by Erin Haynie, Executive Director, Marketing
PatientMatters’ proven systems and operational intelligence results in our clients consistently achieving key performance indicators (KPIs) that exceed industry averages. Today, we’d like to share the success story of our hospital client, Montefiore St. Luke’s Cornwall (MSLC). MSLC’s results illustrate that a personalized patient financial services approach through standardized patient access workflows and real-time data technology can significantly improve the financial health of a healthcare organization while bolstering its ability to serve its patients.
Hospital Introduction
Montefiore St. Luke’s Cornwall (MSLC) is a 242-bed not-for-profit hospital dedicated to serving the Hudson Valley community in Newburgh, New York. Its Newburgh campus was founded in 1874 by women of St. George's Church and the Cornwall campus was established in 1931. St. Luke's Cornwall Hospital joined the Montefiore Health System in 2018.
As part of a leading population health management organization, it offers modern facilities, state-of-the-art treatment led by a dedicated staff of over 300 physicians representing dozens of medical specialties. The organization cares for 270,000+ patients each year and is accredited by The Joint Commission.
Challenge
Montefiore St. Luke’s Cornwall Hospital encountered significant hurdles relating to outpatient services and patient access collections. The patient financial experience was inconsistent. Patient registration and financial services varied by each site and across service lines, leading to patient frustration and negative financial repercussions including:
- Inaccurate and missing bill estimates
- Low and slow cash collections
- High no-show and cancellation rates
Opportunity
Through its partnership with PatientMatters, MSLC identified areas of improvement for its patient access model including patient financial experience, registration staff productivity, and patient collections. The initiative focused on five goals:
- Increase collections with focus on point-of-service
- Collect and analyze patient data patterns for those who fail to meet appointments to identify process modifications
- Normalize all outpatient departments' preregistration processes
- Decrease registration wait-times, no-shows, and cancellations
- Improve patient satisfaction scores for patient financial services equaling the high satisfaction levels of its clinical services
Strategy
To address its patient access challenges, PatientMatters implemented a five-part strategy that focused on data capture, KPI analysis, and cultural change.
Part 1: Leadership Buy-in
To create the culture change needed, MSLC’s patient access and revenue cycle leaders gained buy-in from the top down. Once senior leaders understood and approved the initiative, MSLC worked with PatientMatters to design and implement a new patient-friendly pre-access system model. The focus of the redesign was to consolidate central scheduling, streamline workflows across departments, develop custom financial guidance and planning, and expand staff roles to cover registration and financial services responsibilities.
Part 2: Patient-centric Engagement Model
To meet the needs of each patient, a different organizational structure with centralized scheduling and patient registration was implemented to normalize pre-access patient engagement. The new model acknowledges the uniqueness of each patient, as some are easily able to pay their bills while others may appreciate financial conversations for establishing payment plans and out-of-pocket responsibility before care is received.
To meet its patients’ needs, MSLC expanded its daily service center hours to 14 hours. Patients were also provided one contact phone number where inquiries were addressed allowing for the same staff to assist patients throughout their care journey.
Part 3: Pre-Access Registration Process Design
As revealed in the opportunity analysis, it was clear that the patient registration process was too time-consuming. The highly manual registration processes left data collection prone to errors, negatively impacting clean claims rate, and resulting in delayed payments.
PatientMatters and MSLC’s leadership team joined together to develop a straightforward pre-access registration process. The key to the streamlined approach was to complete all or most of the steps before the patient appointment.
Pre-Access Patient Engagement
Contact patients by phone a minimum of five days before care to:
- Verify insurance information, deductibles, and copayments
- Run billing estimates
- Assess patient ability to pay
- Determine the most appropriate payment options and generate a customized financial care plan; Collect payment
- Pre-register patients for all approved services
Based on these steps, patients arriving for care are segmented into three groups:
- No-Stop Status: The patient has preregistered and is cleared to proceed directly to the patient care area upon arrival.
- Quick-Stop Status: The patient has preregistered but has chosen to pay a copayment on the day of service rather than in advance.
- Full-Stop Status: The patient must complete the entire six-step process before proceeding to the patient care area.
The enhanced process reduced lobby wait times, appointment cancellations, and accelerated patients to their clinical destination.
Part 4: Automated Systems & Workflows
To ensure that registrars followed common policies and procedures for scheduling, authorization of services, and financial clearance across departments, a suite of technology was implemented. The technology automated and streamlined workflows specific to the patient's needs. The workflows normalized patient engagement across scheduling, registration, financial clearance, and customized payment planning teams.
The technologies implemented standardized patient financial assessments using real-time data tools that verified benefits eligibility and patient demographic information to predict patient propensity-to-pay. The tools also delivered accurate out-of-pocket patient cost estimates that allowed for payment plan options to be tailored to each patient’s budget and ability to pay. When appropriate, uninsured and underinsured patients were connected to financial assistance programs.
Part 5: Accountability and Continuous Improvement
As benchmark data for key indicators of the patient experience were generally not captured, the adoption of standard pre-access procedures and staff accountability was essential. As such, productivity reports identifying KPIs were developed for managers and department leaders to capture, monitor, and measure individual and team performance. The performance reports included:
- Daily Activity Report (including all daily transactions)
- POS Collections Report (including missed collections)
- Eligibility Report (including active and inactive eligibility results)
- Open-tasks Report (identification of staff not closing open items promptly)
- Bill Estimation Report (including patient responsibility and payments at a glance)
- Phone Reports (all phone-related activities including wait times and abandoned calls)
Additionally, to ensure the most suitable team members were in place for the new structure, new job descriptions were created reflecting salary adjustments for higher levels of responsibility. Centralized scheduling and patient registration staff were invited to apply for positions and those who were not selected were offered positions elsewhere in the organization.
Results
The immediate results achieved by MSLC exceeded leadership expectations.
- Monthly POS collections quickly surpassed the system’s monthly goal, with a 220 percent increase in POS collections within two years.
- Patient wait times decreased from 16 minutes to less than six minutes for full-stop patients, three minutes for quick-stop patients, and zero minutes for no-stop patients.
- Seventy percent of scheduled appointments do not experience wait times.
- 80% of patients fell into the ‘No-Stop or Quick-Stop’ categories, dramatically decreasing its no-shows and cancellation rates.
