In this business profile, Sheila Schweitzer, founder and CEO of PatientMatters, offers insights on ways hospitals and healthcare systems can address rising patient receivables.

Sheila SchweitzerTell me a little about your organization.

PatientMatters brings a comprehensive approach to optimizing the financial experience between patients and health systems: an experience that breaks down the traditional barriers to creating a true consumer relationship with patients. The company was created in response to the unprecedented growth in patient receivables with the goal of educating patients as consumers of healthcare services. It offers a sophisticated decision-support and workflow system that allows caregivers to communicate efficiently and effectively with patients. In addition to a full-time onsite director who oversees technology implementation, implements programs and ensures sustained adoption, the company provides dedicated patient advocates trained to place patients on the right financial path from the outset. The goal is to ensure they can receive the care they need and are placed on the right path to meeting their obligations. Founded in 2012, PatientMatters currently has a service center in Houston, an office in Fort Worth, and corporate headquarters in Orlando, Fla.

What are some of the biggest challenges you see affecting hospitals and health systems?

Historically, the revenue and financial side of health care has depended on the payer-provider relationship. Systems and processes were designed so providers could work with payers to manage medical claims, remittances, and other third-party transactions. Optimizing patient cash collections and the processes supporting the patient’s financial experience played a small role in an organization’s income.

However, in recent years, the healthcare industry has moved into a provider-patient-payer relationship with a substantial increase in patient financial responsibility. Changes in reimbursement policies are placing patients at the center of quality- and value-based purchasing and bundled payment models. This shift is putting a significant percentage of our health systems’ A/R in the hands of patients. For example, in 2007, about 4 percent of A/R for a group of 2,000 hospitals and free-standing clinics rested with patients. That figure grew to 30 percent in just four years.

Although hospitals and health systems face increasing numbers of self-pay patients and individuals with balances after insurance, their response to this evolving dynamic has been hampered by ineffective existing technology and inadequately trained staff, stacked on top of out-of-date processes.

How do your services address these needs?

Realizing how the healthcare payment market was evolving, PatientMatters spent 15 months building an exception-based workflow system and updated processes that focus on the patient and not just his or her account. This type of solution was not available in the market to date.

Our technology focuses on seven key areas of cash leakage: pre-registration and scheduling, emergency department, point-of-service collection, patient advocacy, early-out, payment plans, and bad debt. Our platform, known as Periscope, is highly integrated and can operate across all patient care delivery sites within a healthcare organization. It customizes the patient access database for each client, develops real-time patient access information dashboards, and provides immediate feedback to identify errors in registration and scheduling. The technology allows hospital staff to produce accurate estimates of what the patient may owe; determine his or her ability to pay that amount; assess the probability of payment; complete a pre-approved process that certifies the patient for a loan/payment plan; initiate a communication protocol with frequent touches leveraging texts, e-mails, phone calls, and comprehensive patient statements; and maintain a simple payment portal where the patient can view and pay his or her bill from any device. In addition, we offer smart form technology that staff can use to electronically complete, validate, and send crucial information in real time.

PatientMatters also offers the Medical Advocacy Services for Healthcare, Inc. (MASH) program that provides third-party eligibility and advocacy services for patients. By using sophisticated technology and highly trained onsite advocates, the MASH program links uninsured patients with publicly provided insurance coverage. MASH has been a Medicaid eligibility company since 1988 and was acquired by PatientMatters in 2012.

How is your approach different from that of other organizations involved in improving the patient experience?

We partner with hospitals and health systems on a long-term, three- to five-year basis. In addition to our unique technological infrastructure aimed at patient access and receivables, we place highly skilled and experienced directors onsite for the length of the engagement. Our staff has deep experience, previously holding positions as directors of patient access and other similar titles. They work with hospital employees to familiarize them with the technology, teaching them about best practices for monitoring and collecting patient receivables. Our staff takes responsibility for implementing the technology workflow system and any associated policies and procedures. They also manage and train staff and conduct trending and analysis to give healthcare institutions unique insight into their patient bases and the ability to truly manage their growing patient balances. Our arrangement does not require any of our partnering hospitals or health systems to assume up-front costs. We put our people, technology, and workflow system onsite risk-free and we generate revenue only when we exceed the institution’s most recent 12-month performance.

What advice would you offer to healthcare leaders to control rising patient A/R?

Many healthcare organizations are dealing with the patient payment issue post-discharge. At this time, they offer individuals multiple ways to learn about their  financial obligations and pay for the services they  receive. However, we believe it is important for patients to be educated about their financial options as early as possible in the care journey. Organizations should be contacting patients five to seven days before a scheduled visit and educating them about their benefits, informing them if they do not have benefits, and helping them find alternative payment sources.

Secondly, patients often visit multiple locations within a healthcare system to receive treatment and services, and their care plan can frequently change during the course of an episode. Organizations should be communicating with patients as they go along, and patient data should be managed across the entire care journey, regardless of the healthcare delivery site. Our data set captures a complete view of this journey, identifies changes that should be communicated to the patient, and triggers the correct patient outreach.

Hospitals and health systems should think of the current changes in health care as an opportunity to rework their culture and mind-set, and develop a business model that improves financial performance by transforming patients from uneducated healthcare consumers into wise and satisfied healthcare customers.

Where can readers learn more about PatientMatters?

Readers can read our blogs or view our webinars on our website.

HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more.

Patient Matters LogoContent for this Business Profile is supplied by PatientMatters. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.

Publication Date: Tuesday, November 01, 2016