Upgrading patient experience is essential to improving RCM performance

Joe Politi
Vice President of Solution Design and Delivery,
R1 RCM

Consider the massive technological advances that occurred in healthcare organizations in just the last decade. Care can now be personalized down to our DNA, electronic health records are in 96%¹ of hospitals, and smartphones have virtually replaced landlines and pagers as the preferred clinical communication device.

Yet when it comes to patient interactions with the most basic administrative processes: Scheduling an appointment, registration and bill payment, the healthcare industry seems stuck in the 20th century. Patients call on the phone for an appointment, handwrite on paper forms, have their insurance card photocopied, and then use postal mail to pay their bill.

Now consider how much easier these processes are in other industries: Retail, banking, and travel. Healthcare, however late, is finally catching up to these other markets in simplifying the patient experience with intuitively designed self-service platforms.

This is important not only for patient satisfaction, but also because patients’ out-of-pocket spending now represents a major revenue stream for hospitals nationwide. Average health plan deductibles were $1,505² in 2017 for an individual, but recent survey³ findings show that more than 60% of Americans do not have savings to cover a $1,000 emergency.

Sophisticated, technology-enabled revenue cycle management (RCM) platforms are now available to fully automate and digitize the registration, scheduling, financial counseling, and bill payment processes, even offering patients an estimate of their out-of-pocket expenses prior to care delivery.

Modernizing the patient’s experience with the revenue cycle can apply lessons learned from these other industries to help organizations streamline operations and gain market share while also improving patient yield by double-digit percentage points.

Patients’ changing expectations

Patients’ service expectations from healthcare are changing. Provider loyalty is a thing of the past. For example, a 2017 survey⁴ shows that 88% of patients would switch providers if they were dissatisfied. The survey also reported that 41% of patients say scheduling appointments online would improve their satisfaction with their providers and 49% say advanced knowledge of treatment costs would improve their satisfaction.

Data⁵ also indicates that positive clinical outcomes can be overshadowed by a negative administrative and billing experience. Every touch point in the revenue cycle, from scheduling an appointment to the final bill, impacts patients’ satisfaction with the healthcare organization. In fact, one survey⁶ showed that satisfaction can decrease by more than 31% between discharge and the final bill.

For a first appointment, patients want to schedule an appointment online, on their own devices, rather than repetitively making calls to make a single appointment. Once they have found a convenient appointment slot, they expect total self-service from their own mobile devices.

When they arrive at the facility for the appointment, patients expect to have their benefits eligibility already confirmed and co-pay calculated. They also prefer a seamless in-office check-in process—one with self-service options. Post-visit, the patient wants to receive and pay their bill electronically for added ease and convenience. Collectively, the ideal encounter for all patients would nearly be all self-service and managed through a laptop, mobile device or in-office kiosk, which is similar to most of their other consumer transactions.

In addition, although the Millennial generation consumes few healthcare resources now, by 2025, they will comprise 75%⁷ of the workforce. As this generation ages and accesses more care, they will take their online, self-service and convenience expectations with them as they engage with providers.

The patient becoming a bigger payer

Improving the patient experience with scheduling, registration and billing is important for more than just evolving with consumer expectations and streamlining workflows. Patients are increasingly paying more out of pocket for their healthcare costs. In 2016, patients paid for 38%⁸ of their healthcare out of their own pockets, an increase of 3.9% over the previous year. In addition, the number of Americans younger than age 65 with private health insurance enrolled in a high-deductible health plan reached 42.3%⁹ in the first three months of 2017. Average out-of-pocket maximums for patients with these high-deductible health plans were greater than $4,000¹⁰ in 2017.

Facing greater financial pressures, all patients will want a clearer perspective of what their care will cost. Most hospitals and health systems, however, are unable to present the patient with a cost estimate, a common practice with most other major consumer service providers.

Advanced RCM platforms can now offer patients a transparent estimate of their out-of-pocket costs with reports calculated using proprietary rules engines developed over years of analyzing payer contracts. As a result, patient bad debt has been reduced at some organizations by 25% with a 20% improvement in patient cash yield, while patient satisfaction with the billing process increased by 40%.

These rules engines also help to confirm health plan benefits eligibility, identify pre-authorization and referral requirements in advance of the appointment, and to conduct medical necessity validations. Such automated processes eliminate waiting and frustration on the patient side, while also alleviating administrative staff from time-consuming RCM activities, reducing costs by as much as 45%.

Adding transparency

Patient cost estimates for individual services may only be the beginning. Algorithms are in development which will allow providers to deliver cost estimates for entire care episodes. For example, when a patient with Health Plan XYZ arrives in the emergency department with a torn ACL, the organization’s RCM platform will be able to provide a comprehensive cost schedule for the surgery, hospital stay, rehabilitation, follow-up appointments, and other associated hospital and physician charges.

Before the industry arrives at that point, hospitals and health systems can begin improving the patient experience today. Exploring an intuitively designed patient self-service platform is important, but understanding and delivering personalized service across multiple generations is just as important as selecting the right technology partner. Technology solutions should improve operational processes in order to enable great service; technology should not dictate the process.

When integrated enterprisewide as part of a technology-enabled RCM solution, such a patient experience platform can empower patients to more easily navigate our healthcare system. For healthcare organizations, the technology can simplify, standardize, and transform the patient experience to ease administrative burden, drive substantial financial performance improvements, and grow market share.

References