It’s about putting systems in place that allow people to get their jobs done more efficiently so they can focus almost entirely on enhancing the customer experience.
All successful businesses have at least one element in common—they create a stellar customer experience. This is true in a variety of industries, and health care is certainly no exception.
However, healthcare organizations—and specifically hospital revenue cycle departments—face many challenges as they try to focus on customer service in such a complex and fast-paced environment. How can revenue cycle staff increase cash flow, mitigate denial risk, and improve customer satisfaction all at the same time?
One solution is workflow redesign, says Chris Byers, CEO of Formstack. He points to the Ritz-Carlton Hotel Company as an example. “System behind the smiles” is a concept that the luxury hotel chain uses to revamp workflows to make customer service its number one priority. The good news is that “system behind the smiles” isn’t limited to the hospitality industry. In a recent interview, Byers said that healthcare organizations can also apply the notion to achieve comparable results.
In your own words, can you describe “system behind the smiles?”
Byers: It’s about putting systems in place that allow people to get their jobs done more efficiently so they can focus almost entirely on enhancing the customer experience. The more processes you can automate, the more time and energy you have to focus on customers.
Have most healthcare organizations embraced this concept?
Byers: I don’t think so. Healthcare providers are focused on patient care but not on the entire experience from the moment patients walk in the door. For example, with “system behind the smiles,” hotel employees meet every morning to remind themselves of the overall mission—that is, to create the best possible customer experience. Does this same thing happen in most healthcare organizations? It doesn’t.
Why is that? Why aren’t more hospitals striving to improve the patient experience?
Byers: When you choose a hotel, you go online and make your decision based on brand, price, and customer ratings or reviews. In health care, there isn’t that same type of transparency. There are sites that rank hospitals and physicians, but they don’t provide the same level of detail regarding customer satisfaction. As a result, most hospitals don’t necessarily feel the need to invest in these efforts.
Is there any data that supports the ROI of improving the patient experience in health care?
Byers: No, there isn’t sufficient data that quantifies how improving the patient experience translates directly to increased revenue or other benefits. That’s because collecting this data isn’t easy. To do so, you would need to compare the experiences of a control group and an experimental group. You would expose the control group to current processes, but you would expose the experimental group to your revamped—and more automated—processes. This would require you to train people and systems to interact with both groups differently over a defined period. Conducting this type of research may take considerable time and resources that many hospitals don’t have.
Should healthcare organizations start thinking about the patient experience even if it’s difficult to prove ROI? If so, why?
Byers: Yes, definitely. Improving the patient experience undoubtedly improves patient satisfaction and retention, both of which are important in an increasingly competitive healthcare environment. Improving the patient experience may also increase the likelihood that patients will pay their healthcare bills, which is important in this era of high deductible health plans. When you connect emotionally with patients, let them know you care, and focus on their experiences, they’re more likely to follow through with payment. That’s true in any industry, including health care.
I’m glad you mentioned high deductible health plans and the patient payment aspect of health care. Based on your experience, how do patients generally feel about their the process of paying for healthcare services?
Byers: The biggest complaint is that they have no idea what they’re going to owe when they leave the facility. Another complaint is that the billing process is very impersonal. They receive a bill, don’t understand what they owe and why, and then they don’t know how to ask questions. Patients also frequently complain about the time it takes to fill out paperwork during the intake process.
Based on this feedback, what specific revenue cycle workflows should organizations automate or improve to enhance the patient experience?
Byers: Many paper-based workflows can—and should—be automated. For example, consider an electronic intake process where patients can complete the process online in advance. Rather than having to input information when the patient presents for the appointment, staff members simply validate that the information already provided is correct. Patients appreciate this because it often reduces wait times.
Hospitals also benefit from electronic workflows. For example, when patients provide insurance and demographic information in advance, hospitals can verify coverage as well as identify copayments and deductibles. Patients have a better sense of what they’ll owe before services are even rendered. Information is also automatically included in the electronic health record, eliminating the possibility that information will be lost or misplaced. Another benefit is that electronic forms eliminate the problem of illegible handwriting. Not only can this help reduce denials because of errors such as misspelled names and incorrect insurance identification numbers, but it can also help mitigate medical errors and reduce unnecessary or duplicate tests.
Electronic workflows also eliminate costs associated with scanning and filing. According to the AIIM Institute, the cost of doing business with a paper form is $4.50 per form. It costs an additional $2.84 per form for scanning. So you’re talking about a $7 transaction for every form that isn’t digitized. Multiply this by hundreds or thousands of patients per week, and suddenly, your costs skyrocket.
Payment processing is another workflow that can benefit from redesign. More specifically, healthcare organizations can improve the patient payment process by converting to an electronic workflow that includes the ability to pay online using a credit or debit card. This should be a rapid process during which patients are required to enter as little information as possible to complete transactions. Many patients appreciate the ability to pay online. Filling out credit card information on a paper form and mailing it back to the hospital is a frequent source of frustration.
Think about patient engagement during the entire payment process. For example, provide patients with options to ask questions or sign up for payment plans during online checkout by simply clicking a “contact us” button rather than requiring them to call the hospital directly. The help ticket should trigger separate workflows that prompt revenue cycle staff to contact patients directly. If patients are required to make initial calls for help, many won’t follow through—and they won’t pay their bills either.
Another idea is to tie the patient experience directly to the billing process. For example, before patients pay their bills online, request feedback through a brief survey where patients can rate their interactions with providers. Preface the survey with a personalized message, such as “You came to visit us for a post-surgery visit with Dr. Smith, and we’d like some feedback about your experience.” Doing so helps patients feel as though their opinions matter, and it also gives valuable insight into how the organization can make improvements—or continue doing what works well.
What’s the biggest challenge for healthcare organizations as they try to get the ball rolling with improving patients’ revenue cycle experience?
Byers: The biggest challenge is that so many processes are siloed, and no single individual or department is motivated to drive collaborative process improvement. However, forward-thinking organizations are starting to hire solution consultants/architects to uncover inefficient processes and then either buy or build software to addresses these inefficiencies.
Who else should be involved in improving the patient revenue cycle experience?
Byers: In addition to the solution architects and revenue cycle directors, you also need the marketing department because they’re the ones who can articulate the culture, brand, and experience that the organization wants to create and convey. Second, you need to involve patients. Three to five patients will likely identify 80 percent of the problems or complaints. These conversations don’t need to be long—even 30 minutes can be very enlightening. Patients will be direct, and they’ll also appreciate that you asked for their feedback. Finally, executive buy in is also important. Executives help secure any necessary resources, and they also communicate the urgency and importance of the initiative. Without buy in, there’s a strong likelihood that these efforts won’t go anywhere.
What about engaging revenue cycle staff to improve the patient experience?
Byers: Revenue cycle departments—and all departments—can take higher-level approaches and champion cultures that engage staff and value transparency. Culture lays the groundwork that permeates all aspects of organizations, including patient experiences. When staff are more focused and invested, they help drive process improvements that enhance overall patient experience.
Interviewed for this article:
Chris Byers is CEO of Formstack, Indianapolis, Ind.