Children's faced a major revenue cycle challenge when it sought to convert to Epic from its old Meditech IT system. To avoid the receivables nightmares that can accompany computer conversions, the hospital's senior team wanted to work down its existing self-pay account balances before making the switch to Epic.
The following content is sponsored by Xtend Healthcare.
Over its 100-year history, Children's Hospital Oakland has developed a sterling reputation for patient care. More than three-quarters of the East Bay's pediatricians that are on the "Best Doctors in America" list practice at Children's. The medical staff's expertise covers more than 30 pediatric specialties, making the hospital a destination for children with rare illnesses and complex health problems.
With the Bay Area's only Level 1 Pediatric Trauma Center, the facility (which has been renamed UCSF Benioff Children's Hospital Oakland following a recent affiliation) sees more young patients each year than any of its competitors. Its Research Institute is one of the top 10 National Institutes of Health-funded pediatric research centers in the country, and the hospital boasts a 99 percent retention rate among nurses.
But Children's faced a major revenue cycle challenge when it sought to convert to Epic from its old Meditech IT system. To avoid the receivables nightmares that can accompany computer conversions, the hospital's senior team wanted to work down its existing self-pay account balances before making the switch to Epic.
"We did not want to convert the old A/R on Meditech," explains Gloria Drown, the hospital's interim director of patient financial services. "Instead, we wanted to implement a plan with a vendor partner that would ensure the A/R was effectively managed. We wanted to free our key managers to focus on the new system build and conversion.
"And we wanted to maintain a high standard of customer service during the transition with inbound and outbound calls as well as all patient communication."
After a careful review, Children's chose Nashville-based Xtend Healthcare. "Xtend has worked with a number of West Coast providers with great success," Ms. Drown says. "They bring on a team of expert project managers and on-site staff to keep the communications and A/R decisions timely and effective."
When the project started in September 2013, the Xtend team began working through a backlog of inventory. The team also made recommendations to resolve aged A/R and put in place processes to enhance workflow.
What made the A/R reduction objective at Children's especially challenging was the nature of its patient base. "The fragile nature of our pediatric patients and the trauma for their families are key focal points for our hospital," Ms. Drown says.
For one thing, she explains, when children are hospitalized, the family's resources often are stretched thin. Parents may have to take time off from their jobs, which in turn may affect their financial situations. These financial difficulties may be compounded when pediatric patients need long-term care with recurring, high-cost treatments that cannot be postponed.
Moreover, because many care decisions for the hospital's patients must be made at an accelerated pace, parents often have difficulty keeping up with the paperwork. Communication between parents (and, often, step-parents) becomes an issue. Especially when children are admitted as the result of a health crisis, Ms. Drown says, "the family is often unprepared to identify the correct payer source, particularly if the health plan subscriber is not a custodial parent. Often, the non-custodial parent becomes the guarantor but is not able to get good communication with a custodial parent. And, due to the stresses on the family, keeping up with the administrative burden of interacting with payers to resolve eligibility is often very difficult."
On top of everything else, notes Xtend's Mindy Scher, with a children's hospital "you must be aware that you're often communicating with or about minors, so you must be very conscious of privacy issues and areas of medical sensitivity."
All of these factors made it imperative for Children’s Hospital to select a partner that was prepared to work through such obstacles. "Responsiveness to the family and their concerns is an important requirement for us," Ms. Drown says, "and the staff at Xtend were prompt and worked proactively to keep the relationship transparent to the family."
Xtend's team, which became a seamless extension of Children's business office, worked with families to help identify the correct payer for each case. Particularly valuable are Xtend's automated charity, propensity-to-pay scoring processes. In addition, their automated, ongoing demographic processes utilized to obtain patients' phone numbers, addresses and other key attributes, enable the hospital to ensure the patient contact is as accurate as possible.
"We had listed a number of accounts as private pay for which Xtend, after their screening process, discovered other Medicaid resources," Ms. Drown says. "This has been very effective as a safety net for our billing."
Meanwhile, she says, Xtend used leading-edge technology to "hit the ground running with inventory reduction as soon as it placed" and concentrated their work efforts to ensure a high percentage of collectability. In addition, Xtend's Saturday hours and extended daily office hours increased the collections window for the hospital.
While the engagement with Children's Hospital is ongoing, the results to date of Xtend's efforts to recover self-pay balances have been impressive.
Midway through the project, Xtend has resolved 56 percent of the accounts in the hospital's legacy system. They have also recovered 42 percent of the cash from these legacy accounts — and 75 percent of the cash on the accounts that have been resolved.
At the end of January, Xtend also began working on the self-pay accounts within Children's new Epic system. Within the first three months, the company had resolved almost one-fourth of the accounts, recovering 93 percent of the cash from them.
Xtend's goal, Ms. Drown says, is to reach overall account resolution of 95 percent or better.
While crediting Xtend's processes and technology, Ms. Drown also attributes much of the success in reducing the hospital's self-pay balances to the company’s ability to work with families through what is often a stressful time.
"In addition to a partner assuring cash flow," she says, "having a partner who is invested in the best customer service for our patients has been invaluable. It provides a connection for the patient for immediate and prompt response to any insurance or private pay issues and the ability to have a number of creative payment options for resolving their account balances.
"Xtend is constantly evolving their strategies to maximize both customer service and the effectiveness of our joint collection activities. With so many hospitals transitioning to new systems at the same time, it is fortunate that we had the full resources of a good vendor partner that allowed us to focus on our new system — knowing our legacy accounts and patient customer service were in good hands."