Surge in self-pay, underinsured shows no sign of slowing down
Revamp your processes
If a patient requests financial assistance at University of Mississippi Medical Center in Jackson, he or she can expect to be asked for some very specific information about finances more specific than that previously requested. This makes it harder for patients to "game the system."
"Patients realized the new requirements would reveal information they were trying to hide. Thus, the volume of patients submitting applications decreased," says Richard Pride, director of access management.
This is one change that Pride's patient access department has made, to cope with a continued surge of self-pay patients. Two years ago, the department revamped its self-pay program. "We streamlined the requirements, we expected more specific information, and we shortened the approval period," says Pride.
These changes reduced the percentage of self-pay patients using the hospital to some extent, while the percentage of patients with insurance who used the hospital increased dramatically.
The new process requires fewer phone calls between the financial counselor and the patient. "The old process was confusing, and the volume of phone calls was high," says Pride. "By streamlining the process, we eliminated many phone calls."
There is a shorter approval period, so the patient must repeat the process twice a year. Some patients decided the process was not worth going through, and went to other providers.
The smaller volume of self-pay patients meant that the percentage of insured patients rose. "The volume drop of self-pay patients meant our expenses decreased. Thus, our margin of profit increased," says Pride. "Secondly, by decreasing the volume of self-pay patients, we were able to add more patients with insurance."
The department also increased its percent of profit margin. "In some ways, we were close to capacity. By decreasing the volume of self-pay patients, we were able to add more paying patients to our volume," Pride explains.
Even more volume
Now, more changes are in the works. "In the past few months, we have seen an increase in the volume and percent of self-pay patients who are out of work or can't find work," says Pride. "We are considering several new processes to address this."
First, financial counselors were added to specific clinics. The goal is to give patients easy access to financial counseling assistance while they are in the physician's office.
"By capturing the patient early in the process, we are getting the paperwork completed. We are making a decision about assistance sooner," says Pride.
Pride says that "we acknowledge and desire to have a percentage of self-pay patients. It is part of our mission. We want to assist patients early in the process, so we can capture the volume of dollars going to self-pay patients."
Pride says that the volume of dollars being absorbed by self-pay patients is important information for access departments to know. "We can also control statements being sent out to patients, and thus save money on statements being sent to patients that have no means to pay," says Pride.
A group of financial counselors spend most of their days answering questions from patients. "We hope by putting them in the clinics, we can answer their questions and get the paperwork back more timely," says Pride.
As part of this effort, patient access staff assist patients to find other sources to help pay for their medical care. Pride says that some local churches assist patients with medical expenses, and some not-for-profit organizations contribute money to cover medical bills. In addition, Victims of Violent Crimes and the state's Office of Vocational Rehabilitation also assist with some medical bills. "There are pharmaceutical companies that will send patients medications if they fall under the poverty criteria," adds Pride.
Proactive approach
Maureen Moreno, manager of the PAFS Contact Center at Danbury (CT) Hospital, says there has been "a definite shift" in the patients her department sees from the commercial payers to the Medicaid population since the onset of the recession.
"We prepared ourselves, because we were expecting the number of self-pay patients to rise," says Moreno. Her access department took these steps:
All patient access staff were training in scripting and the hospital's charity care policies.
The two-week training covered requirements and payer websites. It included shadowing coworkers and spending time in departments. Access staff got a better understanding of procedures performed and developed relationships with the clinical staff, she says.
At the end of each day, staff got some one-on-one time with a supervisor so they could ask questions. "Department leads then shadow the employee to make sure they are ready, and answer any questions during the actual workflow," says Moreno. Reviews are done at 30, 60, and 90 days with the supervisor, with feedback provided from audits.
When the Contact Center first opened in October 2007, it used basic standard scripting. "However, we found that we needed to continually review and tweak our scripting. This is based on feedback from the departments, physician offices, and patient financial services," says Moreno. One change replaced "leading" questions with questions that require specific answers.
Staff inform patients that the hospital has a charity care policy that may be able to assist with the cost of the scheduled test, and that it is based on income and need. Patients are given the phone number to financial counseling.
Estimated charges are given at the time of service or scheduling, and/or during the financial clearance process.
The department is looking into price estimation software. "We hope to go live with this in 2011," says Moreno.
Staff refer patients to a financial counselor, based on specific guidelines.
This is done for patients with high-dollar accounts, patients without insurance, patients with large out-of-pocket deductibles, and patients who come in often for small dollar testing. Staff ask patients if they can make a payment today. Then, they e-mail patient information to the financial counselors.
When patients call to schedule a specific service, some don't have insurance or have a large-out-of-pocket deductible to pay. "We are now almost 90% centralized in terms of scheduling and financial clearance," says Moreno.
Staff were instructed on how to financially clear the patient's account.
"This was really about giving staff the confidence to ask questions about money," Moreno says. At first, staff were very uncomfortable asking the questions, "Would you like to make a payment?" and "Do you feel you need assistance?"
To put things in perspective, they were asked the question, "What if it were your mother on the phone?"
"We told them to put themselves in the patient's shoes. Think about how you would want to be spoken to," Moreno says. "We explained that there might be opportunities to assist them before they had their services. There were things we could do to relieve stress and anxiety for that patient."
Staff saw that by clearing up financial matters beforehand, they were actually helping the patient in the long run.
"We are taking an extra step to do whatever we can then and there, instead of waiting until they get a bill," Moreno says. "We let the patient know, 'You are not alone. We are here to help you.' That seemed to really hit home with the majority of the staff."
Patients with big-dollar accounts are asked to meet with a financial counselor, but are also asked to pay something upfront. "By paying something right then and there, they don't have to worry about it at the time of service," says Moreno. "A lot of patients really appreciated that. The idea is to have less touches to the patient. We want them to have the procedure done and walk away and say, 'How'd that happen?'"
[For more information, contact:
Maureen Moreno, Manager, PAFS Contact Center, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810. Phone: (203) 730-5822. Fax: (203) 739-8851. E-mail: [email protected].
Richard Pride, Director, Access Management, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. Phone: (601) 815-1650. Fax: (601) 984-4881. E-mail: [email protected].]
If a patient requests financial assistance at University of Mississippi Medical Center in Jackson, he or she can expect to be asked for some very specific information about finances more specific than that previously requested. This makes it harder for patients to "game the system."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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