Q&A with Matt Simon, PatientMatters Director On-site Partnership
Healthcare systems and organizations looking to improve both clinical and financial performance are implementing a variety of patient‐centered models. In today’s blog, we’ve enlisted Matt Simon, PatientMatters Director On-site Partnership in a Q&A session where he explains patient-centered care as it applies to revenue cycle management, and the benefits and behaviors of patient-centric hospitals.Q: What is a patient-centric financial approach?
A: A patient-centric financial approach delivers a positive patient financial experience before and after care has been rendered by putting the patient first. The approach begins with how a hospital on boards a patient into the health system and acts on the understanding that each patient’s financial situation is unique. It mirrors what businesses in industries outside healthcare have been promoting for years. Amazon is a prime example of customer-centricity as they’ve created a culture that focuses entirely on the customer and their needs.
With the upsurge of the COVID-19 pandemic combined with high-deductible health plans and rising healthcare costs, patient uneasiness about healthcare affordability and the need for financial assistance and patient-friendly payment plans has grown. Patients are demanding more information about their care costs and financial responsibilities. Not only do patients want more details, but they also want it in a timely and easy-to-understand format. They want the same degree of service they are used to receiving from other industries.
The recent Price Transparency mandate that goes into effect on January 1st, 2021 has compelled hospitals to become more transparent about pricing and cost-sharing with their patients. Since healthcare billing and payment complexity persists, organizations regularly struggle to effectively collect patient payments while at the same time meet patient expectations. To address these concerns, hospitals are finding success through Pre Access Service Center (PASC) implementation.
A PASC helps to standardize the onboarding process for all patients regardless of the service line. This ensures that all patients receive the same level of care regardless of ability to pay. Additionally, patients receive complete transparency pertaining to their financial responsibility with the option to participate in flexible payment plans that work for not only the hospital but for them as well. Price transparency will empower patients to price shop. This added visibility can increase the momentum for hospitals to utilize a patient-centric approach to build long-term relationships and recruit patients to their system.
Q: Why is a patient-centric financial approach important?
A: As a result of the Price Transparency mandate, hospitals are now required to move the patient financial conversation from the back end of the Revenue Cycle to the front end. This shift will make the impact of implementing an effective patient-centric financial approach even more important as it can set the tone for the entire patient care journey. Price transparency will motivate hospitals to start with the financial aspects of care and focus on their patient's financial needs.
With more focus placed on transparency, patients will have the ability to determine their financial obligations of care before the care is received. Our experience proves that patients who have full transparency into their cost of care and better budgeting options pay their bills promptly. With high deductibles health plans and insurance premium costs continuing to rise, financial concerns are often the most crucial piece to overcome in fostering patient engagement.
The shift towards becoming a truly patient-centric organization is both complex and long but even the tiniest of changes can have a significant benefit to the hospital's bottom line and the patients served. The main idea is to always put your organization in the shoes of the patient. By doing so you, the hospital will reduce surprise bills that routinely occur with a failure or breakdown in financial obligation communication. Inaccurate cost estimates can also lead to patients being responsible for larger than estimated medical bills, which negatively impacts both the hospital and the patient.
Q: What are the challenges in implementing a patient-centric financial approach?
A: Implementing a patient-centric financial approach requires hospitals to anticipate and act on the needs of their patients. Therefore, it requires the hospital to create processes, policies, and a culture that is designed to deliver patients with a financial experience that is tailored to patient need.
There are many areas hospitals can focus on to ensure the patient-centric transition goes smoothly. Patient-centric organizations not only need to understand patient needs but also need to share information across the organization. Hospitals will need to invest in education and tech-infused workflows so staff can effectively explain financial responsibility to patients, answer any questions they may have, and accomplish it in a consistent, accurate manner. A best-practice training method is to engage staff in role-playing to get them comfortable explaining benefits and communicating out-of-pocket responsibility.
If your hospital is not already providing financial communication before the scheduled appointment then you may find your staff lack particular knowledge on key insurance terminologies such as out-of-pocket maximum or the difference between individual deductible versus family deductible. This can present a challenge if trying to move towards a more patient-centric financial experience.
Q: What are the main behaviors of patient-centric providers?
A: Patient-centric provider behavior starts by ensuring that all patients receive financial communication before arrival for scheduled appointments. For those with a PASC, this step should be included in their Pre-Registration processes. Member benefits should be explained so that patients understand whether they have a high deductible plan or if they will be responsible for any copays or a percentage of overall cost via a co-insurance.
Hospitals with a patient-centric financial approach do not wait to communicate financial responsibility with the first statement. Instead, these hospitals have implemented a patient estimation tool to coincide with their PASC. A patient estimation tool enables patients to determine their financial responsibility before service and at the time of Pre-Registration. The tool calculates the contractual rate for the scheduled service and applies the member’s benefits. With this level of detail, patients have a better understanding of not only the cost of care but how that cost is determined.
Hospitals need to make sure their overall onboarding process is efficient which includes receiving accurate orders will all necessary information to utilize a patient estimator tool. Orders should include not only demographic and insurance information, but also all coding detail such as CPT and diagnosis codes.
Although not every organization will have the same success metrics, it’s important to identify key performance indicators that can be monitored and tracked to measure patient-centricity. You can’t forget the adage, you can’t measure what you don’t manage. A hospital can't know whether or not it is successful unless success is defined and tracked. The key to committing to patient-centricity is to analyze, plan, and implement carefully devised strategies that effectively address patient needs while sustaining profitability.
Q: How can a patient-centric approach add value outside of the patient financial experience?
A: Hospitals that have implemented an effective patient-centric approach have also seen the added value throughout their entire Revenue Cycle. For instance, accurate price estimates require orders to be completed with proper CPT coding to clear medical necessity, verification of eligibility coverage, and authorization status checks before the day of service. Missteps in these essential processes can negatively impact not only the patient’s experience but can lead to denials and revenue loss.
The communication of financial responsibility also results in the reduction of scheduled appointment no show and cancellation rates. Additionally, as more appointments receive valid pre-registration, a drop in registration errors occurs which in turn reduce billing errors.
By creating a patient-centric registration process, patients experience less frustration and their care begins on a positive note. In a time when patients can shop for healthcare to obtain the best price and patient experience, it is vital hospitals implement processes, technology, and training that will strengthen patient loyalty and progress the financial health of the hospital.
Want to learn more?
When hospitals give patients a financial experience they can trust and the options they need, everyone wins. Learn more about PatientMatters Patient Access and Advocacy solutions, here.
Matt Simon is the Director of On-site Partnership for PatientMatters. His current responsibilities include the strategic oversight of patient access, patient financial services, and revenue cycle integrity for client healthcare facilities across the United States. Prior to PatientMatters, Matt held various hospital leadership roles where his responsibilities spanned from the development and oversight of the cost accounting system to management of Patient Access, credit and collections, and centralized scheduling staff. His areas of expertise include EHR revenue cycle optimization, revenue cycle technologies, and operations integration, and staff onboarding programs that emphasize the role of patient financial care.
Matt earned a Bachelor of Science in Organizational Management from Nyack College and a Master of Public Administration from Marist College. He is a member of the Hudson Valley NY Chapter of Healthcare Financial Management Association (HFMA). He enjoys attending multiple live sporting events throughout the year, supporting the local animal rescue and shelters, and spending time with his wife and two young sons.
