In this episode, Barbara Tapscott, VP of Revenue Cycle at Geisinger Health discusses patient access strategies to help improve collections.
Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast. Today, I’m joined by Barbara Tapscott who is Vice President of Revenue Cycle at Geisinger Health System.
Barbara has joined us to discuss patient access strategies that help improve collections. Barbara, welcome to the Hospital Finance Podcast!
Barbara Tapscott: Thanks, Mike!
Mike: We’re glad to have you with us. Let me start off. Patient access is a big term. And it tends to include things like registration, scheduling, pre-registration, insurance verification and upfront collections. What should hospitals be thinking about when they think about patient access?
Barbara: So, hospitals should be thinking broadly about patient access. There are many tasks that are required to ensure timely payment. But at the end of the day, hospitals should be thinking about the patient experience first and foremost, what to do and how many of the typical patient access tasks could be accomplished pre-service to maximize the patient’s visit to the facility, whether it is the physician or the hospitals to maximize that time in the clinical environment.
Mike: And what would you say are some of the aspects of a solid patient access program?
Barbara: Well, this is where the adage of people, process and technology comes into play. You must leverage technology. There’s so much technology today to facilitate real-time information and the verification of insurance or a patient’s address or a coordination of benefits, things of that nature that used to take an inordinate amount of time from registrars and financial counselors.
But you have to have an educated workforce so that you maximize also your investment in labor by having them work on an exception basis.
And then, as I’ve said before, very defined workflows and scripting so that the interaction between the patient-facing staff and the patient is optimized, so that things that could be automated or implied or leveraged with technology, et cetera, don’t need repeating.
One of the aspects that we’ve heard sometimes from patients is, “You know, I visit the hospital. And I visit different departments. And in a single day, I get asked the same question multiple times.”
So, this is where we leverage an educated workforce and technology to make the patient experience seamless.
Mike: Barbara, let’s talk about financial counseling. What have you found to be effective strategies for building a solid financial counseling team?
Barbara: So, I will tell you that Geisinger is an integrated delivery system, and so is our revenue cycle. We handle not only hospital providers, but physician providers. And what I’ve found in our experience to build a solid financial counseling team, our patients are coming to us for information.
This new population that has insurance as a result of the Affordable Care Act needed a lot of education and outreach. And so we find that we need to have a very well cross-trained workforce. We need people that can speak hospital terms, people that can speak as well physician terms, that can talk about insurance coverage, coordination of benefits, exceptions in the coverage, et cetera.
Counseling patients requires transparency, empathy and clarity in communicating insurance reimbursement. For most people, this is a foreign concept. Even you and I, I don’t know the nuances of my insurance coverage unless I need to use it. And then, I’ll find out what is appropriate for that event or that need.
So, our counselors need to be cross-trained. But yet, they need to have the empathy in communicating with the public that sometimes is very stressed out. This is not the best time in their lives unless they’re having a baby. This is not the best time in their lives to be worried with can they afford healthcare or not.
In addition, we are mandated that our financial counselors be also certified as application counselors. Although we could not recommend insurance coverage or insurance plans to our patients, we needed to be knowledgeable to be able to guide patients in their decision-making and what they should be looking for that fit either their budget or their needs from a medical perspective.
So, effective strategies, I cannot stress training enough and having the right fit in attitude as well as aptitude for people that are patient-facing and communicating with the public.
Mike: Barbara, you touched on part I think of the next question that I have for you because it does relate to how you interact with patients. You’re talking to a patient about their portion of their financial responsibility for care can cause anxiety for them especially if they have a high deductible or maybe no insurance at all.
So, touching on maybe what you’ve already gone over, can you just dive in a little bit deeper and tell us how an organization can compassionately handle that conversation so that the patient has a good experience and the hospital has a positive outcome?
Barbara: Right! So, I touched on it briefly on the previous question, but I will say privacy and empathy and leveraging and maximizing that patient experience transparency.
Management needs to provide our patient-facing employees with multiple options and a certain degree of latitude when counseling patients on payment options, insurance options. And for some patients, it may be that they will need to be converted to other source of funding like, for example, Medicaid if they have no insurance at all or other sources of funding like other federal programs if they’re disabled.
Ultimately, it may be that a patient needs care, but that patient has no means and doesn’t qualify for any other program other than financial counseling. Management needs to provide the options, make them varied because we serve a diverse population, and then training that person in the front to be knowledgeable of insurance reimbursement and all of the options that are available to the public including financial counseling.
Mike: And certainly, in the environment that we’re in where insurance coverages are changing and you’re seeing higher deductibles happen, it’s put more of an emphasis on front-end collections.
So, when my question for you is when you think about front-end collections, what types of functions within the hospital may have to be changed or reordered to accommodate for a higher level patient responsibility, for instance, will some of the backend functions have to come forward.
Barbara: Absolutely! I will tell you that at Geisinger, we have tried to—let me just say this. A lot of what we do relies on patient education and transparency so that, early on, if it is a scheduled service, our patients will know what their responsibility may be and what the options are for payment.
But high deductible plans bring on a different challenge in that some people have their high deductible. They have an HSA account. But immediately, right out of the gate, they cannot just pay all of it. So we provide options for interest-free payment plans, et cetera.
And what we have found is that it helps us, as we have a collection function in the back, to bring that forward and put information in front of our patient-facing staff in the front to say, today, you offer this, or you have a past due balance of x, or there’s continuity in the conversation that has started pre-service to say someone called you prior to this appointment, and you agreed to pay x towards today’s visit.
It presents a solid experience to the patient to know that as large as a hospital or a physician provider may be, that there is continuity and no one has to repeat or make different arrangements.
And for that, you leverage technology. We leverage a customer resource management technology so that, at any interaction with our patients, we know exactly what took place before, and then we document our interaction today for the future.
So, we try to mitigate the anxiety that may come into play with high deductibles, et cetera. But knowing what may happen on the backend, we may bring those functions to the front.
Mike: And one of the aspects that we deal with now in healthcare is pricing transparency as you bring those elements to the front. So what are providers doing to deliver accurate pricing to patients at the point of care?
Barbara: It’s so interesting that you would ask this question because there is so much information out there. And what we see in the media is people talking about charges.
And charges for the insured population are rather meaningless. Patients essentially owe what their insurance says their deductible or their co-insurance is. There’s a component for charges.
What we are doing—and I can speak for what we’re doing at Geisinger—is we’re trying to put forth to the patient and answer their question. “If I need this service, how much will I have to pay?” An insured patient is looking for “how much will I need to pay.”
In addition to that, there is the value component of a medical encounter. It is not how much I will need to pay, but also is my physician, is my hospital qualified to deliver this service with the highest degree of quality. And there is public information regarding quality, and then of course there is internal information regarding quality.
So, we try to answer those questions for our patients. The most expensive is sometimes not the viable option, and neither is the cheapest. It is what I consider the middle ground where a patient can say, “This is a quality provider. This is their experience doing the service that I need.” And the question is answered, “How much will I need to pay?” Providers need to do that.
Now, there’s a lot of technology out there. There’s a lot of data out there that people can leverage to bring those two portions together—the quality and what will I owe for this service.
Mike: Barbara, how does offering a variety of payment methods affect a hospital’s ability to collect?
Barbara: So, I’m biased on this. I believe that the more payment methods there are available to patients, the greater a provider’s ability to collect, accepting any form of payment (including HSA accounts, and as I’ve said before, we offer interest-free payment plans and payroll deductions for employees also). The more options that we can provide to patients, not only the type of payment, but also how to pay.
Most people today pay their bills electronically. They don’t even want to receive a paper statement. And so we have to make ourselves join the electronic wave of presenting payment options.
So, we present a combined statement, number one, to our patients. And then, they can either pay it the old way. But I will tell you, most of our payments come in electronically. People can access the Geisinger portal and make their payment. They don’t need to be enrolled in my chart (although we would like them to be). But we need to offer payment options.
We’re looking now at the ability to just pay in a mobile device. So we’re looking for diverse demographics regarding payment. And some people want to call in and talk or come to the hospital and talk to the cashier who is their friend.
But the more options we make available for the diverse populations that we serve, the better off the hospital or a provider will be.
Mike: Barbara, do you have any additional advice for hospitals that are looking at improving their patient access programs?
Barbara: A little bit. I will say that the advice here is universal, in my opinion. The patient experience does not end with the clinical encounter. And it often extends to the billing period. And that’s where clarity, and price transparency, and the payment options that we’ve just talked about, and financial counseling, comes into play.
Most people will aggregate, not only their clinical experience, but how easy or complex the billing experience was to grade a hospital.
So, patient access is not just a revenue cycle function. There is a lot of congruency, if you will, with other stakeholders. And we need the support of clinical operations to be very effective. We need to look at patient flow in and out of a provider, how long does it take to do what we’re doing, could we do some of this in advance again to maximize the patient experience with the clinician, but also, to make it easy on the back end so that when a patient receives a statement, it is what they were expecting.
And that breeds credibility and creates a halo, if you will, a service halo around the entire encounter.
Mike: Barbara, I enjoyed our conversation today. Thank you for joining me on the Hospital Finance Podcast.
Barbara: Thank you, Mike.