If you think it’s tough to create a comprehensive patient payment plan among the staff members of your own practice, imagine doing it with 115 physicians and staff spread across six locations in Utah, who process more than 1,000 claims per day.
That was the case for Granger Medical Clinic (GMC), the largest independent multi-specialty medical clinic group in Utah’s Salt Lake Valley. GMC was facing the same issues as smaller practices: an increasing number of patients responsible for a higher financial burden of their healthcare through high deductibles and copays. What's more, they were losing money once those patients walked out the door, mostly because of a soft or absent payment policy and training for staff.
“We had opportunities [to collect] missed and it forced things to the back end when a lot could have been resolved on the front end [of operations],” said Tim Ledbetter, former director of revenue cycle operations for GMC and currently a healthcare IT consultant. Ledbetter discussed GMC’s collections transformation at a session during this year’s Health Information and Management Systems Society (HIMSS) conference in Las Vegas.
Ledbetter noted that across healthcare today, out-of-pocket spending for patients is on the rise, not only among plans affiliated with the Affordable Care Act, but also those sponsored by employers. Add to that rising medical debt among patients and practices are facing a tough situation with those who actually show up for treatment.
A 2014 Bankrate survey indicated that 55 percent of patients worry they won’t have enough savings to pay their medical bills. “You have more than half of patients walking into a clinic not just worried about their care and services, but also paying that bill,” Ledbetter said. “That’s a lot of stress walking in the door.”
To collect more on the front end of patient visits, GMC gathered its internal stakeholders (physicians, front-desk staff, etc.) as well as its health IT vendors to not only come up with a standardized policy for its six locations, but a technology process to manage and streamline it.
What they developed, with help from clearinghouse and billing partners, was facilitating time-of-service payment through an automated estimate on costs (using traditional coding for services and researching the patient’s plan) and to have a discussion with patients up front on what the visit will cost and —more importantly —how they will pay for it.
Using a patient financial portal, GMC was able to get up-front commitments from patients to pay their balance via credit card for automated billing that met their needs, said Ledbetter. These payments, he said, could be done in weekly installments, monthly, or perhaps two months after the visit, after a tough time passes or a pre-paid vacation is taken. This only happened after developing the tools from its technology vendors vs. accepting what was off the shelf, he said.
“There’s a lot of technology out there and a lot of vendors today,” Ledbetter said. “Do your vendors work for you or do you work with in their solutions … When they do not meet your needs, tell them how to do it.”
The results of a combination of the right tech tools, staff training, and patient interaction early in the process? GMC scheduled more than $100,000 in payment plans within 30 days of implementation and saw a 29 percent increase in monthly payments over the same time period. Furthermore, the automation of the process helped improve its first pass claim rate to 96 percent by avoiding denials with better information from the patient earlier in the process.
GMC was also able to retain patient satisfaction with more informed, accepting patients who understood their financial responsibilities before care was rendered. “It’s great to have that good conversation [about finances] up front to set things up,” he said. “If patients are more comfortable knowing finances won’t get in the way … that can benefit their treatment.”