Patient Estimation and Upfront Communication How Emory Healthcare Achieved Patient Satisfaction and Increased Collections 1
Today s discussion Emory Healthcare Overview Emory Clinic faculty practice 5 acute care hospitals Tackling self-pay Identifying the target Upfront communication and collection strategy Patient Estimation Using Patient Responsibility Pricer (PRP) Process and people Success story Emory University Atlanta, Georgia
BILLING ENTITY OVERVIEW Emory University Hospital Bills for all Emory Healthcare Radiology Services 579-bed adult, tertiary care facility Staffed by 1,221 Emory SOM Faculty 25,300 admissions 157,852 outpatient services Emory John s Creek Hospital Joint operating company Founded in 2007 Acquired in 2011 by Emory 110-bed acute care facility 10,000 admissions 50,000 outpatient services Emory University Hospital Midtown Bills for all Emory Healthcare Infusion Services 511-bed adult, tertiary care facility Staffed by 1,126 Emory SOM Faculty and 433 community physicians 21,000 admissions 148,000 outpatient services Emory Saint Joseph s Hospital Joint operating company 410-bed acute care facility Staffed by 620 private physicians 13,148 admissions 186,471 outpatient services Emory University Orthopaedics & Spine Hospital Extension of and bills under EUH s acute care services 120-bed adult, Orthopaedics and Spine specialty hospital Emory Clinic Bills for EC Physician Encounters across the enterprise 1,964 clinical provider 2,814 non-physician employees 2.7M patient care visits
Self-pay A/R analysis Shift in healthcare Health Insurance Exchanges (HIX) misunderstanding about what covered means in a High Deductible World Employers offering HDHP Healthcare financial responsibility shifted towards workers or pushing them onto the HIX Impact on self-pay account receivables Greater patient out of pocket expense Copayments Deductibles Coinsurance Payments owed for services already rendered Disconnect between provider and patient Need for improved strategies to address
Economics of self-pay Increasing patient responsibility
Emory s journey with Patient Responsibility Pricer Beginning of 2007, self-pay A/R was increasing drastically Increased $3 million in 6 months (total >$20 million) 75% of self-pay accounts are after insurance (still true today) Anti-self-pay reconciliation culture (academic medical center) No offensive tools Experian Healthcare Contract Management already in use at Emory Patient demands: Benefits education Reduced financial surprises Short turn-around time Consistency Business demands: Identify after-insurance responsibility Increased upfront collections Short turn-around time Improved decision making and credit risk identification
Patient Responsibility Pricer Hospital + Physician The patient-friendly estimate mirrors an EOB and includes detailed descriptions of the line items, including the allowed amounts, copay, deductible, and co-insurance amounts which determines the patient s portion The Patient Responsibility Pricer estimate generator uses Emory s contract definitions and the patient s benefits to adjudicate professional and facility claims to provide us with the patient s total responsibility
CENTRALIZED ESTIMATES: PRP ESTIMATE EXAMPLE- PAGE 2 Page 2 provides a brief explanation of benefits and the patient portion The signature line includes an explanation of This is only an Estimate Payments made at the time of estimate are reflected Page 2 8
Patient Responsibility Pricer end user accountability Patient Responsibility Pricer counselors are audited monthly on collections (40% of score), workflow/accuracy (30% of score), and maintaining credit balances (30% of score) This process ensures we keep the counselors core responsibilities monitored and provides for timely coaching opportunities as well as process improvements.
Patient estimation process Emory Clinic Patient Responsibility Pricer collections year-over-year FY12 average collections per counselor per month= $23,127 FY13 average collections per counselor per month= $35,190 FY14 average collections per counselor per month= $45,637 Credit balances average $35,000 per PRP counselor Credit balance goals range from $37K to $27K Average refund is <$100 Key factors in process Upfront communication and benefits education sets payment expectation and empowers patients to make decisions based on their financial responsibility Allows Emory Clinic to analyze collection risks before service is rendered Increased transparency
Key performance indicators FY14 Emory Clinic cash collections through the Pre-Service Estimate Process $2.9M* Current Total Emory Clinic Self-Pay AR dollars that are balances after insurance, the target of our PRP process 69% FY14 Emory Clinic Self-Pay AR resulting from facility based services 49% FY14 number of PRP Estimates provided to patients 12,872 Looking forward: 2015 Navigator services to identify and enroll HIX patients Only 28 patients in 2014 enrolled in an in-network plan through this effort Better defined processes for 2015 enrollment will increase enrollment in participating plans and increases the HDHP patients needing estimates. The FY14 Emory Clinic average bad debt adjustment as a percent of charges 1.8% *$10.9M in TOS Collections Overall, 27% of department s collections come from PRP 12
Patient Responsibility Pricer: Hospital project Patient demands One healthcare estimate Consistent communication Ability to plan sooner Understanding facility vs. physician Business demands Greater ability to collect across the system with increasing shift to patient responsibility Ideal patient and family experience Reduced calls to customer service Pricing transparency
Centralized estimates: Front end process flow Request Create Communicate Complete Web form Email follow up to provide estimate Estimate hotline EPP Centralized Office (2 business day turnaround) Patient Collection & Scheduling Email inquiry Telephone follow up to review estimate with option to send by mail
Benefits of PRP Recognized by The Emory Clinic since 2007 Intentional process of identifying, discussing, and mitigating collection risk Millions of dollars collected prior to services being rendered Decrease in self-pay after insurance AR Decrease in statement expenses Decrease outbound call volume Tens of thousands of patients educated on out of pocket responsibility Empowered patients Improved Patient Satisfaction Decrease in customer service call volume Assist in shifting academic medical center mindset about self-pay environment and risk Meet customer expectations for communicating price upfront
People Patient Responsibility Pricer Best Practices Find an interested physician champion with an involved administrator to gain buy-in Look to compensation model Assign staff members a realistic but stretch collection goal Tracks success of your efforts and makes the process their priority Process Pilot as a shift in FTEs Review existing processes to inserted process Pre-Cert Process (EC) Clear escalation and communication between collectors and decision makers Reschedule non-paying patients