Case Study

From Adjustment to Overhaul

“Many of my new staff members have very little work experience and there’s absolutely no healthcare exposure for probably about 95% of them when they begin. Because of that, we have to look for ways to ‘error-proof’ the system.”

Several years ago, financial leaders at Unity Health – White County Medical Center decided it was time for a revenue cycle adjustment. At the time, the hospital was beginning to feel the impact of patient access errors and, with high deductible health plans kicking in, each dollar was becoming more difficult to collect. The time had come for the hospital to examine their processes and tweak their revenue cycle operations to effectively respond to the changes in the industry.

“As we dug deeper, we realized that we needed to do much more to improve our overall revenue cycle process and to prepare for the move toward consumer-centered payment models,” said Kevin Burton, director of patient financial services at the Searcy, Ark.-based hospital.

Upon further inspection, the organization’s need for a revenue cycle adjustment became a need for an overhaul. Hoping for an easy fix, they instead revealed several areas that required attention, such as:

Poor Registration Workflow

“Our registration quality was extremely low. Part of the problem was due to the fact that our electronic medical record’s eligibility verification product just was not very robust,” stated Burton.

While leadership was aware that registration quality and eligibility verification were not up to par, they did not comprehend the magnitude of their problems until they looked at the numbers. With the electronic eligibility rate and registration accuracy (percentage of error-free work) of a typical practice generally hovering at about 75 percent and 98 percent, respectively, prior to implementing an Access Management solution, White County Medical Center’s same figures were at a dismal 47 and 39 percent.

Lacking a robust eligibility solution, the organization’s registration workflow – including the quality and accuracy of registration – clearly suffered. With an electronic eligibility rate below 50%, registrars were obviously spending significant time hunting benefits down online or failing to check eligibility all together.

As Burton noted, “Many of my new staff members have very little work experience and there’s absolutely no healthcare exposure for probably about 95% of them when they begin. Because of that, we have to look for ways to ‘error-proof’ the system.”

Without an Access Management solution, productivity problems were costing the organization 2.6 hours per day, which equated to 0.325 full-time equivalent (FTE) expended on correcting errors.

Elevated Denial Rate

Without access to eligibility verification tools, claim denial rates at Unity Health – White County Medical Center were elevated. In fact, as the organization began analyzing their processes, they discovered their technical denial rate was eight percent, versus one percent – or lower – for a leading practice. While this may not sound like a dramatic difference, it equated to a noteworthy $2.7 million per month at risk for the hospital. With this knowledge, Unity Health – White County Medical Center quickly identified a need to alter their practices in order to establish denial prevention strategies on the front-end of the revenue cycle, rather than waiting to address potential issues on the back-end when it is often too late.

“We’re seeing a lot of high deductible plans under the Affordable Care Act. So, every dollar is becoming more and more difficult to collect for us. We’ve realized, however, just how important point-of-service collection is. When you have patients in front of you, it’s so much easier to collect from them,”

Low Point-of-Service Collections

As the healthcare landscape shifted and patients began taking on more financial responsibility for their own healthcare, Unity Health – White County Medical Center knew it would be important for them to maximize preservice collections.

“We’re seeing a lot of high deductible plans under the Affordable Care Act. So, every dollar is becoming more and more difficult to collect for us. We’ve realized, however, just how important point-of-service collection is. When you have patients in front of you, it’s so much easier to collect from them,” Burton said.

As Unity Health – White County Medical Center wrapped up their revenue cycle inspection, their point-of service collections stood at a mere 0.19 percent – the equivalent of only $22,000 per month.

Holistic Help

Given the challenges the hospital was facing, leaders quickly realized the need to implement a solution that would enable them to tackle their most pressing patient access issues and proactively work with patients under emerging consumer-centric health plans. While their revenue cycle obstacles were certainly complex, when it came to evaluating Access Management vendors, the hospital had an easy choice.

Compared to the hospital’s other leading option – an equally well-known Access Management solution – The SSI Group (SSI) offered a level of trust that was not found elsewhere. Over time, it became evident that Unity Health – White County Medical Center viewed SSI as a long-term partner committed to their revenue cycle success. Not to mention, SSI’s Access Management presented an understated, valid and comprehensive return on investment that was difficult for the hospital to ignore. When coupled with the solution’s focus on eliminating errors at the front-end of the revenue cycle, which were a major source of revenue leakage, leaders at Unity Health – White County Medical Center chose SSI to integrate with their existing information system and provide what was needed to succeed under changing payment paradigms.

Immediate Value

In an effort to provide immediate value to the hospital, SSI followed a phased approach to implementation. The first module implemented – SSI eligibility – was fully installed within three months, with additional functionality following soon thereafter. By focusing first on eligibility, the hospital was able to hone in on their registration processes to enhance registration accuracy by ensuring registrars correctly verified patient benefits on the front-end of the revenue cycle. The implementation phase also presented the perfect opportunity to map out the hospital’s workflow and develop a plan of action to address costly errors. Both prior to, and after, the system going live, SSI provided on-site training to end-users and continues to do so on an as-needed basis.

“Just knowing what amount to ask for and requesting a payment upfront has made a huge impact”

From Problem to Partner

Unity Health – White County Medical Center’s revenue cycle was long overdue for an overhaul and an overhaul is exactly what it received. With SSI’s Access Management, the organization has been able to streamline registration workflow, resulting in improved registration quality. Initially drawn to SSI’s focus on error prevention, the hospital has indeed been pleased with the solution’s ability to help identify the root cause of errors and direct staff behavior, or stop a registrar in their tracks, when necessary. Front-end staff at the hospital now utilize “intelligent guidance,” or customized rules based on the organization’s business rules, that direct them to take the proper actions throughout the registration and collections process.

“The system will warn or even make suggestions to registration staff as to what the right data is to enter. This intelligent guidance allows registration staff to operate on an even level. Every one of them has the same knowledge, whether it is in their head or provided to them on the screen,” Burton points out.

SSI Eligibility helps ensure that patients qualify for services under their health plans. Since the tool easily accesses data that is housed in the hospital’s information system, registration personnel can confidently identify patients and verify eligibility at the point of service. While the hospital was once failing to get patient coverage right – or failing to check coverage all together – they are now able to use SSI the SSI access management solution to ensure proper patient coverage. As a result, the organization has observed a downstream reduction in payer denials and has gained the ability to have meaningful conversations with patients about their financial responsibility. With SSI Estimation tool in place, patient access professionals can provide an estimate of the cost of each service and establish the expectation that patients need to make a payment before they actually receive care.

Since Unity Health – White County Medical Center began their patient financial clearance initiative, the hospital has observed an astounding 168 percent increase in point-of-service collections. In fact, the organization’s patient access processes have improved so dramatically since implementing SSI Access Management that their point-of-service collections continue to go up; from 2015 to 2016 (several years post implementation), point-of-service collections increased by 40 percent. Bad debt has dropped from $2 million to $870,000 in three years and was down to $745,000 for the first half of 2016.

Statistics aside, SSI Access Management is helping registration staff at Unity Health – White County Medical Center work more proactively with patients. Over time, SSI has become a trusted partner for the hospital, and the hospital has become a trusted partner for its patients… even in uncertain times.

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