Despite all the data available today, most provider organizations are not routinely tracking some key metrics critical to supporting value-driven Patient Access. These key indicators can help revenue cycle leaders better assess the performance of their Patient Access operations. They can also be used to improve the patient experience and your financial results alike. Patient liability continues to increase with more than 51 percent of patients having a single deductible greater than $1,000. 1
Commonly Tracked Indicators
Over the past decade, healthcare providers have continued to increase focus on Patient Access and the front-end of the revenue cycle. The industry is tracking more registration-related metrics than ever before, such as:
Point-of-Service (POS) Collections - The amount of cash collected from patients at point of service, including co-payments and deductibles;
Pre-registration - The percentage of patients registered in advance of their dates of service; and
Insurance Verification - The percentage of patient accounts that have insurance verified, eligibility confirmed, and benefits documented.
Five Metrics to Add to Your Patient Access Scorecard
As with any metric, comparing some key indicators across hospitals and health systems can be difficult at best due to differences in the way they are calculated and tracked - leading to an apples-and-oranges comparison. Each of these metrics below, however, can be valuable to an organization by first simply tracking internally and then focusing on performance improvements that can be compared to a hospital's historical performance to drive better results.
POS Collections as a Percentage of All Patient Collections
While tracking POS collections is commonplace today, many providers are not yet looking at overall patient liability collections. This metric allows healthcare providers to track patient liability collections in total, where the payment originated, and also payment trends over time. The results are good indicators of the effectiveness of Patient Access training. With more healthcare providers offering pre-service financial counseling and accepting credit card payments in advance of service, POS Collections as a Percentage of all Patient Collections could be further broken down by trending Pre-POS, POS and Post-POS collections.
"POS Collections" and "POS Collections as a Percentage of all Patient Collections" targets can vary significantly from one hospital or health system to the next, based on the type of healthcare provider.
For example, small suburban hospitals with higher percentages of elective procedures typically collect much more of their patients' liabilities at or before service. By comparison, large inner-city trauma centers with high Medicaid populations and busy ERs might collect much less.
"POS Collections as a Percentage of all Patient Collections" also typically trends down throughout the calendar year as patients satisfy their deductibles. Conifer Health works with clients to help reverse this trend by increasing the percentage of patient liability collected on or before delivery of service. Conifer Health continues to invest in technology and process improvements to help reverse the trend of decreasing POS collections in the latter half of the year. With these improvements, some of Conifer Health's clients have seen as much as a 15 percent increase in POS collections.
POS Collections as a Percentage of Potential Patient Liability
Most healthcare providers set goals for POS collections based on historical collection rates. A better POS collections goal is based on a percentage of the total estimated patient liability. The total estimated patient liability should include co-payments, deductibles, and co-insurance.
Due in part to high-deductible health plans, patients are expecting to pay more upfront, but they are also demanding better cost estimates for procedures and more flexible payment options. In addition, providing patients with time to financially prepare to meet their liability by the date of service greatly increases the rate of collections. Conifer Health recommends that providers proactively contact the patient a minimum of three days prior to the procedure so the patient has the opportunity to understand their payment expectations and make arrangements to pay on the date of service. This is a proven patient and physician satisfier because this early notification reduces cancellations and reschedules.
The estimate for total patient liability can be easily calculated by using a patient liability payment estimator tool. This tool combines eligibility and benefit data with managed care contracts to help Patient Access staff quickly determine how much to collect from patients. Knowing the potential patient liability amount and comparing that to actual collections will give healthcare leaders a good indicator of the effectiveness of their pre-service collections efforts.
Percentage of Accounts Not Financially Cleared
Trending insurance verification rates and POS collections gives Patient Access operators a good indication of the effectiveness of their financial clearance processes. The verification of benefits and collection of cash at the point of service are essential parts of financial clearance. Although these activities are essential, they do not provide the complete picture of a Patient Access operation. The missing piece - accounts not financially cleared - provides a more complete outlook in determining whether the Patient Access operation is running effectively. Providing liability information well in advance of the service reduces cancellations, reschedules and no-shows.
Root-cause tracking and analysis of these accounts can help place focus on gaps in the process. Patient Access operations can fill these gaps by creating and implementing policies and procedures detailing activities and results required to financially authorize an account. These policies should also define criteria for any services and/or thresholds that make it acceptable for a patient to proceed with services outside of the completion of those identified activities.
Ultimately, the root-cause analysis can provide a clear picture of when a department may be allowing patients to "slip by" without complete financial clearance. Completing pre-authorizations and financial clearance confirms the patient is covered by his or her insurance provider for services, thus reducing the financial risk to the healthcare provider. The tracking, trending and analysis of the percentage of accounts with incomplete financial clearance every month help leaders create results-oriented strategic plans to address the root causes.
Patient wait times are routinely scrutinized by healthcare executives. However, many leaders do not realize these wait-time metrics do not accurately reflect the actual time patients spend waiting prior to service. Providers can develop comprehensive cycle time measurements by segmenting and tracking each component of the patient's experience. These components include:
Prior-to-service date - This includes patient time spent self-scheduling or waiting for the physician office staff to schedule an appointment. It can also include the amount of time devoted to pre-registration activities such as providing insurance and demographic data.
Initial arrival - This includes time from the moment a patient enters the facility until he or she is able to begin the check-in/registration process.
Registration time - The time from the moment a patient begins the process of providing and/or validating his or her information and signing all necessary documents.
Clinical service times - The time a patient spends waiting for a procedure in the clinical department before service.
Healthcare providers should understand and measure each of these time intervals separately, as well as collectively, to identify the areas with the greatest opportunities for improvement.
Plan ID Changes
Repeated, unanticipated changes of the insurance plan identification code on an account are indicative of inefficiencies in the revenue cycle. Whether an incorrect insurance carrier or health plan is documented by registration, or if billing is erroneously changing the primary payer information, plan identification changes can lead to denials and extra days in accounts receivable.
Proper pre-service clearance and registration can greatly improve financial performance. It is during the registration process that providers are most vulnerable to the top four denial categories, which include authorization, medical necessity, coding and eligibility.
Healthcare providers can measure this statistic by comparing the number of accounts that have a plan identification changed as a percentage of all accounts volume. The ability to analyze and understand plan identification changes by payer, by department or even by registrar can help revenue cycle leaders identify failure points and correct root causes.
A Proven Partner
These key indicators can help revenue cycle leaders better assess the performance of their Patient Access operations and prepare for value-based healthcare. Put yourself on the path to success with visibility into eligibility and registration processes that support downstream success. Conifer Health can help drive your operations to the next level by providing superior customer service and financial clearance results, resulting in higher patient acquisition and retention, and an optimized revenue cycle.
- The Kaiser Family Foundation. 2016 Employer Health Benefits Survey. September 2016.