The industry-wide transformation from volume- to value-based care delivery systems has spurred an increasing emphasis on patient satisfaction and catalyzed the drive for healthcare to mirror the retail consumer experience. While much of these efforts tend to center on quality and health outcomes, the revenue cycle is an important, often overlooked area with the potential to make or break the patient experience.
The healthcare environment today is forcing hospitals and health systems to rapidly change their approach to customer service across the board — making appointments, the inpatient stay itself, the discharge process and billing process — all with the hope to further bolster brand reputation and increase patient loyalty.
No longer can hospitals rely exclusively on their history and clinical prestige to maintain favorable reputations among patients. Patients' interactions with both clinical and administrative staff substantially influence patient perceptions of their experience in the hospital, their loyalty to the organization and the likelihood they will recommend the hospital to family and friends. All of these factors either add to or detract from a hospital's brand. Moreover, since the first and last experience most patients have in an episode of care is with the revenue cycle process, revenue cycle performance may disproportionately influence patient perceptions.
"In most of my conversations with healthcare CEOs, they don't want to talk about revenue cycle management," Le Anne Trachok, chief strategy officer of revenue cycle solutions company Optum360 said during an executive roundtable at Becker's Hospital Review's 2nd Annual CIO/HIT + Revenue Cycle Conference in Chicago. "They say, 'Our biggest issue is our brand.' Brand is what's important for growth." However, Ms. Trachok contends the revenue cycle and the organization's brand are closely linked. A terrible billing experience can ruin an otherwise positive patient experience, thereby contributing to a negative brand image.
Human interactions — not technology — have the most influence on the patient experience
Technological tools that help streamline and automate RCM processes and increase efficiency for RCM staff are integral for effective eligibility verification, coverage discovery and denial minimization. However, when it comes to the patient experience and its impact on the hospital brand, the human interactions between patients and RCM staff are most important.
"If you want to get into branding and you have the tech in place, the thing you need to work on is human interactions," said the CFO of a 25-bed critical access hospital in the South. "All of the complaint letters that come in are not about the tech, but about the human beings with whom patients eventually have to speak. That will make or break the experience — the voice-to-voice communication."
For example, a woman whose father died in the hospital called the billing office regarding his medical bills five times over a period of three months, according to the CFO. Each time, the woman spoke to different billing staff members and had to re-explain her relationship to the deceased patient and her concerns with the bill. Being forced to endure these conversations repeatedly while grieving made this woman's experience with the hospital painful.
Anecdotes like this illustrate the need to improve behavioral training for billing staff who communicate with patients. It is no longer enough to only be polite and professional when interacting with patients, according to Ms. Trachok. Instead, these staff members "must be empathetic and really hear what [the patient] is saying."
In addition to active listening and making the patient feel understood, such conversations between patients or family members and billing staff could provide information that is valuable to a patient's long-term care plan.
"In a world where we are increasingly managing health and taking on risk, it is important to share all kinds of information about patients' health," said Ms. Trachok. "The training for people who are interacting with patients in the revenue cycle must expand to include really listening and showing compassion, and then following through in care. For example, if a patient is depressed, it would be important for the care coordinator to be aware."
Retail billing principles can remedy RCM woes in healthcare
In any given retail service, the customer leaves with a statement and knows what they owe. Patients, on the other hand, receive an explanation of benefits in the mail some time after receiving medical care. EOBs are difficult for most people to interpret, especially given the technical language of each itemized charge. The entire process could be less painful if hospitals borrowed the retail industry's billing practice.
"Right now, hospital discharge comes and goes and doesn't mean anything," said Ms. Trachok. However, with better planning, the time of discharge serves as a meaningful pivot point for the revenue cycle. "How can we apply [retail billing principles] to inpatient care, surgeries and diagnostic procedures at the time of service?"
Prospective planning can also make the billing process more manageable for both RCM staff and patients, according to Ms. Trachok. Systems that enable the automatic aggregation of information — the patient's risk level, comorbidities, age, gender, medical history and other factors combined with presumptive diagnosis at the time of admission — can build a claim earlier on. Armed with this information, RCM staff can work with payers on appropriate reimbursement, making changes along the way to reflect the patient's current clinical situation.
Technology and human behavior must complement one another
Patients today are more discerning when it comes to choosing where they seek healthcare services. Various factors are at play in guiding their decisions. Quality outcomes will always be top of mind, but at the end of the day, human behavior and memory will be the greatest determinant of the patient experience. RCM leaders must prioritize technology systems that improve efficiency, but above all, they must emphasize the importance of behavior, compassion and empathy, and their impact on the organization's brand.
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This content is sponsored by Optum360