At the Margins

How to build a revenue cycle that works for your patients

by James Green

Let’s think about your hospital’s revenue cycle for a moment. Was it designed to get work done as efficiently and cost-effectively as possible? I suppose most of you would say yes. Would most of you also agree that it was designed with the highest regard for the patient financial experience?

It’s no surprise that most hospitals have designed their revenue cycle to fit their own workflows. But making things easy for ourselves is no longer enough. Patients find our "efficient" workflows frustrating and confusing. In fact, clumsy billing and collections processes may ruin their overall experience, regardless of our clinical excellence.

With the rise in high deductibles, more of our revenue comes directly out of patients’ pockets than ever before. So a negative patient financial experience may be putting our margins at risk. The recent Connance Annual Consumer Impact Study found that 67% of patients who were dissatisfied with the billing process failed to pay their total financial obligation. But 74% of patients satisfied with the billing process paid their bill in full! And 95% of satisfied patients were likely to return to that hospital for another service. To both boost patient loyalty and increase collections, progressive organizations are beginning to tailor their revenue cycle processes to patients’ needs and expectations.

Let’s take a look at what the revenue cycle can look like when it is designed around patient flow, instead of your own work flows.

Providing the right price information

Before scheduling an appointment, more and more patients want the answer to a simple question: How much will this service cost? Unfortunately, most hospitals don’t have the tools or capacities to tell them. What’s more, plenty of hospitals that do have pricing tools often ask patients for CPT codes for their upcoming procedure. That may make life easy for us. But most patients don’t know what a CPT code is, much less how to find the right one for their procedure. And when we can quote a price, it is often our charge for the service, which is typically much higher than the patient’s out-of-pocket cost.

Overall, price opacity is a huge dissatisfier that can make your patients look elsewhere for service. So, progressive organizations are learning how to give quick and reliable out-of-pocket cost estimates. The best of the best are also using multiple channels—telephone, website, mobile app, etc.—to truly meet patients where they are.

Collecting patient data

At sign-in, patients are generally asked for insurance information, emergency contacts, and so on. Often this information was already gathered during pre-service interactions. Since most hospitals function through a patchwork of IT systems with complex workarounds, patients are often asked for all of this information again when transferred to another part of the same institution. From the patient’s perspective, this redundant information collection makes no sense at all. In recent conversations with members, I’ve encouraged leaders to prioritize sharing information internally to ensure a smoother patient experience.

Billing and collection

Regardless of how we see their time in the hospital, patients experience it as one single service. So they expect one bill, with clear instructions and payment options if necessary. They don’t care that the ED is separate from inpatient services or that ED physicians belong to a different group. They don’t understand why each requires a separate bill. And they don’t understand the bills themselves, which are awkwardly formatted, filled with jargon, and unlike anything they encounter elsewhere. To meet patients’ reasonable expectations, progressive organizations are providing consolidated bills in plain English, offering flexible payments options, and using patient advocates to help them navigate these processes.

With deductibles on the rise, leading hospitals and health systems are recognizing that the patient financial experience is critical. By thinking about patient flow, instead of their own work flow, they are not only improving collections performance they are building long term patient loyalty.



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