
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– Step 0 – $16.03/hour (old wage was $12.88)
– Step 10 -- $20.84/hour (old wage was $18.60)
– Step 20 -- $23.24/hour (old wage was $20.75)
Pay scale for Certified Healthcare Access Associate
NEW REQUIREMENTS – HIGHER PAY
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Require walk-in ancillary tests (labs & straight x-rays) be coded at registration
Convert worded diagnoses to coded diagnoses as necessary (skill also needed for
ABN’s)
Bills can go out within 2 days and lowers DNFB and improves cash flow
CODING AT THE TIME OF REGISTRATION
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Previously had two patient registration managers
Changed their titles and roles to:
o Patient Registration Operations Manager
o Patient Registration Training Manager
• Increased skill set requirement and complex system justified need for
focus on training
Added a Patient Registration Supervisor
MANAGEMENT STRUCTURE CHANGE
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200
400
600
800
1000
1200
1400
1600
1800
January-14 January-15 December-15 April-16
Subscriber Data Insurance Data Admission Data Patient Data
RESULT – DROP IN ERROR RATE
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One of our Vice Presidents came in for lab services.
The bill was sent electronically through clearing house to the
insurance, processed, electronic remittance received and
posted, balance transferred to patient and statement went out
to patient 8 days later for the patient responsibility.
RESULT – FASTER TURNAROUND OF BILLS
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Fragmented financial clearance process
Missing authorizations
Not meeting with scheduled patients early enough
Not asking for out-of-pocket before day of procedure
Point of service collections
Primarily asking for co-pays
Not asking for deductibles or larger out-of-pockets
Need for ACA up-front pricing and transparency best practices
Self-pay unit unable to manage incoming/outgoing collection calls
Not able to increase FTE’s
PHASE 2 -THE NEXT SET OF CHALLENGES
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Create a new job description called Financial Advocates
Change the financial counselors and self pay team to the new financial advocate role
Move self pay team to the front into new job role
Create a financial advocate supervisor (promoted senior self pay staff person to this role and eliminated that position—net FTE impact 0)
Partner with an external company as an extended business office to answer all of our incoming calls and make outgoing collection calls (better customer service – we had high abandoned calls from the queue)
ADDRESSING THE CHALLENGE
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AA degree in business, finance or healthcare preferred
Medical terminology required or Anatomy and Physiology
3 years healthcare experience with a focus on finance and customer service
Microsoft Excel and Word course certificates
Must become a certified application counselor for the Healthcare Marketplace within 6 months of entering position
Must become a notary public within one year into this position
Must take a basic coding course within 3 months of hire
Financial Advocate
NEW JOB DESCRIPTION
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Review all scheduled surgical, cardiology and radiology procedures for:
Insurance information
Authorizations
Out-of-pocket responsibility
Meet with all patients who have out-of-pocket responsibility prior to scheduled procedure
Review payment options
Collect prior to procedure
GOALS OF FINANCIAL ADVOCATE
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Embed the financial advocate in other departments and processes to make this
seamless and well coordinated for the patient. Examples – joint program, cancer
center
Reduce bad debt
Increase price transparency to patients
Continue to meet with all self-pay bedded patients
GOALS OF FINANCIAL ADVOCATE
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Rewrote new job descriptions and cleared through union
Created Financial Advocate Supervisor position and filled from within
Implemented extended business office
Had to have in place before staff could be moved from back end to front end - EBO live on
November 10, 2014
Worked with facilities to build 4 new offices for financial advocates
STAGED IMPLEMENTATION
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Cashier Positions
Eliminated positions
Financial advocates process patient payments for improved patient flow and
satisfaction
All other cashier functions deployed elsewhere – i.e. foundation, etc.
One cashier became financial advocate and one absorbed into general accounting
Built new financial advocate offices in old cashier space
STAGED IMPLEMENTATION
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Had to fill vacant financial advocate positions out of the gate
Surgical implementation started roll out - Jan 2015
First financial advocate placed in Emergency Room - Feb 2015
Financial advocate as part of “joint program” – May 2015
Financial advocate embedded in cancer center - June 2015
STAGED IMPLEMENTATION
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• In final selection of vendors for:
Patient estimation software
• Contracted with vendor and currently installing:
Cashiering/credit card integration/balancing software/mobile payment app
Go live scheduled for July 2016
ADDITIONAL TECHNOLOGY
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Chose two of our existing vendors to review for
possible partnership
Went on site to both companies
Toured
Talked with staff
Observed
Reviewed proposals
Went live November 10, 2014 with CCI answering all
incoming calls
EXTENDED BUSINESS OFFICE SERVICES
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Implement in a 30 day timeframe
Answer all incoming phone calls/take insurance
Transition from CVPH to partner transparent to patients Same phone number on statements - forwarded to EBO
Answer phone as CVPH
Staff trained on CVPH Soarian system
Reduce abandoned calls
Improve customer service
Goals
EBO – STAGE 1
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Initiate effective collection campaigns
Interactive voice response (IVR) technology
Live conversations in between patient statements
o Using dialer system
Careful analysis of patient population (AR) to
determine efficient approach and maximum
performance
Propensity to pay scoring
Segmentation strategy
Goals
EBO – STAGE 2
ccipowerinside.comSCALABLE AFFORDABLE COMPLIANT COMPATIBLE PROVENPERSONAL
We know patient pay / self-pay, 44 years experience
Fully scalable services evolve with you
Implement within 45 days, integration with Epic, Cerner, McKesson & MEDITECH
Employee owned & independent – committed and passionate about clients success
No term contracts – subscriber agreement requires proof of value month to month
EBO @ CCI
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• ANALYTICS Propensity to pay scoring and presumptive charity screening
• SEGMENTATION Strategies for identifying value and mitigating risk
• AUTOMATED WORKFLOWS Communications and resource configuration
• INBOUND IVR SYSTEMS Self-service and after hours options for patients
• OUTBOUND IVR CALLS Automated patient outreach
• U.S.-BASED CONTACT CENTER Professional staff for live calls
• PAYMENT PLAN MANAGEMENT Supplemental staff and reminder technology
• MAIL CENTER In-house mail operations, a USPS central access point
• HOSPITAL CORRESPONDENCE Statements, data-mailers, letters
• CREDIT CARD PAYMENT PROCESSING Convenient, secure transactions
• COLLECTION AGENCY ENGAGEMENT Escalation for unresponsive balances
A COMPLETE TOOLSET
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$-
$50,000.00
$100,000.00
$150,000.00
$200,000.00
$250,000.00
Series1
Linear (Series1)
RESULTS – POS COLLECTIONS 50%
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$-
$100,000.00
$200,000.00
$300,000.00
$400,000.00
$500,000.00
$600,000.00
$700,000.00
$800,000.00
$900,000.00
$1,000,000.00
Nov-14 Apr-15 Jul-15 Dec-15 Mar-16
Self Pay Collections Linear (Self Pay Collections)
RESULTS – SELF PAY COLLECTIONS 75%
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Improved patient satisfaction – patient complaints regarding wait times on
phones have been eliminated
On-line e-payment collections - $2.2 M in past 12 months
Bad debt expense has been reduced
Bad Debt is at 1.2% of the gross revenue per audited financial statements
In the 3Q of 2013, HARA* reported that hospitals across the country wrote off 3.30%
of their gross revenue as bad debt
Self-pay receivables are now lower than pre-conversion levels
*Hospital Accounts Receivable Analysis Report
RESULTS
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Possibilities for new skill sets in patient access
Patient access job descriptions
How to shift resources from back-end to front-end for proactive
collections
How to partner with your existing vendor or new vendor for
extended business office
Overhauling the financial counselor position into the current
century
Financial Advocate job descriptions
TAKE-AWAYS
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Kathy Peterson, FHFMA [email protected]
Laurie [email protected]