Sharp HealthCare reaped immediate returns after simplifying its billing statements.

When the economy stumbled in 2009, Sharp HealthCare, a seven-hospital system in the San Diego area, saw its self-pay collections fall by $3.4 million in a single year. Gerilynn Sevenikar, vice president of hospital revenue cycle, pulled together staff members representing a broad range of perspectives—access services, billing, information services, private pay contracts, and others—to brainstorm solutions.

The group ended up overhauling the health system’s four billing statements using Patient-Friendly Billing® principles, in addition to adopting other patient engagement tactics

The result: Self-pay collections rebounded to their historically normal levels in 2010, even though the economy had not recovered. In addition, phone calls from confused patients fell sharply.

“This has definitely been the right thing for us from a patient-relations perspective and from a cash-flow perspective,” Sevenikar says.


Gathering Feedback

Before redesigning the patient bills, Sevenikar, a Lean Six Sigma green belt, organized an information-gathering event to identify problems with the existing documents. The front and back of the bill were taped to poster board, and about 30 front-line staff pointed out problems that patients had with the statements.

“I had our customer service unit and self-pay collections staff conduct a gallery walk around the room, documenting the issues that generated the most phone calls from patients who received our statements,” she says. “They represent the voice of our customers. They hear directly what our customers are saying, what aggravates them, what works, what never makes sense, and they know what questions they are answering over and over again.”

Sevenikar then accessed HFMA’s Patient Friendly Billing materials, which provide guidance on issues from type size and layout for billing statements to wording. She also reviewed the tapes from patient focus groups that had been conducted a few years earlier and found that patient comments mirrored the feedback from her customer service staff.

Drafting a New Bill

Sevenikar then created a draft billing statement that reflected Patient Friendly Billing principles and the issues that Sharp’s staff and patients had identified.

Next, Sevenikar and the group took the following steps.

A second gallery walk to review the draft. Staff from the customer service unit and private pay collections reviewed the revised draft bill in comparison to the existing bills and made another round of comments.

Input from marketing. After that feedback was incorporated into the draft, Sevenikar asked Sharp’s marketing team for input and was advised to make the balance-due information more prominent. Marketing staff members also suggested a few wording changes that Sevenikar found helpful. “They are able to look at it as an audience that has nothing to do with collections,” she says. “So they are able to put themselves into the shoes of a patient probably a little easier than my own team.”

Implementation. The new bill was presented to Sharp’s CFO for approval, translated into Spanish, and implemented—just seven months after the health system decided to redesign its bills.

Simplifying and Streamlining

Sharp’s previous bill had a long narrative that went away with the redesign. “Simplify billing statements, keep like information together, make it easy for a patient to see what the bill is for, and keep the narrative to a minimum,” Sevenikar says.

The new bill includes a summary of patient charges, which had not been included in the old bills. It also stacks the billed charges and adjustments in a single column so patients can see how the balance due has been calculated.

Exhibit 2 Sharp Healthcare New Billing Statement

Be patient friendly. Sevenikar’s top priority in redesigning Sharp’s patient bill was to change the tone of the document. “Most important, I wanted to use words that assume the best of our patients instead of assuming that patients are trying to avoid paying their bills,” she says.

For example, the new bills include a sentence that apologizes if the patient’s payment and Sharp’s most recent bill crossed in the mail.

Do away with misguided statements. Before the overhaul, the first statement that Sharp’s patients received said, “Thank you for choosing Sharp HealthCare to serve your healthcare needs.” However well-intentioned, it irked patients.

“Many patients were upset at the inference that they ‘chose’ us when they were brought by ambulance or their physician actually made the decision to come to Sharp and ‘choice’ was never a consideration,” Sevenikar says. “When you get a hospital bill and you don’t have insurance, this statement is a little aggravating.”

Another annoyance: The phrase “Balance due now.” “Patients thought ‘I have 20 days to pay, don’t I? How dare you tell me it’s due now?’” Sevenikar says.

Achieving Bottom-Line Results

In addition to increasing self-pay collections, the redesign accomplished Sevenikar’s goal of decreasing phone calls from patients who had questions about their bills. The call volume to Sharp’s customer service unit immediately dropped when the new bills were introduced. 

Equally important, the new bills encourage patients to call if they need help. “They do have a debt, and it’s not going to go away unless they communicate with us,” Sevenikar says. “We want to help patients feel comfortable about making a phone call if they need help resolving the balance.”

Engaging Patients in Other Ways

While Sevenikar is pleased with the billing statement overhaul, she says Sharp also adopted several other tactics to help the system recover from the rocky patch in 2009.

Talking to patients while they are in the hospital. Financial navigators meet with hospitalized patients who have high out-of-pocket responsibilities, or their families, to discuss the funding options that might be available, including financial assistance and charity care.

Encouraging compassionate conversations. Sharp provided training to customer service and private-pay collection staff to help them talk to patients about financial issues in a considerate and kind-hearted way. “If we can enter into a compassionate and caring dialogue with patients, then they may be more likely to feel like they have a relationship with Sharp and some responsibility to pay their debts,” Sevenikar says. “In some cases, patients end up contributing something towards their hospital bills, instead of just turning and walking away.”

Seeking out other sources of financial assistance. Sharp contracted with an agency to help patients apply for Medi-Cal and other public funding programs in California. In addition, the health system contracted with a company that offers patients low-interest loans so they can pay off their medical debts over time.

For Sharp, it was not just a revision of the statements that contributed to the increase in cash flow, Sevenikar says: “It was a comprehensive effort to improve our patient engagement in a lot of different ways.”


View a comparison of Sharp’s previous statement and its newly designed billing statement by clicking on the following links: 

Sharp HealthCare's Old Statement

Sharp HealthCare's New Statement

Lola Butcher is a freelance writer and editor based in Missouri.

Quoted in this article:

Gerilynn Sevenikar is vice president of hospital revenue cycle, Sharp HealthCare, San Diego, and a member of HFMA’s San Diego-Imperial Chapter.


Publication Date: Wednesday, May 15, 2013