Financial challenges? 2017 survey says don’t overlook patient billing

Recently, the American College of Healthcare Executives released a survey of more than 1,000 hospital CEOs about their biggest concerns in 2017.

The number one issue proved to be the same as it has been since 2015’s survey: financial challenges. Unsurprisingly, rising operating costs, uncollected revenue for services rendered, and intense competition are at the heart of those concerns.

What is surprising, is how often the patient billing experience is overlooked today. It’s one of the most negatively viewed aspects of service from providers across the country. But, from revenue generation to customer retention, billing is an integral part of every organization’s finances. That makes improving the billing process one of the fastest and most direct solutions to address a range of financial challenges.

 

Reducing Operating Costs and Expenses

Increasing operational costs exert a huge burden on health systems. While much effort is directed toward coding and claims processing, healthcare organizations largely ignore efficiencies that can be gained in the patient billing process. By focusing on the needs of today’s consumer, health systems can dramatically decrease the cost to collect from patients. Take Sirono’s Patient Receivables Suite as an example.

The comprehensive communication platform of the Suite gathers all the financial information for a patient and all of their dependents, across departments, to provide one single view of the guarantor’s obligations. This leads to an overarching reduction to operating expenditures, including lower statement costs and contact center call volumes. With these efficiencies, staff is able to resolve many more issues every single day. With a high level of automation, a smaller contact center staff can do far more with much less.

 

Revenue Generation

The billing experience is at the absolute center of patient accounts receivable. When frustrated with the billing experience, only 33% of patients pay their bills in full. But when satisfied with the billing experience, 74% of patients satisfy their financial obligations.

That means an improved billing experience can increase payments by as much as 41%. Now that patient payments account for more than $330 billion in yearly revenue, the billing experience should be a top priority for financial management.  

Healthcare organizations that use Sirono have seen an average year-over-year increase of 35% in patient payments. With that level of revenue boost, organizations can fund other initiatives to drive financial improvements.

 

Patient Satisfaction

Patient satisfaction is also a top concern of healthcare executives, ranking at number five in 2017. No matter how much effort goes into the patient’s clinical care, a frustrating billing experience can spoil all the goodwill you worked so hard to earn. As the last touchpoint for patient satisfaction, billing is the perfect opportunity to secure all the benefits from happy patients.

People are 52% more likely to write about their negative experiences online, and each patient lost to poor service represents a loss of $200,000 in lifetime revenue. Improving the billing experience is key to fighting the financial losses from bad PR and customer attrition. But more importantly, a great billing experience better positions a health system to compete in their market and  creates lifelong customers. And, as we explore in this article, it can even increase your HCAHPS scores.

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How the Payment Process Impacts HCAHPS scores

Have you ever had a great clinical experience in a hospital or clinic, then have that feeling soured by a horrible billing process? Healthcare organizations go to every length to ensure you’re comfortable, informed, and attended to while you’re in their care. But, they fall short by ignoring customer service once you’ve left their facility.

The billing process is the final act of customer service, and it’s the last chance to make a positive impression. While it’s becoming known that a frustrating billing process slashes payment rates–to as low as 33%–it also cuts into the reimbursements that are tied to HCAHPS scores.

If you’re skeptical, put yourself in the patient’s shoes.

You’re receiving bills you don’t understand that are higher than expected. The entire process of reaching customer service representatives, creating payment plans, and making payments is extremely inconvenient and confusing. Then you receive an HCAHPS survey. So how would you answer the following two questions?

  1. We want to know your overall rating of your stay at [FACILITY NAME].
    • (0-10)
  2. Would you recommend this hospital to your friends and family?
    • <1> Definitely no, <2> Probably no, <3> Probably yes, or <4> Definitely yes?

Chances are, you’d give the lowest scores that you possibly could. Considering that 85% of patients believe the billing and payment experience is a critical part of healthcare, and in some states, billing complaints have risen more than 1,000%, it’s certain that some of your patients have sabotaged your HCAHPS scores over billing resentments. More importantly, they’ll continue to do so–unless you make a change.  

The fastest way to improve customer service in billing–and your overall HCAHPS scores–is to focus on the following:

Communication: From pre-service estimates and adjustment alerts all the way through questions about final charges, your team needs to thoroughly explain the financial aspects of the patient’s care at every step. It’s also vital to go beyond the standard 9-5, Monday-Friday helpline hours for patients who work during those times and need (or simply prefer) text and email options.

Clarity: Even the most reasonable charges will be met with suspicion and frustration if they aren’t clearly explained. Unfortunately, the practice of splitting one service into multiple bills perplexes patients and sometimes even billing agents. Crystal clear, consolidated charges for past and current services is a prerequisite for satisfactory billing.

Self-Service: Waiting an hour for someone to do something that only takes you ten minutes is universally frustrating, and that applies to both finding information and making payments. When healthcare organizations provide billing information online and enable patients to create their own payment plans, they make the payment process work on the patient’s terms.

While it’s true that the billing process is only one factor of many for HCAHPS survey takers, it’s almost entirely overlooked by healthcare organizations. That means it’s ready to be improved right now.

At Sirono, we’ve created a platform that builds communication, clarity, and self-service into every step of the payment process. Contact us today and increase your HCAHPS scores through better billing and payment experiences.

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It’s True, Customer Service Is Critical in Healthcare

 

“It is so much easier to be nice, to be respectful, to put yourself in your customers’ shoes and try to understand how you might help them before they ask for help, than it is to try to mend a broken customer relationship.”

Mark Cuban, Entrepreneur, Shark Tank regular, and Owner of the Dallas Mavericks

 

Even before the preeminence of the internet,  it would have been difficult to find a successful business person who would disagree with that sentiment. With the ubiquity of online reviews and the amount of trust that people place in posts on Google, Yelp, WebMD and many other sites, customer service is more important than ever.

As Jeff Bezos, founder of Amazon.com, poignantly stated, “If you make customers unhappy in the physical world, they might each tell six friends. If you make customers unhappy on the internet, they can each tell 6,000.” Unfortunately for business owners, people are 52% more likely to leave negative reviews online than positive reviews.   

Despite these observable trends in everyday life, very few hospitals or health systems prioritize customer service as restaurants, retailers or hotels do.  

But statistically, patients are just as likely to switch healthcare providers as hotels,  cell phone providers or banks due to poor customer service. As each patient represents $200,000 in lifetime income for the typical practice, undervaluing customer service is an extremely costly mistake.

The good news is that great customer service carries an equally impactful upside for providers. Starting with a pre-service estimate, all the way until final bill resolution, patients behave as consumers, and great customer service in the billing process dramatically increases rates of full patient payments.

When satisfied with the billing experience, 74% of patients fulfill their financial obligations. Compared to the average rate of nonpayment–two in three patients that do not pay their bills in full–customer service in the revenue cycle presents a tremendous financial opportunity.

How should providers approach customer service in their billing process?  There are three major qualities to consider and build upon.

  1. Accessibility: From financial information to payment tools and billing staff, easy access shows the patient that you understand their situation and have taken all the necessary steps to anticipate their needs.
  2. Transparency: In terms of past and current financial obligations, patients will feel much more comfortable paying bills that they can easily understand.
  3. Personal Preferences: Giving patients the choice of when and how–phone, text, email or live chat–they can seek assistance proves that you respect their time and understand the way they like to communicate. Allowing patients to create their own payment plans online shows that your organization seeks to empower them as a consumer.

Customer service is an ongoing challenge in healthcare for good reason. The provider only has so much control over the clinical and insurance-related aspects that impact the patient’s perception. But providers can own the financial process and ensure that it is guided by excellent customer service. At Sirono, we’ve created an innovative platform to make that possible for any hospital or health system. Reach out today for help in building a customer service experience that drives revenue.


[1] “Bad Customer Service Interactions More Likely to Be Shared Than Good Ones”, http://www.marketingcharts.com/online/bad-customer-service-interactions-more-likely-to-be-shared-than-goodones-28628

[2] http://pacificmedicalcenters.org/images/uploads/KCMS_Customer_Service_in_Healthcare.pdf

[3] https://www.accenture.com/t20160322T034105Z__w__/us-en/_acnmedia/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Strategy_7/Accenture-Strategy-Patient-Engagement-Consumer-Loyalty.pdf

[4] Prakash, Patient Satisfaction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047732/#ref6, (Journal of Cutaneous and Aesthetic Surgery, 2010), 151-155.

[5] Kelly Gooch, Study: Satisfied patients more likely to pay medical bills in full, https://www.beckershospitalreview.com/finance/study-satisfied-patients-more-likely-to-pay-medical-bills-in-full.html, (Becker’s Hospital Review, 2016).

[6] “Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full”, https://newsroom.transunion.com/patients-may-be-the-new-payers-but-two-in-three-do-not-pay-their-hospital-bills-in-full, (TransUnion, 2017).

The Three Most Important Lessons from Next Generation Patient Experience

From November 29-30 of 2017, the nation’s leading patient experience professionals met at NGPX (Next Generation Patient Experience) in San Diego, California, to discover the future of patient-centered healthcare in the United States.

We were active presenters and participants at the conference, and were thrilled to share our ideas and learn from other experts in the field. If you were unable to attend, or were there and would like to get a different perspective, here are the three most important themes from the conference that we discovered.

1. Because the patient experience crosses departments, interdisciplinary teams are essential to successful programs. 

One of the key themes across NGPX was creating patient experience initiatives that span departments. While the clinical experience is inarguably a foundational touchpoint in patient and family satisfaction, other interactions with hospitals and health systems can make or break the overall patient experience.

As speaker Stacy Calvaruso from Access Strategies noted, “Billing is also a critical touchpoint in the patient experience. Without a positive billing experience, patient satisfaction will be difficult or even impossible to achieve. Revenue cycle and financial teams have to have a seat at the patient experience table in order for initiatives to be both clinically and financially successful.”

Many teams are even broadening their patient experience initiatives beyond clinical and financial management teams. At Hackensack Meridian Health for example, Chief Experience Officer Nancy Corcoran-Davidoff has included their marketing department in an interdisciplinary team focused on improving the patient experience.

The key takeaway is that the patient experience is a hospital-wide endeavour, and including key stakeholders across departments creates the necessary buy-in to improve the patient experience at all touchpoints.

 

2. Look to other industries—especially retailto understand what patients see as the “ideal” patient experience.

Traditionally, patient experience professionals have looked to the hospitality space to provide insight into a better customer experience. However, as rising deductibles and copays have made patients become consumers of their healthcare, retail is now the most realistic and direct comparison for today’s patient expectations.

In that vein, Amazon was the name of the game at NGPX, with almost every presentation that touched on consumerism giving a nod to the online retail giant for “doing it right.” In a presentation by Brent Bowman from Kaiser Permanente, he shared that consumers are nearly split in who they would trust most to manage their health—40% of consumers report that they’d trust large retailers like Walmart or Target, compared to 39% who place their trust in traditional providers. In fact, a surprising 33% report that they would even trust internet-based companies like Google or Amazon to deliver their healthcare.¹

The key takeaway is that offering the same customer service that makes patients choose to shop at retailers like Amazon or Target will also motivate them to choose a hospital or health system for medical care.

 

3. Begin every ‘experience’ project with patient-centered design.

Many of the speakers at NGPX talked about how they are implementing patient experience initiatives at their health systems and hospitals. Across these presentations, one methodology stood out for designing successful patient experience programs: creating the entire experience with the patient as the focal point from start to finish. In many cases, the presenters had to wipe the slate clean of operations-based design and start from scratch.

From bedside manner to patient-facing technology, if the patient’s perspective shaped the initiative, and the impact on the patient was the main priority, programs were far more likely to succeed. Change can be difficult, so, as speaker James Grayson said, you can “break” a system or program down and rebuild it for today’s patients, but make sure you don’t shatter it.

The key takeaway is that patient experience initiatives must be designed with the patient’s perspectives, wants and needs as the primary drivers. Otherwise, expect the impact of programs to be marginal at best.

Interested in learning more about the most important patient experience trends from NGPX? Download our whitepaper and see the how you can shape the patient experience with a consumer focus.

 


1. https://www.strategyand.pwc.com/media/file/The-birth-of-the-healthcare-consumer.pdf

How Amazon.com Has Changed Your Patient’s Expectations

Patient satisfaction has become an important consideration in healthcare, and providers have responded with a number of clinical initiatives, some at considerable cost. Yet, according to many online reviews, and in light of rising non-payment rates across the industry, today’s patients still aren’t satisfied. So why aren’t these initiatives enough?

It’s because today’s patient is accustomed to digital consumerism. Giants like Amazon have raised the bar for customer service to lofty heights. Consumers can have whatever they want, whenever they want. They can check the status of their purchases with ease, and talk to customer service representatives through live chat, email, text or phone at their convenience.

Consumers also have the power to tell the world about their experience. And if it’s negative, they are 52% more likely to leave a critical online review [1], which could be read and believed by thousands.   

With rising deductibles and copayments, your patients are likely paying much more for your services than they are for their online purchases, yet the customer service they receive from healthcare providers is significantly inferior.

 

Price Transparency & Visibility

When ordering from Amazon, consumers can see exactly what they’re buying down to precise product specifications.

But with healthcare, patients often receive charges that are not only different from initial estimates, but are also split into multiple bills that arrive at different times. It may be months after service before a patient can even manually calculate their total financial responsibility.

 

Easy Resolutions

If an Amazon customer is confused about a product they received, they can visit Amazon at any time of day or night and find vendor resources, user reviews and comprehensive answers to product questionseven for very inexpensive items.

Patients often have to work very hardcalling multiple times, trying to connect with the right insurance representatives, or unsuccessfully searching bare-bones patient portalsto better understand thousands of dollars worth of charges.

 

Multiple Channels of Access & Self-Service Options

Shoppers on Amazon can access customer service representatives through email, phone, chat and other channels, and can also manage their entire accountfrom payments to addresses to returnsall on their own.

Patients on the other hand have few options beyond calling representatives during inconvenient working hours and mailing checks with physical bills. If a patient can’t pay their bill in full, they usually need to call the Contact Center to see if the hospital offers a payment plan.

 

Take Amazon’s Advantage and Give It to Your Patients

While providers have little control over patients’ out-of-pocket costs, they are able to offer their patients every customer service perk that Amazon provides.

Amazon and many other consumer powerhouses use customer service platforms to provide the price transparency, fast resolutions, and convenient account access options outlined above.

That’s why we created Sironoto offer the world’s best customer service platform to healthcare organizations. In fact, Sirono is built on the Salesforce framework, the same customer service platform that Amazon uses for its operations. Contact us to learn how you can have the best customer service tools, too.

 


[1] http://www.marketingcharts.com/online/bad-customer-service-interactions-more-likely-to-be-shared-than-good-ones-28628/

Why the Last Impression Is the First Priority for Revenue

Many hospitals and health systems are working hard to create a positive clinical experience for patients—offering proactive service estimates, improving bedside manner, and providing online patient resources to name just a few. We’ve even heard of patients being greeted by crews of coordinated staff members like they’re shopping at the Gap. In fact, it’s common practice for patients to be polled after a procedure about the warmth, friendliness and communication skills of the hospital staff.

The logic is, if patients are happy with the medical service, they’ll be likely to pay the medical bills. And then they’ll leave nice reviews online, too. Perhaps if patients paid their balances in full before they left the hospital that would be the predominant case. Patients would have a great first and last impression of their provider before moving on.

But in healthcare, the last touchpoint happens weeks after service when the patient receives their medical bills. And if those bills are much higher than expected, confusing to understand, and inconvenient to pay (which they so often are), the warm and fuzzy feeling from great care will be entirely forgotten.

The financial impact of a bad last impression from billing cannot be overstated. In terms of direct losses, 67% of patients fail to pay their bills in full when frustrated with the billing process.1 The revenue lost from collection fees and write-offs is a major driver of the industry-wide rise of bad debt.

And the indirect costs are potentially greater. People are 52% more likely to leave bad reviews than good reviews on sites like Vitals, Healthgrades, RateMD and Yelp.2 Those negative online reviews are powerful. Search engines like Google prioritize user-generated content, bringing patient complaints to the front of a hospital’s web presence. As 77% of patients consult online reviews before selecting a doctor3 and 70% of those patients trust online reviews4—billing complaints can drive thousands of patients to the competition.

Billing is the last touchpoint with patients. Allowing it to be a negative experience can do serious damage to the bottom line. But this doesn’t have to be bad news. A positive financial experience has the opposite effect—securing patient loyalty and influencing more patients to pay their bills in full and on time.

Every health system and hospital has the power to make last impressions that drive revenue.

If you’d like to see how, read our whitepaper, Five Strategies for Health Systems to Increase Patient Payments.


[1] 2015 Softwareadvice.com survey of 1,438 patients in the United States

[2] http://www.marketingcharts.com/online/bad-customer-service-interactions-more-likely-to-be-shared-than-good-ones-28628/

[3] 2015 Softwareadvice.com survey of 1,438 patients in the United States

[4] 2014 Connance Consumer Impact Study Shows Link Between Business Office, Patient Payment Behaviors and Patient Satisfaction, http://www.connance.com/wp-content/ uploads/6-Connance_Consumer_Impact_Study_on_12-1-14_FINAL.pdf

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Why Healthcare Needs to Adapt to Consumer Expectations

Consumers know that we live in a world that’s subject to change.

Take home repairs for example. Everyone who owns a home understands that one repair often and unfortunately leads to another. You get your furnace serviced for $75 and find that a $500 part needs to be replaced.

The hassles of bids, estimates and surprise expenses led me to put off roof repairs for too long. But when the roof started leaking at the slightest California drizzle, I found the highest rated roofer in my area online, got an estimate for repairs, and gave the go-ahead for the work.

About 30 minutes into the job, I got a call from the professional roofer—the wood beneath the shingles was ruined. It would add $1,200 to the repairs. When I asked why that cost wasn’t included in the initial estimate, I was politely reminded that I had been warned about the possibility of additional costs.

And when I asked why the price was so high, what I got was modern, high-quality customer service: on-the-spot pictures of the rotten decking, an email with the price breakdown, a follow-up phone call to if I had any billing questions, and pictures of progress as the repairs went on. Actual pictures! In the end, I was completely comfortable paying a higher fee because I understood the real value of the service. Best of all, I was kept informed throughout the whole episode as I bounced from airport to rental car.

So, if a local roofer with a handful of employees can offer omni-channel customer service and high-level billing support, why can’t a multimillion-dollar hospital with teams of representatives do the same?

That’s exactly what patients ask themselves as they shake their heads in frustration. They don’t care about the complexity of medical claims. In fact, 61% of patients find themselves surprised by out-of-pocket expenses in large part because they were never told that pre-service estimates aren’t 100% accurate or didn’t get an estimate in the first place.

In contrast to the customer billing support I was offered, consider if I had only received a roofing bill in the mail that was $1,200 higher than the original estimate 90 days after they did the job. I would have assumed that I was being ripped off, disputed the charges, and most likely left negative reviews online so others could avoid a similar experience.

It’s no different when a patient receives an unanticipated escalated medical bill—which is so often the case. They become suspicious of the additional charges, question their own financial liability, and delay payment or refuse to pay altogether. Even if the patient is happy with their medical care and would willingly accept additional fees, they may simply assume that their insurer or provider has made an error.

Proactive outreach to explain balance changes does more than prove to the patient that they are valued and respected—it clarifies the quality of the care received, expedites payment, and inspires customer loyalty. As 57% of patients say they received medical bills that were confusing, billing simplicity is a worthwhile goal for every hospital. Utilizing the patient’s preferred methods of communication makes the process easier and far more patient-centered. As with every other industry, consumers want to interact with businesses the way they prefer! Text, email, phone, etc.

From the ease of online shopping to service-oriented local businesses, patients have far higher expectations for customer service than the average hospital gives. As patient payments become more and more critical to the revenue cycle, smart health systems will adapt and prosper. Those who don’t—won’t.


TransUnion Healthcare Survey Finds Cost Transparency is a Top Priority for Patients, http://www.transunioninsights.com/healthcarecostsurvey.

2014 Harris Poll survey of 2,016 American adults, conducted on behalf of NerdWallet Health, https://www.nerdwallet.com/blog/health/managing-medical-bills/medical-bills-debt-crisis

Bad Debt Doesn’t Have to Get Worse for Health Systems

If providers are able to adapt to a different collections model

Even with current “best practices,” health systems collect less than 35% of patient financial liabilities. Trends in the healthcare industry have shifted greater financial liability onto the patient. The ACA and rising prevalence of high-deductible plans have increased patient copayments by 34%. As patients are unlikely to pay medical bills above 5% of their annual income, health systems will see patient bad debt rise and revenue shrinks—unless they recalibrate their strategies for collections.

The current approach is the heart of the problem; despite the fact that patient transactions have become increasingly critical to revenue, health system collection processes continue to be optimized for handfuls of large insurers—not thousands of individual people. With the right methodologies, smart health systems can do better than survive in the current healthcare landscape—they can thrive.

Look to consumer-driven industries for inspiration: setting expectations, clarifying billing, harnessing preferred communication methods, utilizing customer relationship technology, and prioritizing the overall financial experience for consumers.

Consumers appreciate transparency—they reward those who offer it with repeat business, positive online reviews, and direct referrals. But healthcare suffers from opacity. In no other industry does the customer willingly agree to pay for a service without knowing up front what the end costs will be. Yet, it is typical in healthcare, and patients ultimately make providers pay for the confusion.

For example, when providing a patient with an estimate, explaining how the estimate could change and offering proactive payment plans enhances customer relationships. This level of service does more than set financial expectations—it clarifies the patient/provider/insurer relationship and builds trust. Patients with a comprehensive understanding of their financial responsibilities are far more likely to pay their bills.

Redefining “best practices” for collections is the first step toward lower debt and higher revenue. Sirono is always working to increase patient payments for health systems. Sign up for our mailing list to receive alerts on future blog and social posts, white papers and webinars that will show a more profitable approach to collections. But if waiting isn’t an option, please contact us today.

 


Managed Healthcare Executive, ACA Drives 34% Increase in Copayments, Coinsurance, 2014, by Tracy Walker, found here: http://managedhealthcare executive.modernmedicine.com/managed-healthcare-executive/content/ tags/aca/aca-drives-34-rise-copayments-coinsurance?page=full

Becker’s Hospital CFO, Bad Debt on the Rise for Hospitals Nationally: 4 Takeaways, 2016, by Brooke Murphy, found here: http://www.beckershospitalreview.com/finance/bad-debt-on-the-rise-for-hospitals-nationally-4-takeaways.html

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