• Case Study: Clarifying the Business Side of Care

    Apr 28, 2011

    Everyone who works in a healthcare system knows how complicated it is. But Cleveland Clinic believes that patients do not need to be hassled by that fact.

    So says Lyman Sornberger, executive director of revenue cycle management services for the 11 Cleveland Clinic hospitals and the Physician Practice Plan of Cleveland Clinic Health System.

    "Our greatest success is we are making the healthcare experience transparent to the patient," he says. "No matter how complex a health system can be, we are trying to circumvent that-sometimes at a cost to Cleveland Clinic-so the patient doesn't feel challenged to figure it out."

    This case study appears in the Leadership special report, Creating Value for Patients for Business Success.

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    When it comes to improving patient financial services, Cleveland Clinic's CEO and CFO set the tone, he says. These leaders first ask, "What is the impact on the patient?" Only then do they ask, "What is the upfront and ongoing cost of the improvement?"

    That attitude does not reflect unlimited resources. Cost consciousness is as important to Cleveland Clinic as it is to any stand-alone hospital, says Sornberger. Rather, Cleveland Clinic has found that patient satisfaction, word-of-mouth advertising, and a growing patient population-despite a highly competitive marketplace-more than make up for investments in patient-friendly practices.

    Furthermore, managing a business office staff that is focused on improving patient satisfaction makes his job easier, says Sornberger. "It's much easier to say, 'I care about my patients,' than 'I care about the almighty dollar.' And at the end of the day, you will get the ROI that you need."

    Simplifying for the Patient

    Cleveland Clinic is on its way to eliminating one of patients' most ubiquitous complaints: multiple bills.

    "Nothing is worse than an inpatient receiving, on average, six bills from a highly fragmented health system," says Sornberger.

    Over the last four years, the system has consolidated billing from its 11 hospitals and 2,800 employed physicians so that inpatients receive a single bill. Some ancillary care services are still billed separately, but they will migrate into the one bill system this year.

    "It is a huge endeavor," he says. In addition to the technology challenges of consolidated bills, the initiative required operational changes.

    For example, the Clinic created a single database that includes the billing information for all elements of a patient's care. Thus, patients can call a single telephone number to discuss any issue on the bill-whether it is a physician charge or a hospital services charge-without being transferred to the entity that created that component of the bill.

    Another simplification: The Clinic has developed a single call center and patient navigation so that scheduling-and keeping-appointments is as easy as possible. "If you need an appointment, regardless of which specialist you need to see, we will handle that for you," says Sornberger.

    For example, if a patient is referred to the Heart and Vascular Institute, a navigator will identify the tests that need to be scheduled and coordinate physician appointments and diagnostic appointments on the patient's behalf. Appointments are scheduled according to the patient's preference-all on a single day or spread out over several days.

    "Once you arrive on site, we will navigate you as well," he says. Both a clinical navigator and financial representatives are engaged to assist the patient.

    Giving an Accurate Estimate

    Before a patient schedules an appointment, he or she should know what the out-of-pocket expense will be. Indeed, Sornberger says patients should be able to use out-of-pocket cost as a factor in choosing when and where services will be received.

    That is why Cleveland Clinic is working on a new type of bill estimator, which is expected to launch this year.

    "We are developing this internally because we believe there's nothing in the industry that meets our customer's needs," he says.

    Most out-of-pocket estimators are limited in their accuracy because they give estimates that do not reflect the status of the patient's annual deductible. The Clinic's system will incorporate real-time information about the deductible level.

    Further, the estimator will show the patient a range of choices within the Cleveland Clinic system and the out-of-pocket consequences associated with each choice.

    He believes patients also need to be able to compare Cleveland Clinic to other options. "Then you, as a consumer, can shop around and see if you can find a better rate," he says.

    Allowing a patient to know his or her financial responsibility upfront is key to Cleveland Clinic's goal of moving traditional back-end functions of the revenue cycle to the front. Instead of calling patients after the fact to seek payment, the Clinic is contacting patients before they arrive for their services.

    This approach allows the money talk to be less assertive and more patient friendly. "We can say, 'Let me talk to you as a financial counselor about your out-of-pocket responsibility and educate you about your options for payment plans, loans, and financial assistance' and not 'I want you to pay,'" he says. "It is a totally different discussion that is needed to support the Cleveland Clinic mission."

    Educating Patients

    To help patients understand medical bills and how to address financial concerns related to them, Cleveland Clinic's patient financial services department has developed a series of patient education programs.

    The two-hour sessions, scheduled at the Clinic's community hospitals and health centers throughout the year, cover a variety of topics, from "The Basics of Insurance and Billing" to "About to Retire: Preparing for Medicare." The idea for the educational sessions came from a series of feedback forums conducted in early 2008.

    The goals for the education initiative were to reduce incoming calls to Cleveland Clinic's customer service department and to increase patient satisfaction. Sornberger says it is working on both fronts.

    The sessions are promoted via community newspapers, flyers, and other traditional means-and by targeting individuals who might need the information. For example, if a patient scheduling a procedure mentions that he or she has lost employer-sponsored insurance, the patient financial services staff member will refer the patient to an upcoming "Lost Your Insurance?" session.

    Similarly, patients who are nearing retirement age receive a card inviting them to attend an educational session.

    "We all recognize that we have an aging population out there, and health care is confusing," says Sornberger. "From my perspective personally, we have an obligation to our patients to make it less so."