Patient Engagement Strategies: Collect or Charity Maximize reimbursement from those who can pay. Find financial assistance for those that can’t. October 22, 2012 David Dyke VP Revenue Cycle RelayHealth Kim Thompson Patient Access Manager Basset Healthcare Network
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Patient Engagement Strategies: Collect or Charity Maximize reimbursement from those who can pay. Find financial assistance for those that can’t. October.
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Patient Engagement Strategies:Collect or Charity
Maximize reimbursement from those who can pay.Find financial assistance for those that can’t.
October 22, 2012
David DykeVP Revenue Cycle
RelayHealth
Kim Thompson Patient Access Manager
Basset Healthcare Network
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Your Presenters
• Kim ThompsonPatient Access Manager at Basset Healthcare Network
• David DykeVP Revenue Cycle at RelayHealth
Agenda
Transformational TimesCollecting Early is Easy… Right?The Financially Engaged PatientPresumptive Charity ConsiderationsQ&A
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PPACA and Regulatory ReformHealthcare’s Transformation Event?
• PPACA is transformational to healthcare – as with other industries
– 1996 – Telecommunications Act
– 1978 – Airline Deregulation
– 1999 – Financial Services Modernization Act
• Transition to be tumultuous
• Consumerism – new factor
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TrendingGrowth in Patient Responsibility
• Patient OOP to exceed $460 Billion by 2019
– Hospital OOP >$35B
– Continues to outpace inflation and wage growth
$778/Person
$1404/Person
Hospital
All Other
Source: CMS National Health Expenditure
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TrendingInsurance Premium Put Pressure on Families
62% of Employees with insurance spend $14,000 or MORE on annual premiums for family coverage
Source: Kaiser Francis Family Foundation, 2012 HEBS
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TrendingThe steady but slowing march of HDHP
2005
2006
2007
2008
2009
2010
2011
2012
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0%
4%
5%
8%
8%
13%
17%
19%
Conventional HMO PPOPOS HDHP
30% Growth
62% Growth
12% Growth
Source: Kaiser Francis Family Foundation, 2012 HEBS
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Patient Attitudes toward PaymentBalance Matters, Upside with Small Balance
Moving from post-service Patient Accounting focus…
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Emerging Revenue Cycle Model
…to pre-service Patient Access focus to improve overall performance
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A Road Too Far
Not so Minnesota Nice…
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Minnesota v. Accretive/Fairview
“A hospital emergency room is a place of medical trauma and emotional suffering for patients and their families. It should be a solemn place, not a place for a financial shakedown of patients.” Attorney General Swanson.
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Not the kind of headlines you want…
• Mother told to pay $500 before she could return to her daughter’s bedside.
• Won’t discharge a newborn baby unless mother paid $800. Which she did and overpaid and had to fight for months to get the $800 back.
• A pregnant mother who was asked to pay money in the emergency room in the midst of miscarrying her first baby.
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The Social Network Effect
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Finding the Right Balance
• Tools– Most complete data– Defensible estimates
• Training– Staff– Community
• Monitoring– QA– Exceptions
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Tools
• Complete data– Physician Order Entry– Accurate & complete eligibility benefits
• Defensible collections– Co-Pay– Percentage of Deductible Deposits– Patient Specific Estimates
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Training
• Interpersonal Communication Skills
• Revenue Cycle 101 for Front End Stafff– What is a Copay and how do you find it?– What is Co-insurance and how is it calculated?– What is a Deductible and what does it tell you?– What is a High Deductible Plan and is it scary?
– Strengthen relationships with patients to facilitate sense of obligation and urgency to pay
Stratify and Verify Every Patient
PreService38
Collecting Critical Information
Empower staff to:
– Start or complete screening and enrollment process
– Obtain completed and signed charity application at registration
– Go Mobile
Improving:
– Self-pay / Charity classification
– Reducing escalations to Financial Aid Counselor
– Improve patient experience39
Self-pay bad debt written off that meets standard charity-eligibility guidelines.
Add mobility to improve collection of time sensitive data
Up To
31%
Agenda
Transformational TimesCollecting Early is Easy… Right?The Financially Engaged PatientPresumptive Charity ConsiderationsQ&A
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Polling Question
Do you today use a “Presumptive Charity” process to assign charity status to patient accounts?
(A)I’m not really sure what “presumptive charity” is.
(B)We are familiar with it, but don’t use it.
(C)Yes – we use patient’s FICO score.
(D)Yes – we use a vendor’s product/process.
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Charity Drivers
• IRS 990 – Schedule H
• Community Benefit and Charity Care Valuation
• Must separate charity from bad-debt
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More Headlines…that no one wants
Some Illinois Hospitals Losing Tax-exempt Status
• Insufficient Community Benefit• $1.2M Property Tax Assessment
Presumptive CharityKey Considerations
Timing (i.e., when to assign charity status)
“Process” Options– Traditional Credit Score– Income Predictors– Manual Review– Custom Charity Criteria
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Too Early? To Late?
Charity too early, and you can’t collect from a patient or third-party (Medicaid) down stream…
Charity too late and you’ve adding expenses that may have a low rate of return….
AND forego collections/recover revenue…
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Presumptive CharityProgressively Better Data
Traditional Credit Score• Should never be used• Measures character not ability to pay• Millionaire late on Tiffany’s bill – low score
Income Predictors• Directional, not absolute• Problem with “no hits”• Black box (i.e., vendor proprietary process)
Manual Review of Credit File• Intuitively correct• Labor intensive – not scalable • Problem with “no hits”• Subjective
Custom Charity Care Criteria• Automate the manual review• Easily understood (hospital specific) • Objective and defensible• 100% coverage Best
Approach
LimitedApproach
Presumptive CharityHow to make the right choice?
• There is no substitute for verified information.• Timing is key decision – culture and cost.• Important vendor considerations -
– Does their process intuitively make sense?– Is process open or proprietary?– Is process objective or subjective?– Is it defensible?– Can you describe it to your boss?
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Agenda
Transformational TimesWe Have Seen The Enemy – and it is usWhat Is a Financially Engaged Patient?Presumptive Charity ConsiderationsQ&A