The Latest Self-Pay Trends: New Burdens and Opportunities

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The Latest Self-Pay Trends:New Burdens & Opportunities

Jessica Sweeney-PlattExecutive Director

Physician Performance Research

athenaResearchLearning from athenaNet

150MAutomatedmessages

delivered in2014.

1.2BData transactions

processed annually.

$4.2BCollectionsposted per

quarter.

73,000+Providers onour network.69M+

Patientrecords.

75 8580 9590 0500 1510

Source: Stampiglia, Tom. “Maintaining Profitability in the Era of Consumer-Directed Health Care.” Group Practice Journal. May 2009.

Patient obligation

saccount for18%

of provider revenue.

Continuing patient obligation trend

4

11.4 M

2011

10 M

2010

13.5 M

2012

15.5 M

2013

17.5 M

2014

Number of People with High Deductible Health Plans

Obligations for commercially insured patients rising fast

5

2010 2011 2012 2013 2014$0.00

$20.00

$40.00

$60.00

$44.19$47.58

$50.06$52.59

$55.40

Average Obligation for Visits with Non-Zero Patient Responsibility

Same-store, among providers active on athenaNet since 2010n = 2,013 providers

This trend is putting health care costs out of reach for an alarming number of

people

6

Percentage of Households with DeductiblesExceeding Liquid Assets

37% 49%

Mid-range Plan Deductible High-range Plan Deductible

$1,200 $2,400 $2,500 $5,000

Large obligations more common for commercially insured patients

7

2010 2014

74% 67%

15% 19%

11% 14%

Under $40 $40 to $100 Over $100

Proportion of Visits by Obligation Type (Excluding Zero-Obligation Visits)

Same-store, among providers active on athenanet since 2010

Practices fail to collect tens of thousands per physician annually

8

80th Percentile

60th Percentile

Median Provider

40th Percentile

20th Percentile

$66,863.20

$31,713.07

$23,357.56

$17,136.00

$8,323.89

Uncollected Patient Revenue for a Fully Allocated Provider, 2014

Uncollected patient revenue per provider for selected specialties

9

Orthopedic Surgery

General Surgery

Cardiology

Urology

Gastroenterology

OB/GYN

Neurology

Dermatology

Family Medicine

Internal Medicine

Pediatric Medicine

$0 $20 $40 $60 $80 $100 $120 $140 $160 $180 $200(thousands)

Median

$12k

$13k

$18k

$20k

$25k

$28k

$36k

$43k

$46k

$56k

$60k

Third QuartileSecond QuartileBottom 10% Top 10%

Distribution for a Fully Allocated Provider (2014)

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Uncollected patient obligations per provider and per practice

1 to 6 Providers

7 to 20 Providers

21 to 150 Providers

151 or More Providers

Per Practice

Top Quartile $10,230 $83,490 $308,772 $2,264,681

Median $26,239 $160,884 $653,111 $3,523,769

Bottom Quartile $59,858 $307,364 $1,240,754 $6,986,078

Top Quartile, Median, and Bottom Quartile Performance

By Number of Providers in Practice

The relationship between the practice andthe patient has changed.

The relationship between the practice and the patient has changed.

13

What is Patient Pay Yield?

Payments collected

within 5 monthsPatient Charges

Patient Pay Yield

Patient charges not collected within 5 months represent true loss – and a real opportunity to

improve revenue on an ongoing, monthly basis.

Best Practices for Improving Patient Collections

Staff Training & Accountability1

Pre-Visit Collections Strategy2

Time-of-Service Collections3

Ongoing Collection Efforts4

1 Staff Training & Accountability

Targeted Staff Training

Impact: HighEffort: High

Ongoing Staff Accountability

Impact: HighEffort: Moderate

What: Educate and train staff on all aspects of payment to become well-versed authorities on insurance benefits, payment policies, and importance of patient collections.

How: Develop training curriculum for staff, using scripted materials and additional training for front-office tools as practice.

Upside: A rigorous approach to training can drive real, measurable financial improvements.

What: Regularly assess staff members’ interactions with patients to ensure collections are being followed through on correctly. Provide support or re-training as needed.

How: Staff-specific metric scorecards, ongoing monthly reporting and evaluations, and meaningfully linked measures of accountability.

Upside: Strong staff audit performance corresponds directly with a well-functioning front office.

15

Premier Family Care

• 30-physician family practice based in Florida

• 84% of overall patient obligations collected

• 82% of copays collected at the time of service

• Noticed in February 2015 copays and outstanding balances were frequently uncollected at the time of service

Case Study: Premier Family Care

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Targeted Training Improved Average Collections, Reduced Variation

Outstanding Balance Collection Rate at Checkout, by Staff Member

2Pre-Visit Collections StrategyPre-Visit

Financial ReviewImpact: High

Effort: Moderate-High

Patient Financial

Obligation EstimatesImpact: High

Effort: ModerateWhat: Review patient accounts 1-2 days before scheduled visits to determine the best way to handle collection attempts for patients with large outstanding balances.

How: Provide staff with appropriate guidance training and support materials.

Upside: Practices that collect outstanding balances at the time of service ted to have a very high overall patient collection rate.

What: Without estimating in advance, practices cannot collect the full patient portion and must rely on patients to pay after receiving a statement 30 days later, when the likelihood of full collection is significantly lower.

How: Review patient records in advance to estimate a patient’s obligation for expected services, typically for high-cost scans and procedures .

Upside: Estimates allow practices to collect the full anticipated obligation before or at the time of service .

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OKC Obstetrics and Gynecology

• 20-provider practice• Overall patient obligations yield on

patient obligations of 79%

• Practice administrator reviews all patient accounts two days in advance of appointments and calls patients with outstanding balances over $100

Case Study: OKC OB/GYN

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Outstanding Balance Collection Driving Impressive Patient Collections

Frequency of Outstanding Balance Collection at Time of ServiceCompared with Overall Yield

OKC OB/GYN vs. Others, > 5 providers, > $20k/month in Outstanding Balances at Time of Service

3Time-of-Service CollectionsCard on File Agreements

Impact: HighEffort: Low-Moderate

Large-Balance Payment Plans

Impact: ModerateEffort: Low

What: Particularly useful when patient obligation is unknown but within an acceptable range agreed upon by the patient.

How: File patient credit cards to pay newly incurred balances before a claim is processed.

Upside: Incorporating card on file can result in a higher patient pay yield. Success with credit card collections at urgent care centers indicates this can be a viable collection approach.

What: Practices should consider offering payment plans by default for insured patients with balances over $500 and uninsured patients with balances above $150.

How: Offer payment plans to patients with large or unmanageable balances, allowing them to pay obligations over a period of time, ideally within six months.

Upside: Payment plans are essential for increasing overall collections, especially for practices with high-cost visits and patients responsible for a substantial portion of the total cost of care.

22

Florida Woman Care

• After promoting card-on-file, the number of card-on-file contracts grew from 1,200 to more than 2,000 per month

• Encounters without a card on file, FWC collects about 70% of patient obligations

• Encounters with a credit card contract, the group collects 81%

Case Study: Florida Woman Care

23

Incorporating Card on File Into the Checkout WorkflowNumber of Card on File Agreements per Month at UPM (2015)

3Time-of-Service CollectionsStandardized

Down PaymentsImpact: Moderate

Effort: Low

Collection-Focused Digital

Check-InImpact: ModerateEffort: Moderate

What: Most helpful for high-cost visits or practices with a high rate of uninsured patients.

How: Collect a down payment from patients when the patient obligation can’t be reliably estimated in advance.

Upside: Practices are guaranteed to recover at least some money from patients who might otherwise fail to pay after visits, with minimal risk of overpayment.

What: Digital check-in tools are dedicated kiosks, such as tablets or single-purpose hardware devices, that handle a variety of front desk tasks with minimal or no hands-on staff time.

How: Installing dedicated kiosks, tablets, or single-purpose hardware devices that handle a variety of front desk tasks with minimal or no hands-on staff time.

Upside: Digital check-in can help practices capture patient demographic information and social, family, and medical histories.

25

Keystone Orthopedic Specialists

Proportion of patient visits with complete registration information increased from 17% to 53%--with significantly less staff time

Payments by credit card more than doubled

Co-pay collection increased by 8%

Case Study: Keystone Orthopedic Specialists

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Phreesia Driving Improvements Across the Front Office Workflow

Percentage Point Change Before and After Implementing Digital Check-In

“Our collection of patient obligations has significantly increased since we started using Phreesia with athena... it’s cut down the time our staff spends

registering patients. It also makes patients more responsible for the information they give you.

—Office Manager, Keystone Orthopaedic Specialists

4Ongoing Collection EffortsUnpaid Balance

Follow-UpImpact: Moderate

Effort: Low

Portal Collection Campaigns

Impact: ModerateEffort: Low

What: When a balance is transferred to a patient after a visit, athenahealth sends monthly statements to the patient unless the practice elects not to do so .

How: Contact patients with outstanding balances to collect payments or discuss payment options. Send unpaid accounts to collection agencies, as needed.

Upside: Taking steps to intensify follow-up efforts with patients presents significant collection opportunity, particularly in practices with large uncollected obligations.

What: Promote the patient portal as a central place to view statements and make payments.

How: For patients with large outstanding balances, use patient outreach tools to direct them to the portal.

Upside: Communicating and using the portal’s payment functionality has been shown to boost patient pay yield and reduce self-pay DAR. High portal adoption rates can also increase patient loyalty and lower administrative expenses.

Summit Medical Group

• Independent, multi-specialty medical group based in New Jersey

• implemented the athenaCommunicator portal in mid-2014

• In eight months of introducing the portal, Summit’s adoption reached 50%

Case Study: Summit Medical Group

29

Improvement in Patient Financial Metrics, Summit Medical Group

“We were surprised by how many people are paying through the portal. We didn’t really encourage patients to do that—they just found it more

convenient.”—Practice Administrator, Obstetrics and Gynecology Practice

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The athenahealth Solution

30

Reminder

Calls

Payment Estimator

Credit Card

ProcessingText Message

Reminders

Live Operator

Patient Portal

Card on FilePayment

Plans

Self-Pay Success

31

93MSelf-pay reminder

notifications sent out in 2013

$82M collected on our Patient Portal in

2015 YTD

Thank You