EMPOWERING The Patient Financial Experience

3/2/2018

EMPOWERING The
Patient Financial
Experience
NCHMFA Presentation March 13th, 2018

Discussion Outline

Transition from patients to consumers

Creating a consistent standardized PFX

Patient Satisfaction – Patient Survey Says What?

The future of measuring PFX

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PATIENTS ARE THE NEW PAYER AND THEY ARE STRUGGLING

When it comes to managing their healthcare finances,
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sumers are optimistic about the future but
frustrated with reality

81%
Patients report
anger or frustration
related to
medical bills

patients don’t pay
their bills because
they don’t
understand them

42.9 million
Americans have a medical
bill in collections

66%

OF AMERICANS WOULD STRUGGLE TO FUND A $1,000
MEDICAL EMERGENCY

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Understanding the Patient and Consumer
Consumers make
non-healthcare payments:

 84% on time or early
 12% not more than 30
days
 3% pay bills 30 days
late
 1% Pay bills 60 days
late or more

Patients make healthcare
payments:

 29% make some
payment prior to
 13% prefer to make
multiple payments
 53% wait until after
insurance payment
before paying
 5% wait as along as
possible, (more than
60 days due to
distrust the billing)

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The Disconnect Between Patients and Providers
Patients Want:
• Accurate pre-service
estimates
• Help understanding their
coverage
• Consolidated bills
• Personal control; how bills
are delivered, payment
options, etc.
• Consistent with a positive

retail purchase experience

Providers Offer:
• 37% of providers offer an
estimate or explanation of
costs prior to services
• 55% of patients not satisfied

with information received

• One quarter of estimates are

inaccurate

• 55% of providers do not
offer combined billing
statements
• Providers are focusing on
improving portals and
payment plan options
• Only 27% offer flexible

payment plans

• Only 12% offer online support

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1 out of 5
Millennial,
Generation X and
Baby Boomers said
their patient
financial
interaction
negatively
impacted their
clinical experience.

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• A one-size fits-all approach does not
work for how today’s patients
financially interact with Hospitals.
• Hospital statement delivery systems
must accommodate for generational
preferences for technology and how
the patient wants bills delivered.

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Historical Practices and Siloed Processes

Pre-Service

Typically engage
patient at time of
service in financial
discussion – patient
not prepared.

Minimal resources
applied to financial
communication and
consumer activity.

Time of Service

Post Service

Patients notified of
financial obligations
after insurance is
billed and paid.

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Hospitals must bridge the expectation gap

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What If?

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Empowered Patient Financial Experience

Engage Sooner for
Better Outcomes

Understand
Liabilities and
means to
resolve

Financial
Clearance

Score & Quantify
Patient Financial
Experience

Tools to
address
when and
how

Accountability
to the PFX you
are delivering

Deliver a
Consistent
Experience
Throughout

Seamless
experience

Consistent Patient Financial Resolution
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Empower Patients

• Consistent and informative financial experience
Information delivered proactively and earlier in the

process
Guidance and assistance in understanding what to pay
Customized patient engagement support (i.e. online
chat and phone support, etc. across all billing access
points)

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Advocate for Patients

• Investing in people, technology and data to improve
patient financial processes – ability, prior balance
discussions and payment options
Prediction technology identifies at-risk patients earlier

in the process
Payment options and plans aligned with individual’s
ability to pay
Personal concierge service

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Align Financial Communication

• Highly integrated financial communication
Single consolidated billing statements
Reminders about balances
Improved access to payment portals, phone, etc.
Streamline billing services across the system

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Negative Patient Financial Experiences

1 out of 4 patients has had a less than
satisfactory hospital financial experience in
the past year.

Patients who don’t understand
their bills, what they owe and
why they owe it tend to give
lower scores on patient
satisfaction surveys
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How do my
patients feel
about the
revenue cycle?
Good
Not
Good
Sure

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Measuring Patient Experience

1 in 20
Financial Survey response
rates are even worse

28%

2016 U.S. HCAHPS
Survey Response Rate

And you typically get
two EXTREMES
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A partner of ours recently
confided: “My Board asked
me to measure our patients’
financial experience. But I
have no idea how to do it.”

Revenue Cycle Distress Signal
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Variation in how
its measured

PFX is
multifaceted

Variation in what is
measured

Limited quantifiable
information
available
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Score

Optimize

Succeed

Revenue Cycle Distress Signal
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Score
• Measure how your organization is doing
against the expectations of your population

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Optimize
• Revenue cycle complaint management leverage data

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Succeed
• Provide a high touch experience

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Score
Identify statistically relevant
patient satisfaction data
• Criteria
• Triggers
Optimize
• Components

Its time to expand
the definition of
what constitutes a
complaint in the
revenue cycle

Complaints are a
form of
opportunity
because they are
drivers of change

Predict patient
behavior
• Likely to escalate
• Look at all
encounters not
just a random
Succeed
batch
Initiate service recovery
• Acknowledge the issue
• Fix the problem
• Follow-up
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Definition of a Patient Complaint
•

Patient states its wrong to be collecting in the ER

•

Patient mutters while handing over their credit card that they’d wished they’d known sooner
about what they owed

YES
NO

YES
NO

•

Patient holds off paying until the last possible moment
YES
NO

•

Patient has the ability to pay but never does

•

Patient gets a bill 90 days after service and calls confused on why they are being billed – and
pays

YES
NO

YES
NO

•

Patient gets a bill 90 days after service and calls, angry – and refuses to pay
YES
NO

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Identifying Complaints Today

• Reactive
 Someone complains – typically to c-suite
 C-suite funnels complaint to RC leader
 Notes are read, calls are listened too, staff are interviewed
 Patient called – service recovery initiated

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Scoring the Patient Financial Experience

Proactively
Measure, Predict,
Score and Improve

100%

Pt. Satisfaction
Surveys

Calls

Chats
Text Messages

Emails

Twitter

of your Patients’
Financial
Experience

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Identifying Complaints – Future

• Proactive
 Q/A 100% of calls
 Predict which calls are likely to escalate
 Detect dissatisfied behavior while its happening
 Apply intervention – service recovery initiated

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Sample Score Criteria

• New or corrected insurance or account information
after initial bill
• Time from hospital service to 1st patient bill
• Patient refuses to pay

• Others?

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Sample Score Card

82%

96%

100%

61%

100%

Criteria #1

Criteria #2

Criteria #3

Criteria #4

Criteria #5

Sep

Nov

84%

81%

Dec

Jan

75%

Sep

Oct

Nov

98%

82%

97%

96%

Sep

Oct

Nov

75%

75%

Dec

Jan

Sep

Oct

Nov

100%

100%

100%

Dec

Jan

Sep

Oct

Nov

61%

58%

61%

100% 100%

Criteria #6

75%

Dec

Criteria #7

Jan

Sep

Oct

Nov

100%

100%

Dec

Jan

Sep

Oct

Nov

100%

100%

Dec

Jan

Sep

Oct

Nov

99%

100%

100%

Dec

36%

100%

Jan

Jan

57%

Criteria #9

Criteria #8

100%

Dec

Criteria #10

Sep

Oct

Nov

100%

100%

36%

Dec

Jan

Sep

Oct

Nov

100%

75%

57%

Dec

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Sample Score Feedback
Criteria

Feedback

New or
corrected
insurance
or account
information

•
•

Time from
hospital
service to
1st patient
bill

•

27% of accounts aged greater than 90 days from
discharge to 1st statement

•




Reasons for refusal to pay:
Poor clinical experience
Expected insurance to pay
Unable to pay

Refusal to
Pay

Action
1.

18% of accounts indicate account errors
82% of accounts indicate new insurance info found

2.
3.

Review account for missing/incorrect
adjustments
Review insurance eligibility pre-service
process
Review type of account (i.e. ER vs.
scheduled, etc.)

1.
2.
3.
4.

Review billing processes
Review clean claim rate
Review claim to payment
Review payment to 1st statement

1.
2.

Escalate poor clinical experience
Review insurance payments against
contracted amount and/or eligibility
Initiate financial assistance, review
financial counseling process for
enhancements

3.

Next

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Bridging the Gap – Strategies
• Get on the same page

• A holistic approach to creating a positive patient financial

experience requires a common understanding across the
organization as to what is expected and delivered

• Build financial continuity

• Engage with patients earlier and more often throughout their

healthcare financial journey. Develop a hospital financial
experience that has continuity between the people, process,
billing and payment tools

• Create a retail-like experience

• Customize patient engagement support, offer a concierge service

• Develop a mechanism to measure and monitor satisfaction with
the PFX
• Score and quantify PFX to ensure visibility, monitoring, and

accountability

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Thank you!

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3/2/2018

Suzanne K. Lestina, FHFMA, CPC
Vice President, Revenue Cycle Innovation, Avadyne Health
As Vice President of Revenue Cycle Innovation, Suzanne
analyzes and advises hospitals in transforming their
revenue cycle, using innovative processes, software
technology and outsource services, to achieve positive
financial outcomes and improvements in patient
financial experience.
As a professionally trained speaker, her messages will
inspire you to transform your health care organization.
Prior to joining Avadyne Health, Suzanne was HFMA’s
Director of Revenue Cycle, and was the MAP product line
expert. In addition, Suzanne has held revenue cycle
leadership roles in the Chicago area as well as revenue
cycle management consulting on a national level. She has
a bachelor’s degree in organizational management from
Concordia College and is a past president of the 1st
Illinois Chapter of HFMA.
Ms. Lestina can be reached by telephone at
(708) 710-3859 and/or by e-mail at
slestina@avadynehealth.com

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Avadyne Data References
https://www.avadynehealth.com/epfxessentials
Avadyne Health’s report: Bridging the Gap;
The Growing Disconnect Between Patient
Expectations and the Healthcare Financial
Experience
A study that captured the viewpoints of
over 500 healthcare consumers who
received hospital based services in the
previous 12 months and 100 hospitals .
E-books;
1. Financial discussion can put even a solid
relationship on thin ice
2. Are patients breaking up with you and
you don’t know why
3. We know how our patients feel about
us! (or Do we?)
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