Expensive and Frustrating Process Gaps
MAP Award recipient, for a large non-profit health system, I oversaw the installation of Epic. So many things about Epic were better than our system at the time…. Unfortunately for the Revenue Cycle side, countless more were not. Many of the automated processes that we had in place before Epic, were not available after conversion. Having to add staff for the new manual processes required was in opposition to our long-standing expense control best practices, which were tracked with the Cost-to-Collect KPI. As our team worked through what we considered critical data elements and functionality following go-live, the frustration of the Revenue Cycle Management team increased. They were exasperated by the lack of functionality with Self-Pay reporting, as well as other KPI and patient engagement trends, stats and information.
For example, we needed to separate straight self-pay from self-pay balances after insurance payment. This was important to the workflow, the patient’s billing experience, and how accruals for charity and bad debt were handled in Finance. Working with Finance we were able to estimate the percentage of each, however, this compromise was not a practice I was comfortable with, especially after having this basic information available in the previous system.
Our ability to separate self-pay accounts, based on propensity scoring, was lost. Previously, we had an automated process that separated self-pay accounts, based on their predisposition to pay. This allowed those patients with a low propensity to be funneled into the charity program, which was the right thing to do for them. The remaining accounts were handled through a SP processes that required a new vendor to become involved. Increasing Expense!
Epic provided little flexibility in reporting for Business Intelligence (BI) use. As a previous Five-Time HFMA MAP award winner, when we were preparing for the next HFMA MAP application, we needed reports and trending that was not available through the Epic workbench reports. The ability to trend and report on critical KPI’s was a large part of the reporting we struggled to provide. Adding a vendor to manage the KPI’s and statistical reporting was required. More expense, and a big one!
Our automated process for refund management was not available in Epic, leaving us with a manual process…again. This loss of functionality came at the expense of adding two FTE’s. More and more expense!
The patient portal for Epic, MyChart, is very robust and a lot of functionality exists for clinical information, but it is clunky with the Revenue Cycle/Patient Billing process in mind. Charity policies, ease of navigation and flexibility for the patient to review detail charges and manage payment arrangements and other billing oriented data/functionality was not there. Enhancements to the portal required adding additional technology, from another vendor. More and more and more expense!!
Like most hospitals and health systems, IT resources were just not available for on-the-fly changes in workflows, reporting etc. Revenue Cycle projects always ended up behind the clinical areas and other projects, with RCM always waiting for the resources to be available.
So, what was there to do?
It seemed EPIC was trying to be all things while not mastering all. They said they can do certain things, or they said it was coming, related to many new or innovative technology/process, but really it just seemed to be an attempt to keep all other tech players/vendors out of the process and have their users only use EPIC for everything. It felt like they were trying to mimic Apple and not allow a more “open source” environment that truly allows the best of the best to interact seamlessly for a user.
I have never been one to accept things as they are, especially in an effort to ensure that the patient experience exceeded expectations. Creating compensating solutions for weaknesses in the new system was a complicated and expensive process, involving numerous additional vendors, whose lack of integration had numerous fail points to monitor daily. It seemed additional expense increases would never stop??
Then I was introduced to CaptureNet
Then I was introduced to CaptureNet. And what I am going to tell you next will have you saying, NO WAY. Which is exactly what I said the first time I had a chance to review the entire CaptureNet Solution.
Experience had taught me that a company could not possibly have the range of fully integrated flexible processes, features and reporting that CaptureNet provides! Right? But with finding CaptureNet, I had discovered a company that could provide all the active Self-Pay services that are needed for an integrated, smooth flow throughout the active self-pay recovery cycle. FOR ONE EXPENSE AND ONE SOLUTION.
AND, CaptureNet had the empirical proof and client references to back them up! You can just see your vendor expense line on the budget heading in the right direction… down!
CaptureNet’s solution provides Self-Pay process functionality superior to EPIC’s.
In a nutshell, CaptureNet’s solution provides superior functionality, analytics, technology and business intelligence that are critical to optimal self-pay recovery.
- CaptureNet provides predictive modeling, specific to each client’s service community. Their process uses the individual facility’s historical data and local demographics to build customized predictive models for each client and uses advanced propensity scores and guarantor level demographic and financial attribute analytics to drive automated workflows to assure and optimize recovery for every Self-Pay patient.
- All communication with the patient uses individualized scripting, whether the communication is by print mail, calls, text messages, emails or voicemail drops. The use of this style of messaging optimizes patient engagement and enhancement of the overall patient experience with the billing process. The customer service resources are handled by an integrated distributed call center with customer service representatives located in the community served by the client.
- Advanced presumptive eligibility scoring that improves the patient experience, increases “pool” payments for charity care expenses, provides ability to apply charity adjustments based on various FPL levels, and ensures compliance 501r related to ECA.
- CaptureNet’s industry-leading expansion of Business Intelligence (BI) for SP reporting is amazingly better than what is available with EPIC. CaptureNet provides real-time BI reporting for all related KPI’s, including performance, call center SLA’s, speed of cash, reconciliation, task management and more. There is the ability to manage financial classes for reporting purposes, as well as unlimited customization of reports for flexibility in reporting.
- CaptureNet uses actual Artificial Intelligence (AI) and Machine Learning to optimize workflows by integrating AI driven robotic processes for workflows like insurance discovery and re-billing, and for speech analytics to assure compliance, capture missed opportunities for collections, proper tone, and talk-off during patient conversations with customer service agents.
- CaptureNet’s streamlined and fully integrated functionality enables the processing and recovery of Self-Pay at a materially significant increase in Net Gain and reduction of clients’ historical Cost to Collect by combining the work previously required by multiple existing/bolt on vendors and improved recovery performance powered by advanced analytics driving workforce automation.
- The CaptureNet solution also provides a more robust, retail-oriented patient pay portal, with advanced functionality that links seamlessly to MyChart. Provider marketing and patient education videos can be added for additional visibility. This functionality significantly improves the patient experience and cash collections.
- Last, but not certainly not least, CaptureNet provides certified IT support/project management for the implementation of the CaptureNet solution, custom programming and continuous improvement with no drain on already stretched internal IT resources.
As good as Epic is overall, it does not provide all of the functionality and technology required to deliver best of class processes for optimizing active self-pay recovery. Bottom-line, even if you’re not an RCM executive driven by winning HFMA awards, you owe it to yourself, your hospital, and your community to take a look at CaptureNet.
About the Author
Now a consultant, Janice Ridling most recently served as Vice President of Revenue Management for Baptist Health System (BHS), Birmingham, AL, one of the largest healthcare systems in the state. During her tenure, Janice was responsible for BHS’s successful installation of Epic. Under her direction, BHS was awarded the HFMA MAP award five times. A noted speaker on a variety of healthcare topics, interviews and quotes appear frequently in industry journals including Becker’s Hospital Review, Health Leaders, Healthcare Informatics and Hospital Access Management. Janice was also one of the editors for the book, “The Trust Dimension.”