by Melissa Masterson, Executive Director, Hospital Operations & Matt Simon, Director, On-site Partnership
Melissa Masterson, PatientMatters’ Executive Director of Hospital Operations, and Matt Simon, Director of On-site Partnerships share how three of PatientMatters’ client healthcare systems are finding Patient Access success amid today's unique and unprecedented challenges. Below are excerpts from the webinar discussion.
Introduction: Today’s Healthcare Landscape
Melissa Masterson: I want to set the stage in talking about today's healthcare landscape because we know that we're all experiencing a lot of challenges that we haven't been accustomed to in the past. We're all adept. We can pivot quickly and we're used to doing that in healthcare, but this has been a unique year for all of us.
As the COVID-19 pandemic rages in the U.S. and as we're continuing to see spikes, we know that the financial future of hospitals and physician practices are kind of up in the air. And though hospitals saw some operating margin gains in September, the patient volumes continue to decline, and the losses related to operating physician practices grew according to two recent reports.
Without incorporating the funding that was received from the Federal CARES Act, medical and hospital operating margins saw about a 6.5% point decline from January to September this year, as compared to the same period last year, according to a recent Kaufman Hall report. Even with the CARES Act funding, operating margins dropped 1.4% points. September also marked the seventh straight month of declines in volume with discharges down 9.5%, almost 10% between January and September, and over 5.5% year over year. We even saw emergency department visits fall over 19% year over year, and 16.4% year to date. That's a lot of volume for all of us and that's not something that we're typically accustomed to seeing. Typically we're looking at rising volumes and determining how to manage them.
What we're boiling down to here is that I think we can all agree that with Kaufman Hall’s warnings there are more challenges ahead with COVID-19. Those are all things we need to consider, and we need to figure out what we're going to do to mitigate the issues.
Sustainable, Long-term Patient Access Models that Garner Success
When we think about patient access to address some of these challenges, there are a lot of hospitals reevaluating their patient access strategies. We know that we need to change how we do things. We want to implement processes that are sustainable with longer-term models that can weather not only today's storm but any storms we may encounter in the future.
The hospitals’ successes all revolve around the implementation of a Pre-Access Service Center (PASC) model. There are essentially five pillars of work that are associated with this model: 1) orders management, 2) scheduling, 3) authorization management, 4) pre-registration and 5) payment collection.The PASC is a consolidation of services where all five pillars of work are housed under one central business owner to ensure everyone is performing at the level expected to succeed across the department and the system. So that means establishing productivity levels that staff adheres to daily. It means formalizing quality requirements so that we know that the work delivered is not flawed as that will negatively impact our downstream customers.
Today, we will review the challenges, strategies, and results of three of PatientMatters client healthcare systems. These include PASC models that:
- Encourage a digital front door to improve processes, performance, and patient satisfaction
- Optimize workflows through consolidation and standardization of disparate systems
- Gain patient-staff trust and satisfaction
Hospital Success Story #1: West South Central Region Healthcare System
Matt Simon: After evaluating their patient access processes, the healthcare system decided to move to a PASC model. The system did a deep dive into their current performance to find where they were falling short and what challenges they were experiencing that were preventing them from being successful.
Challenges
A few challenges that this system identified were that the staff was spending a long time on hold with payers because they were waiting for the day of service to verify both eligibility and benefits and determine whether or not the patient’s service would require prior authorization from the insurance company.
For procedures to be performed that day, the system also realized that its staff was struggling to identify the correct portal or website that should be utilized to obtain the information. In other words, should staff go directly to the insurance website, or through another vendor to get the information instead?
As we all know, patient access departments do have a higher turnover rate compared to other revenue cycle departments, and that's no different for this system. The system discovered that there was a gap in knowledge transfer between its employees. This gap led to an issue with the overall learning curve on terminology, payer rules, CPT and HCPCS codes, fixed code sets, and other data requirements. If one employee became the expert on a particular task, such as prior authorization, then that department suffered if that employee were to leave or have extended time off. Other employees were simply not prepared or did not have the tools to take on that role.
Also, the system discovered that its staff could not work multiple business days out, which led to a lot of work being done on the day of service relating to patient eligibility and benefits. As a result, patients experienced long delays when being routed from the registration area to the service areas.
Strategy
The healthcare system implemented a PASC model powered by standard processes and workflows to enable patients to skip the registration process completely on the day of an exam and go directly to the service area. Every patient, regardless of their financial class or ability to pay, receives the same experience. To help with identifying the cost of care for patients, the system’s overall strategy was to transform to what we refer to as a digital front door. Through various technology tools, patients have accurate visibility and control of their financial experience. They can make healthcare decisions that suit their needs prior to receiving care.
Some of the technologies utilized by the healthcare system include an estimation tool, which allows for patient price transparency. The tool enables the patient to understand the actual cost of a service or procedure. Additionally, technology was implemented that enabled payment plans to be personalized by utilizing a propensity to pay score. The personalized payment plans help patients understand their financial obligations and their current financial picture. The system also implemented a prior authorization tool to automate the payer authorization. The technology houses all payer rules and acts as the one source or knowledge keeper for the department.
Results
After just a few months, the healthcare system achieved a 50% productivity increase by implementing prior authorization technology utilized by its PASC staff. Additionally, a 45% increase in denials savings was achieved.
The PASC model also resulted in a significant reduction in lobby wait times. Before the PASC, patients would experience a total wait time of 24 minutes including 18 minutes in the lobby and an additional six minutes to complete registration. With the PASC, the wait times went from 24 minutes down to nine minutes.
After a full year with the PASC, the system’s point-of-service collections increased by nearly double. The big difference is that now the staff can work multiple days out on the schedule, they're able to contact and pre-register more patients, as well as explain the cost of care ahead of the service. These factors have led to additional success in making payment arrangements with the patients by offering a personalized payment plan that works for each patient based on their financial situation.
Hospital Success Story #2: Mid-Atlantic Southeast Region Healthcare System
Melissa Masterson: In our second example, we're going to focus on workflow optimization and some of the challenges that our hospital partner was facing.
Challenges
One of the main challenges this system faced was standardizing and optimizing workflows across its over 14 electronic health systems. This was a large scale project and the vision of the system was to make the process 100% patient-focused. They wanted patients to have an efficient onboarding process. They wanted to ensure the registration experience was reliable, personalized to the patient, and consistent across the organization. They didn't want patients treated differently based on the service area that was encountered.
Strategy
To achieve its vision, the health system decided to create a PASC to normalize the front-end patient experience by completing scheduling, prior authorization, pre-registration, and patient financial clearance all before the date of service. Additionally, by instituting a robust cost of care technology, each patient would be treated uniquely in terms of what their financial picture looks like and what payment plans were offered to help them.
The healthcare system also needed to increase staff quality and productivity. The PASC model provided the perfect framework to ensure staff is producing quality work and that the goals and productivity standards of the department are met. By bringing all these areas together under a central business owner, staff productivity was normalized to accommodate the entire facility.
The healthcare system also wanted to accomplish all of this in an FTE neutral environment. So that again goes back to the re-allocation of resources or redistribution of resources versus asking for new staff and new headcount. If we think back to some of the Kaufman Hall financial studies we talked about earlier, asking for more money at this point for many facilities is just simply not an option. The money just isn’t there to hire additional staff. So we looked to staff re-allocation to accomplish the goal.
For this particular healthcare system, there was not a culture of collecting cash but there was a lot of opportunity. The system provides about 50% of Medicare and Medicaid services but even so, there's a lot of money to be collected and opportunity to educate patients and staff. We still needed to make sure the systems was collecting where it could and satisfying the financial obligation before the point of service.
Results
Many opportunities relating to front-end eligibility and denials were uncovered and acted upon from the initial assessment. Through workflow redesign and the creation of a centralized and standardized registration, positive results were quickly achieved. Results included the reduction in medical necessity denials of $500K from before pre-access to one month post go-live. The denials and rejected claims decreased by almost 50%. A decrease of 73% in denial related dollars from a month after go-live was also a massive win for this particular healthcare system.
By assessing all of its workflows and honing in the optimization and standardization of workflows across the system’s clinical areas and other functions, the system continues to experience many wins.
Hospital Success Story #3: Mid-Atlantic Region Healthcare System
Matt Simon: Each example we're covering is from a different region but if you listen to the challenges and struggles that led them to implement a PASC, they're all very similar despite the geographical differences.
Challenges
In this third example, the healthcare system identified that its cash collections were too low, but also too slow. What we mean by too slow is that this institution was looking to accelerate cash collections but found a lot of collection opportunities were being pushed to the backend of the revenue cycle, or the back office. And, a lot of money was being spent on statement printing and mailing as well as third-party vendors, such as early out vendors.
This system had never set a point-of-service collection goal, so it was never an initiative for the staff. Each team had a different approach as to whether or not they would even ask, or communicate a financial obligation to patients, depending on where the registration was being performed. So, patients, of course, were frustrated with inaccurate or missing estimates and a lot of that had to do with its lack a centralized registration.
Initially, its clinics did not want to centralize registration activities because they felt that their patients were too unique. But why that may be true for the plan of care, the patient’s financial experience suffers when it is not standardized.
Strategy
The healthcare system’s vision was to improve the overall patient financial experience, but be mindful of its clinicians as to not interrupt the delivery of care. To do this, they put into place a PASC that would allow them to normalize the patient onboarding process across the entire healthcare system regardless of the appointment type or the procedure to be performed. The system’s initiative goals were to accelerate cash, increase collections especially at the point of service, and enhance patient satisfaction scores.
Results
The results continue to be very positive for this system. For point-of-service cash collections, the healthcare system exceeded its aggressive target goal by over $13K within 24 months from go-live. In the four years since the PASC’s deployment, there’s been continued improvement year over year. That’s the beautiful thing about the PASC model, the gains are immediate, and they don't stop. There's always continued growth, especially as staff becomes more knowledgeable and comfortable engaging in financial communications with patients.
One of the goals they set was to accelerate their cash flow and they certainly were able to accomplish that in 2019. Even with the pandemic and some interruption in the delivery of care due to elective surgeries being put on hold, the system’s numbers are still strong for 2020.
Interested in viewing the webinar? Go here.
Melissa Masterson has over 20 years of process design and improvement expertise, including workflow optimization and project management. At PatientMatters, her focus is on revenue cycle processes, centering on point-of-service collections, and patient access workflow technology.
Matt Simon’s expertise includes EHR, revenue cycle optimization, technology, and operations integration, as well as staff onboarding programs that emphasize the role of patient financial care. His current responsibilities include the strategic oversight of patient access, patient financial services, and revenue cycle integrity for client healthcare facilities across the country.
