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To decrease inappropriate emergency department (ED) use, Midland Memorial Hospital, serving Midland County, Texas, introduced a telephone triage system in 2009. The free service allows county residents access to medical advice from a registered nurse (RN) about whether a medical situation justifies an ED visit. Patients who arrive at the ED and do not need emergency care—often referred to as non-emergent patients—are given the option of seeking treatment in a less costly setting, such as the nearby urgent care center, or paying $150 before they are treated in the ED. By promoting suitable alternatives to ED use, Midland Memorial Hospital is successfully redirecting non-emergent patients to more appropriate care options and dramatically improving ED throughput. A bonus: The hospital’s bad debt fell by more than $3 million in the first year as a result of the initiative. Meanwhile, patients who need emergency treatment are being seen much more quickly, and those who do not are saving money. “We don’t collect a lot of those $150 copays or deposits for care in the ED,” says Midland Memorial CFO Stephen Bowerman. “People would prefer to be treated at the urgent care center at half the cost.”
Midland Memorial is one of many hospitals that are charging upfront fees to reduce ED crowding. Indeed, HFMA’s Richard L. Gundling, FHFMA, CMA, vice president of healthcare financial practices, says at least half of all hospitals are now charging up-front fees for non-emergent care and collecting deductibles and copayments at the time of service. Of the more than 6 million ED visits to HCA hospitals in 2011, about 314,000 were screened by a clinician and determined not to have an emergent condition. Advised of their options, about 80,000 chose to seek an alternative setting while about 233,000 remained in the ED for treatment and paid an up-front fee—typically between $100 and $150—to do so, says Ed Fishbough, a director for HCA. “It has been a successful part of helping to reduce crowding in emergency departments and to encourage appropriate use of scarce resources,” Fishbough says. “This helps ensure that the sickest patients get treated quickly and that those who do not have an emergency have access to more efficient, less costly care settings.”For HCA, up-front fees for non-emergent patients visiting the ED started in a Houston hospital in 2004. Although the practice has spread to other HCA facilities, fewer than half of its hospitals currently charge upfront fees. Of those that do, each hospital sets the fee. Pregnant women, children under age 5, and patients who are 65 and older are excluded from HCA’s up-front-fee policy. In addition, clinicians can decide to exclude non-emergent patients from the policy on a case-by-case basis. Typically, two caregivers—for example, a triage nurse and a physician—make a determination about whether to waive the upfront fee in a specific situation.
Up-front fees may have a potential downside, warn some experts: Uninsured patients who truly need emergency care may fear going to the ED because they worry that they will be asked to pay on arrival.Midland Memorial is avoiding that repercussion with its telephone triage system, which directs patients to the best place to seek care. The telephone nurse triage system allows individuals to discuss their symptoms with a registered nurse (RN), who advises them on the proper setting for treatment. The nurses use a proprietary software program, developed by a vendor. It prompts them to ask callers a series of questions about their symptoms and uses algorithms to help the nurses make one of five recommendations:
The phone line, staffed by RNs hired by Midland Memorial, operates around-the-clock 365 days a year. Typically, a single RN staffs the triage line. However, in the three years since it was implemented, Memorial Midland has identified certain time periods in which call volume is heavy, and a second nurse is added during those periods. Maintaining the telephone triage system costs about $500,000 a year, Bowerman says. That includes the salary and other staff costs as well as the software (i.e., the computerized protocols) that helps the nurses evaluate patients’ symptoms. In January 2012, Medical Center Hospital in Odessa, Texas, began partnering with Midland Memorial on the nurse triage line. The two hospitals now split the costs and are working to grow the triage line into a regional service.
In compliance with Emergency Medical Treatment and Active Labor Act, Midland Memorial does not discuss potential ED fees with patients until after they are examined. When patients present at the ED, they are screened for any emergency medical conditions by a physician. If a patient requires emergency care, treatment proceeds.If emergency treatment is not necessary, a member of the registration staff comes into the room to notify the patient about the physician’s determination and to gather insurance information. Patients who do not have insurance are asked to pay $150 before treatment continues or to seek treatment at another setting.These ED screening exams identify between 200 and 300 patients a month—about 5 percent to 7 percent of those who arrive at the ED—that would be more appropriately treated elsewhere. “We have access to the schedule of our urgent care center in town, so we can schedule patients there. It’s much cheaper than $150, and we can usually get patients in within 24 hours,” Bowerman says. “If they need assistance in making an appointment at the federally qualified health clinic, we will assist them with that.”
Midland Memorial’s introduction of upfront ED fees has been successful, Bowerman says, because the nurse hotline was introduced at the same time. The approach has contributed to improved performance on several important measures:
Bowerman credits the nurse hotline for Midland Memorial’s relatively smooth transition. “It was a dramatic change for people who felt they needed to come into the emergency department,” he says. “The telephone nurse triage was helpful because it gives people an avenue to seek before they show up in the emergency department and spend a couple hours going through the medical screening exam process—only to be classified as non-emergent.” Here are some other tips for success from Midland Memorial:Heavily market the nurse triage line. The half-million dollar cost of the nurse triage line is a fixed cost no matter how many calls are taken, Bowerman says, “So we want people to use that line.” In addition to radio ads and billboards, Midland Memorial sought publicity in the local media and advertised the service in its ED. Midland Memorial educated primary care physicians and the staff at the nearby federally qualified health clinic about the nurse hotline and asked them to encourage patients to use it. The hospital also sent refrigerator magnets to all residents in the mail and promoted the triage line with a flier in English and Spanish.
All the promotion has paid off. Within the first year, call volume for the nurse hotline grew by about 1,500 calls—from an average of 2,000 to 2,500 calls per month to between 3,500 and 4,000 calls. Seek early support from ED physicians. Before introducing the ED medical screen exam and up-front fees, gain buy-in from ED staff on funneling patients to the proper care settings. At Midland Memorial, an independent company employs and manages the ED physician staff. “We probably would not have done this had we not had their support from the beginning and their participation as we developed the process,” Bowerman says. Lawrence Wilson, MD, the hospital’s medical director of emergency medicine and hospitalist services, says implementing the upfront collection policy had minimal impact on the emergency physicians other than the requirement of performing medical screening exams so that non-emergent patients can be referred to other sites of care. Although the policy does speed ED throughput for patients who need emergency treatment, ED volume continues to increase, and some patients continue to rely on the ED for primary care. “Importantly, we are helping make our patient population aware of the alternative routes to primary care,” Wilson says. “Nevertheless, when the availability of primary care is a challenge for many of our patients, we are still serving the role of safety net.”The biggest beneficiaries of Midland Memorial’s approach are patients who need emergency care. “The patients who have emergent needs certainly appreciate this new program because they know our emergency department physicians’ attentions aren’t diverted by other cases that don’t require immediate care,” Bowerman says.
Lola Butcher is a freelance writer and editor based in Missouri. Quoted in this article (in order of appearance):
Stephen Bowerman, CFO, Midland Memorial Hospital, Midland, Texas, is a member of HFMA’s Lone Star Chapter (firstname.lastname@example.org).Richard L. Gundling, FHFMA, CMA, vice president of healthcare financial practices, HFMA, Washington D.C. (email@example.com).Ed Fishbough, a director, HCA, Nashville, Tenn. (Ed.Fishbough@HCAHealthcare.com).Lawrence Wilson, MD, medical director of emergency medicine and hospitalist services, Midland Memorial Hospital, Midland, Texas.
Publication Date: Wednesday, January 23, 2013
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
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