Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners

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1 Self-Pay in an ACA World: Optimizing Resources with Soarian Tools, Workflows and Partners Kathy Peterson, FHFMA Director of Patient Financial Services October 11, 2015

2 Our focus today Marketplace changes New skills needed in patient access Creation of patient advocate role Challenge in back-end self-pay collections Extended business office solution Results Take-aways 1

3 2 Champlain Valley Physicians Hospital

4 About us Located in Plattsburgh, NY Now part of the University of VT Health Network Licensed 341 Acute Beds 54 SNF Beds Inpatient Behavioral Health Live on Soarian Clinicals in 2010 Live on Soarian Financials December unions in place (1199 SEIU and NYSNA) 3

5 4 A catalyst for change

6 A changed healthcare landscape Meaningful Use Drove the need for new Electronic Health Records (EHRs) New EHR s drove the selection of new health information systems New health information systems necessitated o Long installation periods o New processes o New workflows in both clinical and financial areas 5

7 A changed healthcare landscape Affordable Care Act (PPACA) Individual insurance mandate o Increase in high-deductible plans and out-of-pocket expenses both in the marketplace and through employer plans Pricing transparency 501r regulations Reductions in Medicare reimbursement 6

8 7 Realignment of the revenue cycle

9 Phase 1 - new IT system / new skills Our Journey begins with Soarian Financials live December 1, month install launch was January 2013 New skill set needed in patient access Created new titles Wrote new job descriptions Nobody grandfathered o All had to meet requirements or face layoff Changed Management Structure 8

10 Patient access -new job titles Healthcare Access Associate Certified Healthcare Access Associate Certification through NAHAM* Must become a Certified Healthcare Access Associate within 15 months of hire *National Association of Healthcare Access Management 9

11 New job description Healthcare Access Associate Associates Degree in Healthcare or business preferred Medical Terminology Certificate requirement or anatomy physiology as evidenced by transcript Microsoft Word and Excel Certificates required Data Entry test (moved away from typing test) Basic Coding Course certificate required One year customer service experience with specific experience asking for payments/money required 10

12 New job description Certified Healthcare Access Associate Same as Healthcare Access Associate except: Within 15 months of hire must become a Certified Healthcare Access Associate through NAHAM Recruiting note a little more difficult but partnered with local technical college and they teach to our requirements and are a major source of employees for us 11

13 New requirements higher pay Pay Scale for Healthcare Access Associate Step 0 -- $14.31/hour (old wage was $12.07) Step 10 - $18.60/hour (old wage was $17.43) Step 20 - $20.75/hour (old wage was $19.44) 12

14 New requirements higher pay Pay scale for Certified Healthcare Access Associate Step 0 $15.64/hour (old wage was $12.88) Step $20.33/hour (old wage was $18.60) Step $22.68/hour (old wage was $20.75) 13

15 Coding at the time of registration Require walk-in ancillary tests (labs & straight x-rays) be coded at registration Convert worded diagnoses to coded diagnoses as necessary (skill also needed for ABN s) Bills can go out within 2 days - lowers DNFB and improves cash flow 14

16 Management structure change Previously had two patient registration managers Changed their titles and roles to: o Patient Registration Operations Manager o Patient Registration Training Manager Increased skill set requirement and complex system justified need for focus on training Added a Patient Registration Supervisor 15

17 Result drop in error rate January-14 May-14 September-14 January-15 May-15 Subscriber Data Insurance Data Admission Data Patient Data 16

18 Result faster turnaround of bills One of our Vice Presidents came in for lab services. The bill was sent electronically through clearing house to the insurance, processed, electronic remittance received and posted, balance transferred to patient and statement went out to patient 8 days later for the patient responsibility. 17

19 Phase 2 -the next set of challenges Fragmented financial clearance process Missing authorizations Not meeting with scheduled patients early enough Not asking for out-of-pocket before day of procedure Point of service collections Primarily asking for co-pays Not asking for deductibles or larger out-of-pockets Need for ACA up-front pricing and transparency best practices Self-pay unit unable to manage incoming/outgoing collection calls Not able to increase FTE s 18

20 Addressing the challenge Create a new job description called Financial Advocates Change the financial counselors and self pay team to the new financial advocate role Move self pay team to the front into new job role Create a financial advocate supervisor (promoted senior self pay staff person to this role and eliminated that position net FTE impact 0) Partner with an external company as an extended business office to answer all of our incoming calls and make outgoing collection calls (better customer service we had high abandoned calls from the queue) 19

21 New job description Financial Advocate AA degree in business, finance or healthcare preferred Medical terminology required or Anatomy and Physiology 3 years healthcare experience with a focus on finance and customer service Microsoft Excel and Word course certificates Must become a certified application counselor for the Healthcare Marketplace within 6 months of entering position Must become a notary public within one year into this position Must take a basic coding course within 3 months of hire 20

22 Goals of financial advocate Review all scheduled surgical, cardiology and radiology procedures for: Insurance information Authorizations Out-of-pocket responsibility Meet with all patients who have out-of-pocket responsibility prior to scheduled procedure Review payment options Collect prior to procedure 21

23 Goals of financial advocate Embed the financial advocate in other departments and processes to make this seamless and well coordinated for the patient Examples joint program, cancer center Reduce bad debt Increase price transparency to patients Continue to meet with all self-pay bedded patients 22

24 Staged implementation Rewrote new job descriptions and cleared through union Created Financial Advocate Supervisor position and filled from within Implemented extended business office Had to have in place before staff could be moved from back end to front end - EBO live on November 10, 2014 Worked with facilities to build 4 new offices for financial advocates 23

25 24 New financial advocate offices

26 Staged implementation Eliminated cashier positions to improve patient flow Financial advocates now handle all payment transactions after making financial arrangements with patients All other cashier functions deployed elsewhere i.e. foundation, etc. One cashier became financial advocate and one absorbed into general accounting Used vacated space to build new financial advocate offices 25

27 Staged implementation Had to fill vacant financial advocate positions out of the gate Surgical implementation started roll out - Jan 2015 First financial advocate placed in Emergency Room - Feb 2015 Financial advocate as part of joint program - May 2015 Financial advocate embedded in cancer center - June

28 Additional technology needs In final selection of vendors and contract for: Prior authorization software Patient estimation software Cashiering/credit card integration/balancing software In budget for 10/1/15 27

29 Extended business office services Chose two of our existing vendors to review for possible partnership Went on site to both companies Toured Talked with staff Observed Reviewed proposals Went live November 10, 2014 with outside vendor answering all incoming calls 28

30 EBO stage 1 Goals Implement in a 30 day timeframe Answer all incoming phone calls/take insurance Transition from CVPH to partner transparent to patients Same phone number on statements - forwarded to EBO Answer phone as CVPH Staff trained on CVPH Soarian system Reduce abandoned calls Improve customer service 29

31 EBO stage 2 Goals include: Initiate effective collection campaigns Interactive voice response (IVR) technology Live conversations in between patient statements o Using dialer system Careful analysis of patient population (AR) to determine efficient approach and maximum performance Propensity to pay scoring* Segmentation strategy* 30

32 Results POS collections 91% $250, POS Collections $200, $150, POS Collections $100, $50, $- Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 31

33 Results Self Pay Collections 78% $1,000, Self Pay Collections $900, $800, $700, $600, $500, Self Pay Collections $400, $300, $200, $100, $- Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 32

34 Results Improved patient satisfaction patient complaints regarding wait times on phones have been eliminated On-line e-payments collections - $1.8M in past 12 months Bad debt expense has been reduced Bad Debt is at 1.2% of the gross revenue per audited financial statements In the 3Q of 2013, HARA* reported that hospitals across the country wrote off 3.30% of their gross revenue as bad debt Self Pay receivables are now lower than pre-conversion levels *Hospital Accounts Receivable Analysis Report 33

35 Take-aways Possibilities for new skill sets in patient access Patient access job descriptions How to shift resources from back-end to front-end for proactive collections How to partner with your existing vendor or new vendor for extended business office Overhauling the financial counselor position into the current century Financial Advocate job descriptions 34

36 35 Kathy Peterson, FHFMA

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