4 Front-End Rev Cycle Revamps You Need for a Competitive Edge

In the crowded healthcare market, smart healthcare leaders must find patient satisfaction advantages everywhere they can.

This article appears in the September/October 2019 edition of HealthLeaders magazine. 

When it comes to patient satisfaction, providing excellent clinical care is a no-brainer. But in a crowded and competitive healthcare market, smart healthcare leaders know that they need an edge everywhere, including an efficient revenue cycle.

That's the case at Baylor Scott & White Health in Texas, which has multiple locations, including the busy Dallas-Fort Worth metroplex and the fast-growing Austin area. Baylor Scott & White considers the revenue cycle critical to the patient experience.

"We're focused on delivering an exceptional revenue cycle experience—from the time we schedule and pre-register a patient all the way through to the statement and patient collection cycle. We are on the bookends of the patient's clinical experience, and we're often the first and last interaction the patient may have with our organization," says Sarah Knodel, senior vice president of revenue cycle.

"The patient experience is something that we talk a lot about internally within the revenue cycle and delivering a customer-for-life experience is one of the organization's strategic initiatives," she says.

Baylor Scott & White Health has been on a multiyear quest to optimize its revenue cycle with patient experience and efficiency in mind, specifically on the front end, so patients have all their financial ducks in a row before they even arrive for their appointment.

"We're trying to take care of as much of that process prior to care [as possible], so that on the day of [the patient's] service, it's more about healing and their well-being versus focusing on the financial aspects of that visit," Knodel says.

HealthLeaders asked Knodel to share the work her department has done to make its revenue cycle more focused on patient experience and satisfaction and improve efficiency. Here are four front-end operations the organization revamped to achieve just that.

1. Made price estimates more accurate
 

Knodel says Baylor Scott & White embarked on its price transparency work about six years ago with the rise of high-deductible plans and high out-of-pocket costs.

A homegrown estimator tool proved inaccurate and inefficient, sometimes taking as long as seven minutes to manually generate an estimate, Knodel says. Moreover, "our ability to assess accuracy was very reactive and was just based on patient complaints. We wanted to do more," she says.

Now the revenue cycle department is using an automated system that generates estimates quickly and efficiently.

"Almost 70% of our estimates are produced automatically, without the need for human intervention," she says. "Those requiring manual review only take several minutes for a revenue cycle employee because much of the data—eligibility/benefits, pricing, and contracted rates—is aggregated within the tool."

The automated system also allows the revenue cycle department to continually assess accuracy.

"We're constantly refining the solution," she says. "Now we have the sophistication to proactively evaluate what we estimated in comparison to the patient's final bill."

Knodel says revenue cycle staff can compare the estimate against how a claim actually adjudicated post-service and use data to understand any discrepancy between the two. For instance, she says, was the patient service that was performed different than what was scheduled and estimated? Was a contracted rate or price loaded wrong into the system?

Most recently the department started to roll out the estimator tool to its physician practices and clinic locations, she says.

"In a one-year period of time, we saw a 31% increase in clinic point-of-service collections for the clinics where the tool was implemented, equating to a $7 million improvement in point-of-service collections," says Knodel. "We continue to work on rolling this out to all physician practices across the system."

2. Implemented automated calls pre- and post-service
 

Knodel says she tells her team to provide pre-service estimates for every patient during pre-service calls. But that's only possible if you can get in touch with patients.

That's why six years ago, the preregistration department coupled its price estimation tool with automated dialing technology to reach more patients in advance. Instead of manually having to dial 60–100 patients to reach at least 25, the technology pushes automated phone calls to scheduled hospital patients. Now, the department is proactively contacting scheduled patients 14 days prior to their service, she says.

When the patient answers, an automated message says the call is to preregister the person for an upcoming appointment to speed up the check-in process on the day of service. The patient is prompted to press "1" to speak to a representative. The automated message also mentions that patients can go online to preregister. If the patient chooses to speak to a representative, he or she is immediately connected to someone on the preregistration team. Patients are provided with an estimate of out-of-pocket costs, and are also asked for a payment, although making one prior to service isn't required.

Knodel says the automated dialing technology has resulted in a 100% increase in point-of-service collections within the department, as well as a 60% increase in the number of patients registered on a weekly basis, without increasing staffing at the organization.

Now, Baylor Scott & White is using the dialing technology for back-end functions as well. Automated account balance reminder calls to patients boosted monthly internal patient collections by $1 million, without adding staff. It also saw a $1.5 million annual decrease in its collection agency fees, Knodel says.

3. Offered flexible, pre-service payment arrangements
 

Baylor Scott & White has long offered interest-free payment plans that stretch up to 72 months. Patients are also offered interest-free payment plans prior to and at the time of service with the estimates, says Knodel.

Setting up a payment arrangement for an estimate sometimes requires adjusting the terms of the plan after the claim is adjudicated and the final balance is known, but patients appreciate having the option upfront, she says. If a patient overpays, they're issued a refund as quickly as possible.

"We want to make sure that we maintain trust with our patients," Knodel says.

Knodel says patients deeply value these flexible, interest-free financing plans, which Baylor Scott & White provides through an external service partner. Thirty-seven percent of patients say they would have delayed care if they hadn't been offered the interest-free payment option, according to annual research conducted by Porter Research, including a specific breakdown for Baylor Scott & White Health, Knodel says.

In addition, the patient financing program drives loyalty among Baylor Scott & White's patients, with 91% saying they will return because of it, and 87% saying they would refer the healthcare system to family and friends because they offer such a program, says Knodel.

"We believe designing a simple, consistent experience can improve loyalty because patients know what to expect when they go to one of our locations," she says.

4. Created self-service options
 

In addition to calling patients with estimates prior to service, Baylor Scott & White has a patient-facing, online price estimation tool patients can access that provides a personalized estimate based on a patient's demographics, insurance information, and the type of service they want.

An online chat capability allows patients to talk directly with a price estimate team member, or patients can email questions and expect a response within 24 hours.

Baylor Scott & White is also working to deliver estimates directly through its existing MyBSWHealth mobile application, Knodel says.