Seattle-based Virginia Mason Health System recently implemented a Patient Cost Estimator service, available via phone, online, or in person, to anyone inquiring about scheduled or planned inpatient and outpatient medical procedures.
“We produce 50 to 75 estimates daily,” reports Steve Schaefer, vice president of finance. “We have found these estimates to have a 95% accuracy rate.”
While the organization also posts prices of its top 100 most common outpatient surgical procedures, these posts don’t necessarily reflect what a particular patient will pay. “That is what drove us to the Cost Estimator,” says Schaefer. “Patients want something more sophisticated than just posted prices, which have no relevance to the bulk of consumers shopping.”
Over time, Schaefer expects to see increases in front-end cash collection and decreased bad debt as a result of the Patient Cost Estimate service.
“It’s all about trust,” he says. “As patients see that they can trust this tool and the estimates we are providing, they will be more willing to pay prospectively rather than retrospectively.”
Tough financial discussions with patients call for top-notch customer service skills. “The two most sensitive things in our lives are health and money,” says Schaefer. “When those two things come together and converge, it’s a very, very difficult conversation.”
For this reason, Virginia Mason’s financial navigators don’t just give information to patients. They do their best to build trusting relationships. “We see this group as a type of sales force. As people shop, they need to talk to someone they can trust,” says Schaefer. “Patients want to feel they are being dealt with in a fair, equitable manner, with care and compassion. Those things are critical to purchasing decisions.”
Shifting costs to patients not only demands updated processes for price estimates. It also places patient access in an entirely new light within the organization, according to Schaefer. “It is no longer a clerical position,” he says. “This will be a total retooling of who you want in that kind of position.”
Closer estimates given
At Mary Rutan Hospital in Bellefontaine, OH, patient access managers are creating standardized policies and procedures so all registration areas use the department’s price estimate tool consistently.
“We expect to give patients an estimate specific to their plan, their planned procedure, and their current insurance out-of-pocket status,” says David Kelly, director of revenue cycle.
Patients will be routed to a centralized team who can provide estimates for all services within the organization.
“We’ll conduct staff education sessions, including role-play sessions to get team members into the mindset of the patient,” says Kelly. Patient access employees will practice these scenarios:
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patients asking about in-network or out-of-network benefits;
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patients asking questions about financial assistance, payment plans, and discounts;
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patients asking questions about how Mary Rutan compares to other facilities.
The price estimate tool at Virginia Mason Health System factors in contractual agreements with payers, eligibility, and procedure codes related to the patient’s care, whether the deductible was met, whether the out-of-pocket maximum was met, and whether any copays or coinsurance are due. “Previously, we didn’t factor in ancillary, laboratory, or radiology services,” notes Schaefer. “We now can get to a very, very close estimate for out-of-pocket.”
