El Camino Hospital reduced staff time spent managing payments and collections by 20 percent with consolidated billing statements that show clearly how charges reconcile with patients’ insurance benefits and deductible balances.


Patients at El Camino Hospital, a two-campus health system serving Silicon Valley, used to struggle to understand how their hospital bills correlated with their insurance benefits and their year-to-date out-of-pocket spending.

No more. In early 2013, El Camino began providing patients with online statements that include all bills from all healthcare providers—even those not associated with El Camino—fully reconciled with patients’ insurance benefits and adjusted to reflect patients’ deductible balances. The result: Patients pay their bills more quickly. In addition, El Camino experienced the following improvements within the first six months of launching the billing system:

  • The number of patient accounts outsourced for collection fell by half.
  • The percentage of El Camino patients paying their bills online jumped from 2 percent to 33 percent. 
  • Patient financial services staff reduced the time spent on the telephone answering patient questions by 20 percent.
  • The overall time staff spent managing payments and collections was cut by 20 percent.

Judi Ashline, El Camino’s director of patient financial services when the new billing system launched, says combining information from multiple sources into the easy-to-understand statement (see the exhibit below) is a patient-friendly service that benefits the health system. “Even though I am a healthcare professional, sometimes I even get a little confused about my own bills,” she says. “This really brings clarity around a process that is very confusing.”

Simplee Claim

The Problem to Solve

As patients’ out-of-pocket responsibilities have increased in recent years, El Camino patients often struggle to understand exactly what is expected of them. Matching billing statements against an insurer’s explanation of benefits is daunting, especially when multiple providers are involved.

Ashline offers an emergency department (ED) visit as an example of how even a brief encounter with the healthcare system can turn into a confusing financial situation for patients. “After an ED visit, the patient gets a facility bill and an ED physician bill and, if there are X-rays, there will be a bill from the radiologist, and there may be a bill from a pathologist for some of the blood tests we do,” she says. “If the patient is getting four bills and then four separate explanations from the insurance company, it gets a little hairy.”

Typical patient behavior is to wait until all statements arrive, stare at the confusing paperwork for a while, and then call the health system for help, Ashline says. Patient financial services representatives field the same questions repeatedly: “Why am I getting this bill from an El Camino ED physician?” “What’s a radiologist?” “Who are these people?”

That is why El Camino’s interim CFO, Ned Borgstrom, was willing to try a patient-payment technology, suggested by the health system’s CIO, which offered a new way of communicating patients’ financial responsibilities. “I was intrigued with the fact that maybe we could improve patient satisfaction by giving patients bills that they could understand,” he says.

How It Works

Participating in the online service is optional. Patients who prefer to receive regular paper bills, which are not consolidated with insurance benefits, simply do not sign up for the service.

Those El Camino patients who do want to sign up start by going to the health system’s website to set up a password-protected account with the vendor that developed the online payment service. Patients provide the names of their health, dental, drug, and vision insurance plans, plus their log-in information to their online accounts for those plans. After the insurance accounts are linked, the technology pulls claims from the insurers’ websites daily and presents the information on a dashboard so patients can see all their healthcare bills, regardless of the provider. 

The dashboard explains every line of the statements, including why coinsurance applies to certain bills, why a copayment is required for others, and why some expenses listed on the bills do not have to be paid. Insurance claims are pulled each day so patients’ deductible balances and out-of-pocket spending tallies are current. Patients can also see the deductible status and spending breakdown by family member, as well as total year-to-date healthcare spending by provider.

Patients who sign up for the insurance-reconciled online statements and other information provided on the patient-engagement platform receive an email message when an El Camino bill is owed. Patients can pay their bills directly on the website. “We are getting paid quicker because patients understand their liability,” Ashline says. “Many patients pay as soon as they get that email, so we don’t need to send multiple statements to them, which is fabulous from our perspective.”  

Other Benefits

El Camino and its patients—even those who choose not to sign up for online access to consolidated bills—receive several other benefits from the new approach:

Improved customer support. Some patients who sign up for this service prefer not to go online to see their hospital bills, electing instead for regular paper bills. However, when patients call to ask questions about paper statements, patient financial services staff can send the patients their online consolidated bills by email to ensure they are viewing the same information. “We say ‘Hang on a sec, let me email you something so that you and I are looking at the exact same thing,’” Ashline says. “Then we can walk through it line by line so that we are not talking about apples and oranges. Customers respond really well to it, and our employees really like it.”

Payment plans. Patients can set up payment arrangements online, creating orders for payments to be made automatically every month. Conversely, patients can opt to be notified each month when payments are due and then use the website to make payments.

Patient eligibility and cost estimates. Because patient financial services staff have access to patients’ insurance information, they use the web tool to verify insurance coverage for specific tests and procedures. They can also provide cost estimates that reflect patients’ real-time deductible balances.

Reductions in Staff, Time, and Fees 

The easy-to-understand bills have reduced El Camino’s revenue cycle workload. “We reduced staff by a half-FTE in the customer service area, and we have reduced our overall talk time on the phone with our patients by an average of approximately 20 percent,” Ashline says. 

One surprise area of savings: reduced fees for collecting past-due accounts. El Camino does no in-house collecting; after three statements, patient bills are referred to an agency for “soft” collections. About six months after adopting the new online billing approach, the agency called Ashline to find out why the volume of accounts had fallen by nearly 50 percent.“The reason is because people are paying their bills more quickly, so we save the collection fees,” she says. 

Lessons Learned

Ashline shared the following tips from her hospital’s experience to date.

Email addresses are essential. Before launching the new online approach, El Camino had not collected patient email addresses, which are needed so that auto-generated email messages can notify patients when their bills are due. Thus, Ashline encourages hospitals that may want to adopt a similar approach to start collecting email addresses now. That will allow them to notify their patients about the service and how to sign up, independent of a medical encounter.

Old technology may impede savings. El Camino’s computer system is currently set to send three statements and “turning off” that function has been a technical challenge. “We are working to fix that, and considering that it costs us $1.50 per statement, eliminating the extra statements will be a significant savings,” Ashline says. “We are finding that for many patients, we do not need to send three statements because they pay when they get the emails.”

One thing that has not been a challenge: Getting patients to try the portal. “It has not been difficult to convince patients to use the portal. Maybe that is because we are in the very tech-savvy Silicon Valley,” Ashline says. “We are just keeping up with today’s technology.”

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

Ned Borgstrom is interim CFO, El Camino Hospital, Mountain View, Calif. 

Judi Ashline was previously director of patient financial services at Camino Hospital, Mountain View, Calif.  

Publication Date: Friday, January 17, 2014