It's easy for anybody caught up in the day-to-day of healthcare administration to get caught up in the whole "data-driven" phenomenon, and all the buzzwords and jargon that accompany it.
Every once in a while, though, a project comes along that reminds us to paraphrase the mantra political campaigning guru James Carville made famous in 1992 "It's the relationship, stupid."
At Gwinnett Medical Center, about 30 miles northeast of Atlanta, Cathy Dougherty, the system's vice president of revenue cycle management, put an idea about providing better customer service first, with very little technological change in mind. In fact, she says, "I think technology is what caused us to be so impersonal in the billing cycle."
Dougherty's idea, to assign each commercially insured patient's account the kind of personal attention one might find at an upscale department store or perhaps a bank taking the "personal banker" approach, stands in contrast to much of the healthcare industry's rapt emphasis on bad debt.
"The system spends untold amounts of time and resources on uninsured patients, and I was at the end of that rope," she says. "So I said, 'I have to spend money on people I want to return, because they have choices.'"
The impetus for the approach, which Dougherty and co-author Steve Levin outlined in the January 2014 edition of Healthcare Financial Management, was the opening of the medical center's open heart program in 2012.
"I figured we were going to get some 40-year-old men who had never been in a hospital before," she says, "and my billing experience needed to be so different that they're going to think, 'Why do I need to go to downtown Atlanta for my care? This billing experience was really good.' I know that's a pipe dream, but a bad billing experience can drive you away if you have choices."
What Dougherty rolled out was what she calls "financial advocacy with a social work approach," in which each patient is assigned a staff member who follows that patient's account all the way past discharge. The staff member keeps track of the patient's insurance status and deductible and out-of-pocket obligations, and keeps the patient informed of their financial status all along the way.
"I ended up having the right people here to move into that and they love it," she says. "They like people. They understand they have to collect money. If there's a problem with somebody's insurance, we don't send them a statement that says, 'Your insurance is denied, send me $10,000.' We are going to call them and say, 'Don't fret when you get that denial from your insurance company, we're appealing this, because this shouldnt be.' We try to alleviate all these fears. I just went through a similar situation with my uncle, and it's daunting. And I'm in the business."
Thus far, Dougherty's gamble appears to be paying off. The hospital surveyed 730 patients who had received the service; all 730 reported a positive bedside financial counselor experience. More than 86 percent of them believed the new process delivered a better billing experience than they had experienced previously, either at Gwinnett or at other hospitals. Ninety-two percent thought the idea of having a direct contact in the hospital's business office was valuable, even though only 61 percent had used that contact information.
Dougherty says the hospital staff follows up with each patient by whichever technology the patient prefers: "We ask them. We won't provide their email to anybody to collect from. If you work, it's usually easier to communicate through email, but if you prefer I call you I can do that. Whatever the patient expresses as a preference is what we're going to do."
To provide some incentive to make payment arrangements prior to discharge, Dougherty also pioneered a partnership with the local chamber of commerce, in which patients who met their obligations at bedside were given the chamber's discount card. Dougherty says she has not received much feedback on the popularity of that aspect of the program, but she will seek more feedback during the next survey round, when, she says, she will finally be able to use some data to drive it further.
"I'm able to track the data now," she says. "We were in the middle of a system implementation during all this. So now I'll be able to track the data, make sure they dont go to bad debt, and actually do better reporting and metrics. So if I need more people to do it I'll have the value.
"This project is still in its infancy. My vision is way out there. Actually, my senior leadership didn't know what I was doing until after I'd done it, because I didn't want anybody to stop me. Sometimes when youre visioning, you just have to try it."
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