Price estimate is biggest challenge

Price estimate is biggest challenge

Tool must be visibly pleasing to the eye’

Point-of-service collections at Ohio Health in Columbus have steadily increased, from about $12.8 million in fiscal year 2011 to more than $19 million for fis¬cal year 2013.

OhioHealth was seeing a steady increase in patient out-of-pocket responsibilities, and a growing number of patient requests for price estimates was coming in to the system’s hotline. "We needed to find an automated solution to create real estimates based on the patient’s specific insurance coverage," says Pam Carlisle, CHAM, senior director of patient access services.

Patient access leaders partnered with a vendor to implement a price estimation tool (PMMC Estimator Pro, manufactured by Charlotte, NC-based PMMC) giving the health system the capability to produce patient-specific price estimates. For pre-service discussions, OhioHealth now generates an average of 9,250 estimates per month. "The estimate combines the payer’s expected reimbursement and charge information," says Carlisle. "The estimate also includes any prior balances a patient may have incurred."

Patient liability is the focus

Patient access leaders at Virginia Mason Medical Center in Seattle still are working with the hospital’s arrival teams on knowing how much to collect for a co-pay or deposit.

"We are not able to communicate the patient’s total liability, and this is something they are requesting from us today," says Kristi Hoagland, manager of admitting.

The department is upgrading its patient estimator to include liability. "This will allow us to communicate total out-of-pocket expense prior to arrival," says Hoagland.

Carlisle gives these tips to use when shopping for a price estimate tool:

• Be sure the tool is "visibly pleasing to the eye, because some¬times data can get so overwhelming and hard to follow," she says.

• When implementing a solution, pricing updates and technical upgrades need to be carefully synched and thoroughly tested in a dedicated test environment before they go live.

• Continuously evalu¬ate the solution to make sure it is being used to the fullest extent possible.

"You need to continuously monitor enhancements to the solution and new ways that you can maximize benefits from its use," says Carlisle.

As patients become more accustomed to requesting information about out-of-pocket responsibility in advance of services being rendered, hospitals are likely to become increasingly dependent on the ability to provide pricing insight, says Carlisle.

"We need to give accurate estimates to our patients coming in, so that as consumers, they can make educated choices about the healthcare they want to have," she says. "You need automation to do that successfully." (See related story, below, on how an automated eligibility tool resulted in increased collections.)

SOURCES

• Pam Carlisle, CHAM, Senior Director, Patient Access Services, Ohio Health, Columbus. Phone: (614) 544-6099. Email: pcarlisl@ohiohealth.com.
• Kristi Hoagland, Manager, Revenue Stream/Admitting, Virginia Mason Medical Center, Seattle. Email: Kristi.Hoagland@vmmc.org.
• Terri Miles, Manager, Patient Access, Wheaton Franciscan Healthcare, Glendale, WI. Phone: (414) 447-2610. Fax: (414) 447-2768. Email: Terri.Miles@wfhc.org.