Footing the Bill: Patient Portals, Part I

June 24, 2011
Deborah Kohn Patient portals have come a long way in recent years. The technology that once offered limited functionality is now multi-dimensional,
Deborah Kohn
Patient portals have come a long way in recent years. The technology that once offered limited functionality is now multi-dimensional, and smart CIOs are cashing in. In this two-part series, we'll look at how hospitals are benefitting from tying portals to EMR, billing and scheduling systems, and how some organizations plan to push the technology even further.
Ken Lawonn
In the financial department, we'll examine how portals have evolved past simply offering bill pay to include myriad services that can lead to significant savings. The administrative department, here, will explore how the technology is being leveraged to improve staff efficiency and consumer satisfaction by placing tasks such as scheduling in the hands of patients.

We'll also look at how portals are helping patients better manage their health, which is at the core of any hospital's strategy. It's a technology whose time has come.

In the fast growing world of portal technology, CIOs need to remember that the financial end of a patient portal is more than just paying a bill. Useful business results in this space can run the gamut from insurance pre-authorizations to improved collections, and from significant savings in call center workload to appointment scheduling. The blossoming of consumerism is making the patient portal ever more important - and tying the financial functions into the overall portal strategy is key.

“A portal is nothing more than a gateway to customer service,” says Deborah Kohn, principal at San Mateo, Calif.-based Dak Systems. “It's a gateway whether your customers are your patients, your physicians or your employees.”

Kohn says that since so many hospitals focus initially on physicians portals, they often don't realize the financial benefits of patient portals right away. “In crafting a portal strategy, we determine what's the most important thing to a hospital,” says Kohn. “And for most of my customers, that is their physician.” And that, she says, is where most hospitals start.

But the patient portal and its financial savings are part of an overall portal strategy as well; and for many hospitals, an easy place to start-especially when looking for a concrete ROI.

Ken Lawonn, CIO of eight-hospital Alegent Health System in Omaha, Neb., found those savings when he implemented his patient portal; it took financial functions he had established on the Alegent Web site to the next level. “We didn't do anything new in the financial world out of the gate, but since we established this patient account, we now have the information stored, so we don't have to ask the patient that information again.”

He says there are a few savings components to the portal - once is the efficiency component of staff taking the patient calls and registrations. “There is some cost savings there, and if we can collect some payments upfront, or get people to pay online, we can work more quickly.”

Lastly, he says that for at least a segment of his population, he can capture some volume because it's the way some patients prefer to interact.

Similar savings were realized by Asif Ahmad, vice president and CIO at Duke University Health System in Durham, N.C. - who turned a simple observation into a portal strategy. “We knew that one of the biggest spikes in our call volumes was at the beginning of the year, around January,” says Ahmad. The reason? Patients wanted actual information on their past spending in order to set upcoming flexible healthcare plan deductions. “From the financial side, that was the trigger,” he says. “Our call center would get bogged down with people looking for summaries of their spending.” Ahmad and his team decided to put it all online through a patient portal. “Oh, and while we're at it, why don't we let them pay their ongoing bills?” he says. “That's where it started.”
Asif Ahmad

The portal at Duke, started two years ago, went from zero to 20,000 patients in a couple of months. And the collections began immediately. Duke currently collects close to $900,000 a month on the portal and expects to pass the $1 million mark shortly - results that please Ahmad, he says. “We have 95,000 patients online interacting with us, which accounts for 20 percent of our repeat patient population, and we haven't even actively marketed it yet.” And he has already begun tracking the impact on no-show rate and revenue.

However, most agree the key to success with a financial portal is having it fit into an overall portal strategy.

For Ahmad, that strategy was about becoming more accessible to patients, especially since Duke is such a large, multi-hospital organization. “We have 20 parking garages alone,” he says, “So our sheer size is overwhelming to a patient. We said ‘How can we be more high touch,’ and the portal was part of that.”

Once Duke went down the financial portal path, Ahmad knew he would need to balance it so patients could view lab reports and other clinical functions online too. “If you do it just from a revenue perspective, you're not going to get as much traffic unless you put other carrots along with it,” he says. He suggests putting in scheduling along with bill pay - at Duke, patients can book appointments the same way they book airline tickets.

Ahmad says his portal functionality has grown as patients demand more, such as patient education, medication lists, and disease management (which has a revenue component of its own.) “You're talking about chronic disease and looking at cost associated with it, and all of this is coming together under the umbrella of the portal,” he says. “So it was a comprehensive strategy from day one.”

At Alegent, Lawonn discovered that clinical data was his next step in the patient portal, too, with patients' needs driving the strategy. He says once the organization began looking at what patients were interested in, clinical data was in demand.

Though Duke had success with its Web site-based offering, where patients could pre-register and pay bills, the larger strategy required a portal. “We recognized that in order to get into physician and patient messaging, we needed to establish a log-in that had to be secure,” he says. “It was the (clinical test) results and the potential to message with physicians that drove us to say, ‘We need to do this.’”

But for any portal, be it patient, physician or employee, CIOs have to decide which solution will work best for their organization. Kohn says the core vendor offerings for portals are paltry, though Epic, because of its PHR and ambulatory link, is taking the lead. “Typically, we go out and purchase portal application software,” she says. “All you need is a portal infrastructure - you can build anything on that.”

At Alegent, Lawonn is using Medseek (Birmingham, Ala.), and says he made that decision because that company had already developed and hosted the organization's Web site. “As we looked at the tools that it would take to develop the portal, and their ability to make it an integrated component of our Web site, that was a pretty significant advantage for us.”

Not everyone goes for the best-of-breed portal solutions, however - nor do they need to. Kohn says an Oracle (Redwood Shores, Calif.) database has very good portal software, as does Armonk, N.Y.-based IBM. “It's not always just a healthcare vendor,” she says.

The IBM route was the one chosen by Duke. “We didn't want to buy any of the vended solutions,” says Ahmad, citing the challenge of three hospitals, with different financial systems: GE IDX for the physicians and Siemens on the hospital side. Duke selected IBM's Medsphere product, used by most airlines and banks. “IBM had a very high security level, and they're very flexible,” says Ahmad. “All we needed to do was work with our various application vendors and have them pull information into this portal. It's not a tough interface.” From contract to go-live, he adds, was 10-12 weeks.

Fast forward to now, and Ahmad says his organization is doing advanced registration, so patients can print their boarding passes at home, so to speak. “We do pre-certification, they come in and scan it, and off they go to the waiting room.”

Though Duke is a large IDN, Ahmad has advice for smaller hospitals looking for a portal solution. “If you are a small monolithic hospital with one dominant vendor, I would say first talk with the vendor you have,” he says. “Even if they have a halfway decent portal, work with the vendor's user group to push for functionality.” And, he adds, the other first step is to analyze and change the process. “Even if a vendor has the best portal, it's not going to solve the problem if you haven't figured out how to improve the revenue cycle process yourself.”

CIOs also should never take the process portion lightly, something Lawonn found to be a valuable lesson learned. “One of the things we underestimated with the portal is the process and cultural change in the department you're working with,” he says. “If it's finance, you have to think through what it's going to take for them to accept these payments or these registrations online.” He says it's important keep in mind the people who are actually going to operationally support the process. “Think through what they need to do, and what they are going to be willing and able to do.”

Most agree that the changes in Washington will have an effect on all IT, including portals. “With the new administration in place, I see a much more simplified way of looking at quality,” says Ahmad. “Not only do you want to have (a sound) revenue cycle, you want that revenue cycle to match up with the quality of care you're giving. And that's where I see the portal going - transparency and accessibility.”

For Kohn, that accessibility is key.” You want to make your hospital one-stop shopping,” she says. “Think of a mall and just keep adding on stores. That's the beauty of having portal application software - you can make it as robust as you want.”

Healthcare Informatics 2009 May;26(5):20-36

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