415 milne and rowles
TRANSCRIPT
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How Emory Healthcare Achieved Patient Satisfaction and Increased Collections
Patient Estimation and Upfront Communication
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• Emory Healthcare Overview Emory Clinic faculty practice 5 acute care hospitals
Tackling self-pay Identifying the target Upfront communication and collection strategy
Patient Estimation Using Patient Responsibility Pricer (PRP)
Process and people Success story
Today’s discussion
Emory University
Atlanta, Georgia
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Emory Clinic• Bills for EC Physician Encounters across
the enterprise• 1,964 clinical provider• 2,814 non-physician employees• 2.7M patient care visits
Emory University Hospital• Bills for all Emory Healthcare Radiology
Services• 579-bed adult, tertiary care facility • Staffed by 1,221 Emory SOM Faculty• 25,300 admissions • 157,852 outpatient services
Emory University Orthopaedics & Spine Hospital
• Extension of and bills under EUH’s acute care services
• 120-bed adult, Orthopaedics and Spine specialty hospital
Emory University Hospital Midtown• Bills for all Emory Healthcare Infusion
Services• 511-bed adult, tertiary care facility • Staffed by 1,126 Emory SOM Faculty and
433 community physicians• 21,000 admissions • 148,000 outpatient services
Emory Saint Joseph’s Hospital• Joint operating company• 410-bed acute care facility • Staffed by 620 private physicians• 13,148 admissions• 186,471 outpatient services
Emory John’s Creek Hospital• Joint operating company • Founded in 2007• Acquired in 2011 by Emory• 110-bed acute care facility • 10,000 admissions • 50,000 outpatient services
BILLING ENTITY OVERVIEW
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Self-pay A/R analysis Health Insurance Exchanges (HIX) – misunderstanding
about what “covered” means in a High Deductible World
Employers offering HDHP – Healthcare financial responsibility shifted towards workers or pushing them onto the HIX
Greater patient out of pocket expense► Copayments ► Deductibles► Coinsurance
Payments owed for services already rendered Disconnect between provider and patient
► Need for improved strategies to address
Shift in healthcare
Impact onself-pay account
receivables
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Economics of self-payIncreasing patient responsibility
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Emory’s journey with Patient Responsibility Pricer
Beginning of 2007, self-pay A/R was increasing drastically
Increased $3 million in 6 months (total >$20 million)
75% of self-pay accounts are after insurance (still true today)
Anti-self-pay reconciliation culture (academic medical center)
No offensive tools
Experian Healthcare Contract Management already in use at Emory
Patient demands: Benefits education Reduced financial surprises Short turn-around time Consistency
Business demands: Identify after-insurance responsibility Increased upfront collections Short turn-around time Improved decision making and credit risk
identification
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Patient Responsibility PricerHospital + Physician
The patient-friendly estimate mirrors an EOB and includes detailed descriptions of the line items, including the allowed amounts, co-pay, deductible, and co-insurance amounts which determines the patient’s portion
The Patient Responsibility Pricer estimate generator uses Emory’s contract definitions and the patient’s benefits to adjudicate professional and facility claims to provide us with the patient’s total responsibility
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CENTRALIZED ESTIMATES:PRP ESTIMATE EXAMPLE- PAGE 2
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Page 2 provides a brief explanation of benefits and the patient portion
The signature line includes an explanation of “This is only an Estimate”
Payments made at the time of estimate are reflected
Page 2
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Patient Responsibility Pricer end user accountability
Patient Responsibility Pricer counselors are audited monthly on collections (40% of score), workflow/accuracy (30% of score), and maintaining credit balances (30% of score)
This process ensures we keep the counselors core responsibilities monitored and provides for timely coaching opportunities as well as process improvements.
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Patient estimation process
Emory Clinic Patient Responsibility Pricer collections year-over-year• FY12 average collections per counselor per month= $23,127
• FY13 average collections per counselor per month= $35,190
• FY14 average collections per counselor per month= $45,637
• Credit balances average $35,000 per PRP counselor
• Credit balance goals range from $37K to $27K
• Average refund is <$100
Key factors in process• Upfront communication and benefits education sets payment expectation and empowers patients to make
decisions based on their financial responsibility
• Allows Emory Clinic to analyze collection risks before service is rendered
• Increased transparency
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Key performance indicators
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FY14 Emory Clinic cash collections through the Pre-Service Estimate Process
$2.9M*
Current Total Emory Clinic Self-Pay AR dollars that are balances after insurance, the target of our PRP process 69%
FY14 Emory Clinic Self-Pay AR resulting from facility based services
49%
The FY14 Emory Clinic average bad debt adjustment as a percent of charges 1.8%
FY14 number of PRP Estimates provided to patients 12,872
Looking forward: 2015
• Navigator services to identify and enroll HIX patients
– Only 28 patients in 2014 enrolled in an in-network plan through this effort
– Better defined processes for 2015 enrollment will increase enrollment in participating plans and increases the HDHP patients needing estimates.
*$10.9M in TOS Collections Overall, 27% of department’s collections come from PRP
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• One healthcare estimate• Consistent communication • Ability to plan sooner• Understanding facility vs. physician
• Greater ability to collect across the system with increasing shift to patient responsibility
• Ideal patient and family experience• Reduced calls to customer service• Pricing transparency
Patient Responsibility Pricer: Hospital project
Patient demands
Business demands
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Centralized estimates: Front end process flow
Web form
Estimate hotline
Email inquiry
EPP Centralized Office
(2 business day turnaround)
Telephone follow up to review estimate with
option to send by mail
Email follow up to provide estimate
Patient Collection & Scheduling
Request Create Communicate
Complete
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Benefits of PRP Recognized by The Emory Clinic since 2007
• Intentional process of identifying, discussing, and mitigating collection risk
• Millions of dollars collected prior to services being rendered• Decrease in self-pay after insurance AR
• Decrease in statement expenses
• Decrease outbound call volume
• Tens of thousands of patients educated on out of pocket responsibility• Empowered patients
• Improved Patient Satisfaction
• Decrease in customer service call volume
• Assist in shifting academic medical center mindset about self-pay environment and risk• Meet customer expectations for communicating price upfront
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• Find an interested physician champion with an involved administrator to gain buy-in
– Look to compensation model
• Assign staff members a realistic but stretch collection goal
– Tracks success of your efforts and makes the process their priority
• Pilot as a shift in FTEs• Review existing processes to inserted process
– Pre-Cert Process (EC)• Clear escalation and communication between collectors
and decision makers– Reschedule non-paying patients
Patient Responsibility Pricer Best Practices
People
Process