Blog, The Hospital Finance Podcast®

Changing the patient experience at rural hospitals [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by David Shelton, CEO of PatientMatters, to discuss improving the patient experience at rural hospitals.       

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Highlights of this episode include:

  • Reasons why the patient experience is so important for rural hospitals and their communities.
  • What unique challenges do healthcare providers face when caring for rural communities?  
  • Strategies that rural hospitals are employing to improve the patient financial experience.
  • What can rural hospital finance professionals do to improve the patient financial experience at their hospitals?
  • And more…  

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Rural hospitals across the country are experiencing financial pressures. While many efforts are underway to try to keep their doors open, it’s getting increasingly difficult. One approach that’s working in hospitals across the country is to change the patient financial experience to reduce uncompensated care and increase patient collections. To talk to us about improving the patient experience at these facilities, I’m joined by Dave Shelton, CEO of PatientMatters. Dave, welcome to the show.

David Shelton: Hey, Mike. Thanks for having me.

Mike: Well, we’re very glad to have you. Dave, for most of our audience who may not be familiar with PatientMatters, can you tell us a bit about what you do?

David: Sure. PatientMatters is a 30-year-old organization and our roots are established in helping self-pay patients obtain assistance for government payer sources. So we originally started working with pure self-pay patients and trying to help them get relief with their outstanding hospital obligations. In the last few years, the definition of a self-pay patient has changed and higher deductibles, larger co-pays, more patients with interest covers that had such a high out-of-pocket limit that their hospital financial behaviors are as if they were actually self-pay patients. So we recognize that the patient changing experience and saw a need for a more robust health care solution and working with hospitals to be able to maximize the front-end patient collection opportunity and, at the same time, building and improving the overall patient-provider relationship.

Mike: That’s great, Dave. Thank you. Let’s dive right in, then. So health care providers– they’re generally paying more attention to the patient experience than ever before for all the reasons you just mentioned. Why do you think the patient experience is so important for rural hospitals in particular?

David: No doubt, the patient experience is important to all health care providers, regardless of the size. For larger hospitals that are fighting for patient census, the patient experience brings real value to a provider in a tough competitive market. But I think the importance for rural and critical access hospitals with even more important– first, in rural and community facilities, I think hospital staff– they really do know their patients. All hospitals talk about it, but in the rural community, those patients are their neighbors, their fellow church members. Their kids attend school together. They see each other in the grocery store. I think the relationship is truly at a different level in a rural community. Probably, secondly, most rural hospitals provide services across the continuum of care from primary care to long-term care. There’s not a lot of specialization in a rural environment, and the hospitals truly engage with the patient throughout their life. And, probably, finally, the patient engagement comes especially important in rural hospitals. When you think about it, the average rural resident travels twice as far to get to the hospital as a patient in an urban setting. I think it’s something like 17 minutes, and can even be further than that, with no public transportation or other things that might be available in an urban environment. So initial visits, patient follow-up visits, these become logistical challenges for the rural patient population. And the patient experience and patient engagement is probably even more impacted because of that, in the rural setting.

Mike: Let’s just dive in on that a little bit more because some of the characteristics that make up a rural population are unique, and I think you touched on some of them there, but what else in your view really makes that population unique?

David: Rural Americans — I think sometimes people don’t think about it but they actually make up about 18% of the US population. That’s more than 58 million people, so it’s not an insignificant number. Rural populations they struggle with lower median household incomes, higher percentage of children living in poverty. There are fewer adults with post-secondary education, more uninsured people. The rural communities are impacted by substandard internet services and spotty cell phone coverage. We talked about the travel challenges that they have. And I think once you take all those together and then you really look at it, what becomes most important the rural areas in the United States have higher rates of chronic disease than people in urban areas. Heart disease, cancer, unintentional injuries like vehicle accidents and the crisis in the opioid addictions and the ability to be able to get to the hospital in a timely manner. Chronic lower respiratory disease, stroke, these are all higher in the rural communities and make it become so much more a unique population that the healthcare providers are working hard to be able to take care of.

Mike: Dave why don’t you walk us through a few strategies that rural hospitals can employ to improve the patient financial experience?

David: Mike when you think about the rural hospitals I think you really have to look at the numbers. Rural hospitals make up about 50% of all hospitals in the United States. Between 2005 and 2012 an average of 7 rural hospitals in America closed each year. Since 2012 that closure rate has doubled to almost 14 a year. And since 2010 there have been more than 100 rural hospitals closing in the United States. 20 of them in my home state of Texas. Almost half of rural hospitals are in the red, and unless their finances improve dramatically, another 21% are considered at high risk of closing. So when you look at these numbers you recognize the importance of establishing a financial relationship with rural patients. That needs to be something that the hospital works at in the initial stages of the relationship. You start to recognize that each patient just like they have a unique clinical diagnosis, they also have a unique financial diagnosis or situation. And one size fits all payment plans they just don’t work for long-term success for those hospitals. 

So I think a couple of strategies that you look at when you’re thinking about improving the financial experience with your patients is number one, you need to partner with vendors that share the spirit of the rural healthcare provider. I think the rural healthcare community might be one of the most poorly treated customer bases in all of healthcare. The vendors shy away from those relationships with rural facilities because of challenges to create margins because of the low volume and the financially challenged customers that they work within the rural setting. So rural facilities, their management teams are looking for ways to be able to make improvements and just struggle to find vendors that they can connect with. And it just causes problems for them and gives them limited solutions to fit their budget requirement. I don’t think a rural facility should have to beg a vendor to work with them. And the solution should fit their particular facility, not try to take a solution that covers all hospitals and make it work for something in a smaller environment or setting.

Probably the other strategy to take a look at is you need to identify technologies and solutions that assist registrations that have been doing a thorough job. Whether it’s a large hospital or a critical access facility, staff need tools to identify and verify patient coverage, provide patient estimations that take into account the co-pays and deductibles based on patient insurance coverage, use prior authorization tools to obtain insurance pay or approval prior to services being rendered. All those things that allow the registration team to be informed at the beginning of the relationship so you can start to measure the collection practices and look for areas of improvements within your business operation.

Mike: Dave there are really so many components that make up the total patient financial experience. If you were talking with financial professionals at a rural hospital what would you recommend as the first steps they should take towards improving the patient financial experience?

David: There’s a couple that come to mind Mike right away. Number one, you’ve got to contact the patient prior to the outpatient services being performed. You’ve got to have established the relationship with that patient. Understand not only what their insurance coverage is but be able to give them an accurate timely estimate so that the patient can understand that they have an obligation and how can the hospital work with them to be able to make that obligation work for them. So the hospital and the patient can partner together to find solutions to be able to allow the patient to pay the bill. We’re convinced and I’m convinced that patients want to pay their bill, but that communication process established at the very beginning is what allows you to be successful and be able to collect that. You also have to work with patients whenever you’re talking about payments. And come up with reasonable payment plans, not $25 a month regardless of the patient balance or the patient’s ability or inability to be able to pay, but something that fits for them specifically. And I think when you do that you show that the hospital has a willingness to be able to work with the patient in whatever their personal situation is and help them find the solution so that both sides can be satisfied and can get everything worked through. The hospital should not be waiting for the statement to draw before engaging with the patient. There’s a lot of good technology platforms that help with this. I think that puts you on the right road to measuring your finances and being successful long-term.

Mike: Great insights Dave. If someone wanted to learn more about patient matters where can they go?

David: Mike thanks for asking. is our website and has all our contact information. It gives some greater details about the services we provide for the healthcare community.

Mike: Excellent. Well we hope everyone takes a few minutes to check that out. Dave Shelton, thanks so much for joining us today on the Hospital Finance Podcast.

David: Mike I enjoyed it. I appreciate the time.

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