Revamp process for financial counseling
Previously, all financial counseling at Virginia Mason Medical Center in Seattle was done on the hospital’s main campus. It wasn’t offered at the organization’s seven outpatient medical clinics.
"If anybody needed a price estimate, help paying a bill, or even help with a Medicaid application, they would have to do that by phone, which patients weren’t always happy with," says Amber Reeff, director of patient access systems.
Financial counselors now are available at every location. "Standardized processes are used, so all patients get the same information," says Reeff. Here are other changes the department made to its financial counseling processes:
• A new price estimate tool is being implemented.
"We had a previous estimate tool, but it did not pull in the patient’s deductible, coinsurance, or what they paid to date," says Reeff. "With this tool, we believe we can get to 99% accuracy."
Previously, most patients scheduled for surgery didn’t give much thought to out-of-pocket expenses, reports Monique Gatterson, supervisor of patient financial services, "but patients are now coming in with detailed questions," she says. "We notice that our patients are really trying to plan now. We will be able to give real-time costs for their out-of-pocket."
The new tool is TransUnion Healthcare ClearQuote, manufactured by Chicago-based TransUnion.
• All financial counselors obtained certification as in-person assisters for the Health Insurance Exchange Marketplace.
"Whether patients are in our hospital or they are just calling and shopping around, we can assist them with obtaining insurance," says Reeff. "This has been a great benefit to our patients."
• The financial counseling team was expanded to include outreach.
The outreach team contacts all patients with scheduled procedures or surgeries. "Previously, we would only do the registration component," says Reeff. "Now we are also having the financial conversation with the patient."
This "pre-admit" registration includes a discussion about the patient’s out-of-pocket costs. "We are setting expectations, so that patients are not getting the bill after the fact," says Reeff. "The worst thing is to have that conversation when the patient is onsite."
In some cases, patients can obtain assistance right away. "Maybe the patients just lost their jobs and they qualify for charity," says Reeff. "If so, the person on the phone will assist them right there, instead of another handoff."
This system gives patients enough time to make payment arrangements or obtain assistance. "We refrain from using the word can’t." We say, Here’s what we can help you with,’" says Reeff. "It may not be exactly what they want, but we can always offer some help."
Some patients report that they already called the payer and were told that no authorization was required for a certain procedure. Financial counselors might discover that in fact, the procedure is not a covered benefit, which is something even savvy patients would be unlikely to ask.
"One thing we forget is that we have a different language," says Gatterson. "We can’t talk in our lingo. We have to talk in patient’s terms."
Patients need help determining what a quoted "cost" or "price" of a procedure means to them specifically. "Patients don’t just want a raw number. They want to know what it means for their out-of-pocket cost," says Gatterson.
