How a Safety-Net Hospital Maintains a Patient-Centered Revenue Cycle

In the Hudson Valley is Montefiore St. Luke’s Cornwall Hospital. The non-profit, safety-net hospital serves more than 270,000 patients residing in the area and hospital leaders have made this community part of its mission.

Being a patient-centered organization is part of the Montefiore St. Luke’s Cornwall’s core values and the organization has even extended that to its revenue cycle.

“We try to [have a patient-centered revenue cycle],” Jill Barton, vice president of revenue cycle at Montefiore St. Luke’s Cornwall, recently told RevCycleIntelligence. “Not only with a unified customer service experience, but the knowledge of healthcare coverage and out-of-pocket expenses is extremely complicated to keep staff fully trained.”

Operating a patient-centered revenue cycle has become more difficult for provider organizations even though patients now have more skin in the game, so to speak.

The average single deductible is over $1,600, up from just $917 a decade ago, Kaiser Family Foundation reports. And more employees are subject to these higher deductibles than ever before, the organization finds.

The trend has spelled trouble for safety-net hospitals like Montefiore St. Luke’s Cornwall, which rely more on their patients with employer-sponsored health plans for a smooth revenue cycle.

“We do our best to estimate the patient’s out-of-pocket [costs] and give them options depending on their ability to pay,” Barton stated. “The options include payments plans, assisting with secondary coverage, and financial assistance.”

Barton and her team have established a robust patient financial advocacy program to help not only commercially insured patients understand their coverage and costs but also the hospital’s main population—uninsured and Medicaid patients—access appropriate coverage.

“The patient management team, we notify them that a patient is here for services, if it is an inpatient, it's in the moment and if it's outpatient, it's after the fact, and maybe reach out to help that patient get Medicaid or secondary insurance after a Medicare plan,” Barton explained.

Every patient who comes into the hospital for a scheduled service has their insurance verified electronically, but Barton’s employees will also look at every patient who comes in for outpatient services on a regular basis whether it be for an infusion or wound care to determine if the patient has a balance and possibly another source of coverage to cover those costs.

The hospital has teamed up with the vendor PatientMatters, a Firstsource Company, to continually improve processes and help patients with high out-of-pocket costs obtain secondary insurance, if available, or even a payment plan to make medical payment manageable for patients.

But technology isn’t the holy grail for improving patient financial management; it is more like a compliment to patient financial advocates.

“We have recently added a weekly review of scheduled outpatients with growing out-of-pocket expenses, we make sure we have an advocate there to talk to them. If we miss the face-to-face conversation, we will call them,” Barton explained.

Technology also supports patient financial advocates fulfill their main responsibility: getting patients insured. Advocates can then assist patients with enrolling in Medicaid or applying for government benefits if say a patient is a veteran.

But these financial advocates can also help patients with high out-of-pocket costs identify supplemental sources of coverage to manage their healthcare costs as well as developing a strategy for paying medical bills.

The patient financial advocacy team alongside key front-end improvements, like an established pre-access center, have helped Montefiore St. Luke’s Cornwall ensure a revenue cycle that maximizes revenue collection while keeping the patient at the center of each transaction.

Moving forward, the hospital plans to bolster its patient-center revenue cycle by actually taking the patient out of one of the greatest revenue cycle pain points for providers: the prior authorization process.

“When a physician is scheduling a surgical procedure, they are the ones who can justify medical necessity, and historically, they have gotten the authorization for that service whether it is for a surgery or infusion or any other service that requires authorization. We're assessing how we can assist the physicians with this process,” Barton said.

The burden of prior authorizations has risen significantly over the last couple of years, and with an increase in burden has come an uptick in denials and, even worse, patient safety risks, providers have reported.

Prior authorizations are still a crucial revenue cycle and clinical care operation, ensuring patients can access the necessary care and providers get paid for delivering services.

Barton and her team hope to smooth out the process and keep the patient away from it as much as possible.

The endeavor will take on additional resources, including new software and access to medical records, but Barton anticipates the prior authorization improvement project to be the revenue cycle’s big undertaking this year.

Additionally, the finance executive also expects more front-end enhancements from the hospital’s ongoing EHR conversion.

“We are amid an entire electronic health records conversion that will have a better patient portal. The patient will be able to schedule appointments on their own and check in at a Kiosk when they arrive,” Barton stated.

“In recap, the revenue cycle in healthcare is very complex and it’s a continuous process improvement opportunity. Always thinking out of the box and trying new technologies must be in the forefront of every effective revenue cycle team,” Barton concluded.