The billing process can begin only after medical services are delivered, so when service delivery is delayed, the revenue cycle is stalled before it gets started.
That is why Johns Hopkins Medicine overhauled its system of reminding patients about their appointments and showing them how to get to the right place at the right time. The results of its initiative: More than $500,000 in increased annual revenue in just two clinics. (See exhibit 1 and exhibit 2.)
Getting Patients to Their Appointments
Like most health systems, John Hopkins Medicine in Baltimore used to rely on staff members at each of its clinics to call patients with appointment reminders and to mail letters telling the patients how to prepare for their visits.
When John C. Lowery, senior director for access services, and his staff analyzed the results of those efforts, they did not like what they found.
- Poor show rates, or the percentage of patients who arrived at their scheduled appointments on time
- Late arrivals because patients had trouble locating the right office or finding a parking spot
- Cancellations because patients arrived unprepared for the visit
“If the appointment is for an MRI, that’s a very expensive procedure,” says Barbara McLaughlin, an executive at Smart Source Solutions. “If patients come after they just ate breakfast, you have to turn them away, and you’ve got techs and equipment standing there idle. It’s a huge issue.”
Lowery found that Johns Hopkins’ show rate ranged from 75.3 percent in radiology to 89 percent in neurology, and he believed the low rate was linked to poor patient communications.
“All the paper documentation—reminders and other information—was being sent to patients manually in a very decentralized, uncoordinated manner,” he says. Letters to patients included no standard content or consistent branding, and the timing of mailings in relation to patient visits varied widely. Similarly, reminder calls did not have a consistent message and did not systematically follow up on cancellations.
McLaughlin says this is a problem throughout the healthcare industry where an ad hoc approach to patient communications is typical. “We frequently see one of two things: Staff members either send no information and just rely on either a phone call or whatever the physician told the patient, or they send a 9 x 12 envelope stuffed with tons of information, most of which is not relevant to that patient,” she says.
Patients preparing for an appointment want information that is relevant and useful. “They don’t want to know about the whole organization and how wonderful it is and all of that,” she says. “They just want to know what is expected of them.”
To address these problems, Lowery overhauled Johns Hopkins’ patient communications program, generating incremental improvement in the patient show rate—and a big impact on revenues.
In the otolaryngology clinic, for example, the show rate climbed from 85.8 percent to 88.4 percent. Over a year’s time, that translates into 1,148 visits—and additional revenue of more than $350,000.
Improving the Patient Communications Program
After analyzing the cost of its existing patient communications, Johns Hopkins decided to outsource the work to firms that make automated calls and send written communications to patients about their upcoming appointments.
The automated telephone reminders cost 15 cents per call, compared with an estimated 55 cents per call when staff members made the call (calculated based on 30 calls per hour for a staff member with average salary and benefits costing $16.64/hour.) Similarly, the cost of appointment reminder letters was reduced from 77 cents per letter when handled internally to 61 cents per letter when handled by a vendor.
The content of the mailings is now controlled and timed, according to the health system’s specifications. Each reminder mailings includes:
- Physician’s/provider’s name and clinical service
- Appointment and arrival time
- What to bring
- Contact information
- Web site address
- Driving directions and parking
- Public transportation
- Campus map and clinic location
As a result, the John Hopkin’s system is spending less money on patient communications while generating more revenue because more patients are showing up on time and prepared for their visits. Lowery credits the revamped communications program for increasing the number of patients who arrive with completed forms and in compliance with the pre-procedure requirements, such as fasting.