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How Emory Healthcare Achieved Patient Satisfaction and Increased Collections

Patient Estimation and Upfront Communication

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• Emory Healthcare Overview Emory Clinic faculty practice 5 acute care hospitals

Tackling self-pay Identifying the target Upfront communication and collection strategy

Patient Estimation Using Patient Responsibility Pricer (PRP)

Process and people Success story

Today’s discussion

Emory University

Atlanta, Georgia

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Emory Clinic• Bills for EC Physician Encounters across

the enterprise• 1,964 clinical provider• 2,814 non-physician employees• 2.7M patient care visits

Emory University Hospital• Bills for all Emory Healthcare Radiology

Services• 579-bed adult, tertiary care facility • Staffed by 1,221 Emory SOM Faculty• 25,300 admissions • 157,852 outpatient services

Emory University Orthopaedics & Spine Hospital

• Extension of and bills under EUH’s acute care services

• 120-bed adult, Orthopaedics and Spine specialty hospital

Emory University Hospital Midtown• Bills for all Emory Healthcare Infusion

Services• 511-bed adult, tertiary care facility • Staffed by 1,126 Emory SOM Faculty and

433 community physicians• 21,000 admissions • 148,000 outpatient services

Emory Saint Joseph’s Hospital• Joint operating company• 410-bed acute care facility • Staffed by 620 private physicians• 13,148 admissions• 186,471 outpatient services

Emory John’s Creek Hospital• Joint operating company • Founded in 2007• Acquired in 2011 by Emory• 110-bed acute care facility • 10,000 admissions • 50,000 outpatient services

BILLING ENTITY OVERVIEW

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Self-pay A/R analysis Health Insurance Exchanges (HIX) – misunderstanding

about what “covered” means in a High Deductible World

Employers offering HDHP – Healthcare financial responsibility shifted towards workers or pushing them onto the HIX

Greater patient out of pocket expense► Copayments ► Deductibles► Coinsurance

Payments owed for services already rendered Disconnect between provider and patient

► Need for improved strategies to address

Shift in healthcare

Impact onself-pay account

receivables

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Economics of self-payIncreasing patient responsibility

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Emory’s journey with Patient Responsibility Pricer

Beginning of 2007, self-pay A/R was increasing drastically

Increased $3 million in 6 months (total >$20 million)

75% of self-pay accounts are after insurance (still true today)

Anti-self-pay reconciliation culture (academic medical center)

No offensive tools

Experian Healthcare Contract Management already in use at Emory

Patient demands: Benefits education Reduced financial surprises Short turn-around time Consistency

Business demands: Identify after-insurance responsibility Increased upfront collections Short turn-around time Improved decision making and credit risk

identification

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Patient Responsibility PricerHospital + Physician

The patient-friendly estimate mirrors an EOB and includes detailed descriptions of the line items, including the allowed amounts, co-pay, deductible, and co-insurance amounts which determines the patient’s portion

The Patient Responsibility Pricer estimate generator uses Emory’s contract definitions and the patient’s benefits to adjudicate professional and facility claims to provide us with the patient’s total responsibility

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CENTRALIZED ESTIMATES:PRP ESTIMATE EXAMPLE- PAGE 2

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Page 2 provides a brief explanation of benefits and the patient portion

The signature line includes an explanation of “This is only an Estimate”

Payments made at the time of estimate are reflected

Page 2

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Patient Responsibility Pricer end user accountability

Patient Responsibility Pricer counselors are audited monthly on collections (40% of score), workflow/accuracy (30% of score), and maintaining credit balances (30% of score)

This process ensures we keep the counselors core responsibilities monitored and provides for timely coaching opportunities as well as process improvements.

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Patient estimation process

Emory Clinic Patient Responsibility Pricer collections year-over-year• FY12 average collections per counselor per month= $23,127

• FY13 average collections per counselor per month= $35,190

• FY14 average collections per counselor per month= $45,637

• Credit balances average $35,000 per PRP counselor

• Credit balance goals range from $37K to $27K

• Average refund is <$100

Key factors in process• Upfront communication and benefits education sets payment expectation and empowers patients to make

decisions based on their financial responsibility

• Allows Emory Clinic to analyze collection risks before service is rendered

• Increased transparency

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Key performance indicators

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FY14 Emory Clinic cash collections through the Pre-Service Estimate Process

$2.9M*

Current Total Emory Clinic Self-Pay AR dollars that are balances after insurance, the target of our PRP process 69%

FY14 Emory Clinic Self-Pay AR resulting from facility based services

49%

The FY14 Emory Clinic average bad debt adjustment as a percent of charges 1.8%

FY14 number of PRP Estimates provided to patients 12,872

Looking forward: 2015

• Navigator services to identify and enroll HIX patients

– Only 28 patients in 2014 enrolled in an in-network plan through this effort

– Better defined processes for 2015 enrollment will increase enrollment in participating plans and increases the HDHP patients needing estimates.

*$10.9M in TOS Collections Overall, 27% of department’s collections come from PRP

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• One healthcare estimate• Consistent communication • Ability to plan sooner• Understanding facility vs. physician

• Greater ability to collect across the system with increasing shift to patient responsibility

• Ideal patient and family experience• Reduced calls to customer service• Pricing transparency

Patient Responsibility Pricer: Hospital project

Patient demands

Business demands

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Centralized estimates: Front end process flow

Web form

Estimate hotline

Email inquiry

EPP Centralized Office

(2 business day turnaround)

Telephone follow up to review estimate with

option to send by mail

Email follow up to provide estimate

Patient Collection & Scheduling

Request Create Communicate

Complete

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Benefits of PRP Recognized by The Emory Clinic since 2007

• Intentional process of identifying, discussing, and mitigating collection risk

• Millions of dollars collected prior to services being rendered• Decrease in self-pay after insurance AR

• Decrease in statement expenses

• Decrease outbound call volume

• Tens of thousands of patients educated on out of pocket responsibility• Empowered patients

• Improved Patient Satisfaction

• Decrease in customer service call volume

• Assist in shifting academic medical center mindset about self-pay environment and risk• Meet customer expectations for communicating price upfront

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• Find an interested physician champion with an involved administrator to gain buy-in

– Look to compensation model

• Assign staff members a realistic but stretch collection goal

– Tracks success of your efforts and makes the process their priority

• Pilot as a shift in FTEs• Review existing processes to inserted process

– Pre-Cert Process (EC)• Clear escalation and communication between collectors

and decision makers– Reschedule non-paying patients

Patient Responsibility Pricer Best Practices

People

Process