5 STEPS TO COMBAT RURAL HEALTHCARE’S FINANCIAL CHALLENGES AMID COVID-19
In today’s rural landscape, rural areas face unique demographic, social, and economic pressures. The rate of uninsured patients is high, there are low patient volumes, high poverty rates, high rates of Medicare and Medicaid coverage, and a lack of resources and staff. COVID-19 has not made these issues any easier. Unprecedented financial challenges for hospitals include sharp declines in outpatient and inpatient revenue, the repercussions of an estimated 25-43 million people projected to lose employee-sponsored health insurance coverage, the projection that Medicaid enrollment will increase by 5 to 18 million by the end of 2020, that 40% of those in non-expansion Medicaid stated are projected to become uninsured, and the large staff reduction due to layoffs, furloughs, and quarantine.
This document serves as a 5-Step Rural Healthcare Strategic Approach guide to driving financial performance by treating patients as consumers, empowering registration staff, personalizing patient payment plans, streamlining financial clearance, driving accountability, and identifying rural healthcare strategies to drive the financial performance of hospitals.
Rural Healthcare Strategic Approach
The 5-Step approach to combating the financial challenges those in rural healthcare are facing can be found below:
- Treat Patients as Consumers
- Meeting consumer-driven expectations is not as easy or obvious as it might seem. Patients often have no idea what their expected financial responsibility will be, receive a confusing mix of bills and EOBs from multiple entities that can be difficult to understand, are surprised by additional bills after believing their balance has been paid, and do not understand the provider’s collection policies and so may perceive they are being unreasonably targeted by the collections team. When there is an internal culture change of your hospital’s operations or systems, patients need to know that Patient Access processes have been completely transformed to change their experience for the better. Clinical staff must be fully informed, and a clinical champion should be appointed for provider-to-provider discussions. Front end staff must be engaged to spread the word! Implementing a deep-level approach to bill estimates can be done by calculating estimations down to the physician level, comparing the actual insurance reimbursement to estimated allowables, and identifying and reporting any significant drops or changes in revenue for CPT/procedure codes and physician orders and procedure changes.
- Empower Registration Staff
- Identify and implement tailored sequences of repeatable operations that normalize the patient intake process across your system. Provide interactive, integrated, and user-friendly payment methods by creating short simple, task-specific workflows to get higher compliance. Introduce automation where necessary (do not over-complicate workflows just so you can automate). Utilize real-time technology to provide accurate patient out-of-pocket obligations. Calculate payment plan options personalized to each patient’s budget and ability to pay. Identify uninsured patients with financial assistance programs when appropriate.
- An example of a best practice, task-specific workflow can be found below
- Personalize Patient Payment Plans
- Take into consideration the impact of COVID-19 on patients when assessing patients to identify their unique payment plans. Analyzing their data from credit-reporting agencies and other financial demographics such as Guarantor Credit Score, Payment History, and Residual Income Measurements can help give an idea as to what their payment plan should look like.
- Streamline Financial Clearance
- Contacting the patient 3-5 days prior to their schedule appointment(s) and verifying their insurance information, deductibles, and copayments helps stay ahead of the curve and avoid issues once patients are in-office. Run their bill estimates, assess the patient’s ability to pay, determine personalized payment options, and generate a customized financial care plan for them. Ensure that you pre-register patients for all approved services and keep track of Rapid Patient Movement from Registration to Point-of-Service Destination in 3 categories:
- Full-Stop: Patients who choose to not participate and use a traditional registration and payment system at point-of-service. You want the smallest percentage of patients to be in this group for optimal streamlining of financial clearance.
- Quick-Stop: Patients who are pre-registered and elect to pay in person
- No-Stop: Patients are fully pre-registered and cleared to go directly to point-of-service location. You want the largest percentage of patients to be in this category for optimal streamlining of financial clearance.
- Contacting the patient 3-5 days prior to their schedule appointment(s) and verifying their insurance information, deductibles, and copayments helps stay ahead of the curve and avoid issues once patients are in-office. Run their bill estimates, assess the patient’s ability to pay, determine personalized payment options, and generate a customized financial care plan for them. Ensure that you pre-register patients for all approved services and keep track of Rapid Patient Movement from Registration to Point-of-Service Destination in 3 categories:
- Drive Accountability
- Capture and monitor productivity reports that measure individual and team performance including a daily report showing all transactions for that day, POS collections reports (including missed opportunities), and an eligibility report for both active and inactive eligibility results.
- Key metrics: What percentage of patient-payment opportunities are captured or missed? What percentage of patients have paid in full for their obligations prior to service? What percentage of patients have made partial payments? What percentage of patients have been put on a payment plan? What is the patient’s ability to pay across the entire patient population?
Identify Rural Healthcare Strategies to Drive Financial Performance
There are three critical ways for your rural healthcare facility to support a better Patient Access experience while boosting point-of-service collections:
- Gain support from the top-down
- Design and implement patient-friendly, pre-access system models that include-
- Consolidation of center scheduling, streamlining workflows across departments, developing custom financial guidance and planning, expanding staff roles to cover registration and financial service responsibilities, and educating all patient financial services staff, patients, nurses, and physicians
- Define metrics for success, capture data to support them and make performance results highly visible