Overcoming Patient Payment Challenges: What Patients …

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Overcoming Patient Payment Challenges: What Patients Want and PracticeSuccess Stories

Ginny ShippProfessional Services | Waystar, Navicure + ZirMed

Ginny Shipp does not have a financial conflict to report at this time.

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©2017 MGMA. All rights reserved. - 3 -

Learning Objectives

•Outline practice success stories

• Explain provider and patient satisfaction trends in billing and payments

• Interpret the data to strategically address risks and opportunities


Current Reality

•Average Individual Deductible is approximately $4300

•Average Family Deductible is approximately $8300

• Bronze Plans are the most popular at 44% - lower premium, but higher deductible

Source: eHealth Health Insurance price Index report – January 13,2017

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Scary Statistics…• Out of pocket costs for patients has increased by

230% in the previous 10 years

41% of employees choosea HDHP when given the option

• Since 2000, U.S. hospitals have provided morethan $502 billion in uncompensated care expenses

• 81% of self-pay net revenues go unrecovered and default at a rate of 30% or more, therefore, it can cost twice as much to collect froma patient as it does from a payer

Sources: https://www.beckershospitalreview.com/finance/21-statistics-on-high-deductible-health-plans.htmlhttp://www.grouponehealthsource.com/blog/12-eye-opening-patient-pay-statistics-you-should-know

Current Reality


The High Cost of a Medical Practice

“To succeed, or even survive, we needto fundamentally change the way that

we organize and operate practices.”

Expected to do more with less• Profit margins down

• Expenses up

Minimal control over reimbursement• Can’t pass expenses on to patients

Value-Based Healthcare • Short-term financial hits to transition

from fee-for-service

https://www.beckershospitalreview.com/finance/21-statistics-on-high-deductible-health-plans.html

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$5000 per month!

Approximately 10% of your patientA/R in the 60-90 day bucket is thecost associated with that A/R.

If the average practice has $50,000in the 60-90 day bucket, the cost associated with ‘carrying’ that A/Ris $5000.

The Cost of Collecting Patient Responsibility

Source: http://swervepayhealth.com/the-real-cost-of-collecting-patient-payments/

- 8 -©2017 MGMA. All rights reserved.

Consumerism

• Reimbursement based online item services provided (volume)

• Power in provider’s hands

• Episodic Care

• Single provider

• Increasing cost

Fee-for-Value

• Reimbursement basedon outcomes (value)

• Power in consumer’s hands

• Cradle to Grave

• Multiple providers

• Decreasing cost

Fee-for-Service

“Understanding what drives consumersand patients will be key to future success”

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Consumerism

What consumers want consumer expectations versus organizational strengths

Consumers rank“Consumer Experience”

as their #2 priority

Providers rank“Consumer Experience”

as the #5 priority

Source: Kaufman Hall 2017 Healthcare Consumerism Survey

- 10 -©2017 MGMA. All rights reserved. Source: Oliver Wyman 2017 Consumer Health Survey

Consumer Experience

26%

Gen Z& Younger

23%

Millennials

22%

BabyBoomers

21%

Gen X

8%

SilentGeneration

want on-demand everything

most open to changes and willing

to pay for them

cost is highest concern

ease of use is highest concern –willing to pay for it

require greatest intensity of care

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Not IF…WHEN…

The Definition of Insanity - doing the same thing over and over expecting different results…

• Sending multiple statements

• Making collection calls

• Turning accountsover to collections

• Writing off bad debt


Survey Statistics78% of patients approve of having a creditcard on file for small charges, but only 20%of providers currently use CCOF.

• There is a trend towards more patients askingfor estimates up front – more than 56% willask for one in the future; 30% want it before scheduling an appointment

52% of patients prefer some type of electronic billing; 90% of providers still using traditional mail

• Among payment methods that an organizationcan offer, 20 percent of patients view CCOF astheir preferred method for charges of $200 or less.

Explore Alternatives

Source: http://info.navicure.com/BlogProspect2017PatientPaymentCheck-UpReport_LP.html

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What are my options?

✓ Estimate cost for patients

✓ Collect up front at time of service

✓ Incorporate best technology

✓ Create a Patient Payment Program

✓ CREDIT CARD ON FILE PROGRAM

Continue sending statements and writing off bad debt

Explore Alternatives


Tapping into Solutions

Create a Patient Pay Program

• What is your Financial Policy for patient responsibility?

• Who is responsible for patient collections?

• What are the exceptions to the rules?

• What are your goals?

• Do we make it easy for patients to pay?

• Do we have the best technology to supportour program?

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Cost Estimates

44% of providers have no plans toprovide cost estimates in the future

• 63% of patients say they are comfortablewith a ballpark estimate (within 10% accuracy)

Collect at least some of the estimateat the time of service

• No more ‘Surprise Billing’

Source: http://info.navicure.com/BlogProspect2017PatientPaymentCheck-UpReport_LP.html



Consumer Experience - Estimates

56% 59% 75% 74% 57%

look for priceinformation before

receiving healthcare

will choose a provider that is less expensive

do not know the cost of services until they

receive a bill

say an up-front estimate would

positively impact their view of a

healthcare provider

Would return if they knew they would get an up-front estimate

Source: TransUnion survey 2017

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Credit Card on File!(CCOF)

The commitment to pay is key!

• Only 20% of providers view CCOF as the best way to reduce cost of collections; 22% consider online bill pay as the best method to reduce the cost of collections

• Only 20% store a patient credit card and charge it when balance comes due

You don’t have to be afraid anymore.


SUCCESS STORY: 50 Physician Urgent Care

“We’re very detail-oriented. Seconds, inches, pennies –what other organizations might consider minutiae

is important to us.”

• 200,000 encounters per year

• 75% reduction in bad debt

• Sustained excellent patient satisfaction scores

“As an urgent care organization, we must differentiate ourselves through quick, efficient

registration and excellent customer service. At the same time, the staff must be able to

secure payment. It’s a challenging balancing act to achieve both, and it requires the

right processes, the right people and the right technology.”

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SUCCESS STORY: 12 Location Multi-Specialty Group

“When we collect balances up front, we don’t have to send out bills, which saves us both staff time and associated hard costs such as

paper and postage.”

• 120,000 patients

• Revenue Cycle Specialist generates estimates24 hours in advance, then patient meets withfinancial counselor on date of service

• Increased time of service payments by morethan $100,000 in just five months

“…patients also benefit from better price transparency for diagnostic services and the ability to make informed decisions up front…how they will pay their balances.”


SUCCESS STORY: 11 Provider Pediatric Ophthalmologist Group

“We created a new position-called a benefit coordinator-and staffed it from the billing department … while this approach

did yield results, we felt that patient A/R was still abovewhere it should be.”

• 35,000 patient visits per year

• Increased patient collections by approximately$40,000 per month

• Saved at least the cost of one FTE within the first 3 months

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SUCCESS STORY: 7 Provider Urology Group

“Practices can’t exclusively rely on the reimbursement they receive from payers anymore.”

• 4000 statements per month

• 32% of revenue comes from patient responsibility

• $10,000 pre-payments collected monthly

• Staff no longer generating multiple paper statementsor spending time on the phone collecting

“By setting patient expectations up front about what their financial obligations will be, we are empowering them to take more responsibility for their care. In

today’s environment, a practice’s financial survival depends on how well they are able to collect from patients and educate them about what they owe.”


How others are getting started The best ways to ensure your medical practice

collects from patients

• Verify insurance

• Estimate the patient’s responsibility

• Collect as much of that as possible before, or just after,

medical services are provided

• Provide a number of payment options to make it easy for

patients to pay

• Establish an effective program to collect amounts that

patients cannot pay at the time of service (CCOF >

Payment Plans)

• Monitor the success of collection efforts

Practice

Financial

Policy

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Continuing Education ACMPE credit for medical practice executives…………... 1ACHE credit for medical practice executives…………..…. 1CME AMA PRA Category 1 Credits™……………………….. 1

*CPE credit for certified public accountants (CPAs)……….. 1.2CEU credit for generic continuing education………..……. 1

*CPE CODE: 7 0 3 G

Let the speakers know what you thought!Evaluations will be emailed to you daily.

Ginny Shipp

MGMA.ORG

THANK YOU.

[email protected], Navicure + ZirMed2055 Sugarloaf Circle, Suite 600| Duluth, GA 30097

Overcoming Patient Payment Challenges: What Patients …

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