Class on financial end of surgery defuses confusion

Hospital administrators understand that the complexity of health care insurance and billing these days requires continuous education of staff.

However, financial leaders at the Cleveland Clinic in Independence, OH, have realized that if patients aren't educated about all these issues as well, they are understandably confused and even angry when they are presented with out-of-pocket charges that they did not anticipate.

"Patients come to us because we provide outstanding quality of care, and they expect and deserve the same level [of quality] from a billing perspective, and the more complicated we make it, the more we are immune to their needs and the less likely the patient is to return," explains Susan Milheim, MA, senior director of patient financial services at the Cleveland Clinic.

To mitigate some of this confusion and arm patients with the information they need to understand their benefits and obligations, the health care system has developed free courses that patients can take to help them better navigate the financial aspects of their care. "The idea came out of focus groups we held when we were revamping our patient statement," explains Milheim.

Input that the health system received made it clear that patients would be receptive to this type of education. The classes were rolled out in mid-2008, "The classes have been very well received by our patients," Milheim says.

Given that the classes are open to anyone in the community, part of the strategy is to attract new customers to the Cleveland Clinic, she says. Milheim says the classes are well-attended.

"We get between 30 and 50 people per session, depending on what it is," she says.

One quarterly class, Preparing for your Surgery, is designed for patients who are scheduled in advance for surgical procedures.

Patients are sent a postcard in an envelope that tells them about the class and invites them to bring their insurance information when they attend. The trainers walk them through the referral process and precertification. They tell them what out-of-pocket expenses to expect and how to read their benefit package, says Milheim.

"We try to have those conversations and educate them as much as we can," she says.

The class is offered at the family health centers, regional hospitals, and the Cleveland Clinic main campus, says Jovanka Djukic, MEd, director of revenue cycle training, Patient Financial Services. It lasts about two hours. [The computerized graphic presentation from the class is available.]

The presentation is interactive and presented with adult learning in mind. "It's never just a straight presentation," Djukic says. For example, in the surgery class, patients are given a guided note-taking sheet. Patients fill in key educational points presented, which helps them process and retain information. Patients also are asked circle specific information on the explanation of benefits (EOBs). "It triggers additional questions, which is what we want," Djukic says.

Patients are asked to respond to questions, and sometimes the presenters offer small prizes such as lotions or items with the Cleveland Clinic logo.

For patients who cannot attend the classes, the health system has started videotaping some of the sessions so that patients can view the classes online thorough the health system's web site. The surgery class is scheduled to be videotaped this fall and posted by December. (The videotape will be offered at www.clevelandclinic.org. Under Patients & Visitors, select "Billing." Then select "Educational Forums." At the bottom right corner of the screen, a list of educational programs displays. Also, a handout is offered to surgery patients who cannot attend the class. See the online issue of Same-Day Surgery.)

Source

Jovanka Djukic, MEd, Director, Revenue Cycle Training, Cleveland Clinic, Independence. E-mail: [email protected].

Preparing for Your Surgery from a Financial Perspective Learning Objectives

After completing this program, patients will be able to:

Define key insurance and billing terms
Identify steps taken prior to surgery to ensure smooth billing process
Insurance Verification (verify if coverage is active, identify co-pays, deductible, co-insurance, and determine if pre-certification is required)
Pre-Certification /Authorization (if required)
Co-Pay/Co-Insurance/Deductible
Differentiate multiple separate bills
Physician Bill
Anesthesiologist Bill
Radiologist Bill
Hospital Bill
Recognize key elements on the Explanation of Benefits (EOB) from their insurance company
Recognize key elements on statement(s). Billing statement from hospital? Yes.
Recognize when final payment is due
Identify payment options: cash, check, or credit card.
Locate online payment options via MyAccount. Set up online on your web site? Yes. Free service. Allows patients to see their statements online. Make quick payments by providing checking account info or credit card info. Can look at previous statement, can store credit card and checking account info. Secured and follows encryption guidelines. Makes it easy to monitor your billing.
Identify lines of ongoing support for questions regarding medical finances. We give them our info: who they can contact. Information on their statement, point to that, also back of handout we give them. We give them information: contact customer service, financial coordinators.

Source: Cleveland Clinic in Independence, OH.

Financial classes impact patients

While the health system has not yet assessed what impact these classes have had on front-end confusion, patients who have filled out satisfaction surveys following the classes have provided overwhelmingly positive input, according to Jovanka Djukic, MEd, the director of revenue cycle training at the Cleveland Clinic.

"They are also suggesting that we need to promote the programs more so that they are more visible" to the community, Djukic says.

Class attendees have established more of a partnership with the health system's financial coordinators, she says. Administrators facilitate this connection by asking patients who register for the classes where they go for care, she says.

"We try to have the financial coordinator who works at that facility attend the session, and then the patient has an opportunity to visit with the financial coordinator at that time," she says. "They know they have someone they can turn to, and they know they can work with someone face-to-face. It is one of the greatest benefits we see on the front end."