A key to Baptist Hospitals of Southeast Texas’s successful advocacy program is staff with strong customer service skills 
and knowledge of coverage and payment options.

When patients have to struggle or are completely unable to pay for healthcare services, we all feel the effects. Patients often are faced with unexpected financial peril, which heightens their anxiety and compromises their dignity.

For our hospital, the answer to assisting these patients is a strong, effective patient advocacy program. Our program design assimilates key front-end processes, financial counseling, and medical authorizations with back-end patient responsibility protocols. It has improved patient satisfaction while enhancing reimbursement.

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Launch a Robust Program

Baptist Hospitals of Southeast Texas (BHSET) is a Christian not-for-profit, community-owned healthcare facility with a mission dedicated to providing high-quality health services. Located in Beaumont, Texas, a city of about 120,000 residents, the facility has 502 licensed inpatient beds with services ranging from outpatient testing to intensive care.

Beaumont is primarily an industrial city. Although the average unemployment rate of approximately 6.5 percent is only slightly higher than the national rate of 4.9 percent, many jobs are low paying, seasonal, or do not offer medical coverage. As a result, more than 38 percent of emergency department (ED) patients at BHSET are uninsured, and we anticipate that we will provide more than $25 million in charity care this fiscal year. All of these demographic needs factored strongly in the design of our patient advocacy program.

BHSET’s patient advocacy program is a coordinated set of services designed to ensure that out-of-pocket costs are minimized or eliminated. It focuses on determining the best financial outcomes for patients and the hospital. To achieve this, advocates spend time with patients and their families to determine what coverage or assistance—if any—patients may be eligible for based on their individual needs.

When we started our advocacy program at BHSET, the first step was to partner with a reputable service provider that had a strong background and experience in patient advocacy functions, such as interviewing and screening patients. The service provider’s staff who would be screening BHSET patients for coverage or charity care eligibility—known as patient advocates—needed to have expertise in federal, state, and local healthcare coverage programs, as well as charity care, financial counseling, patient collections, and the use of technology to ensure efficiency and the ability to measure and track the advocacy program.

Keys to an Effective Patient Advocacy Program
Keys to an Effective Patient Advocacy Program

Fully Screen for Eligibility

In addition to knowledge of various types of healthcare coverage and payment options, the patient advocates needed to have strong customer service skills. One reason is that eligibility screening is a “high-touch” process. Through empathetic interviewing, advocates help establish a comforting relationship with patients at BHSET. We want to send the message that we are working to help them by determining how to cover their medical costs now and perhaps in the future as well.

To determine the coverage and assistance for which they might be eligible, advocates screen all uninsured and underinsured patients at BHSET. A patient who needs screening may present in the ED, for observation, as a pre-registration walk-in, as an inpatient, or seeking a non-emergency elective procedure. Advocates gather as much documentation as possible on the front end (e.g., income statements, paycheck stubs) to help them evaluate eligibility for the many programs based on federal poverty guidelines.

Mine Potential Payers

Advocates have to be exceptionally knowledgeable about the programs available for uninsured and underinsured patients. In addition, through the patient advocacy program, health systems need to develop partnerships with local indigent programs, state-funded Medicaid and county programs, and federal programs. We’ve laid the groundwork with many groups at BHSET.

Medicaid. We partner with the state Medicaid office, hosting a state employee on-site to help evaluate patients’ eligibility and speed up their application processes.

Social Security Administration (SSA). For patients eligible for coverage through the SSA, experienced advocates can help shorten the SSA’s decision-making time frame. Monthly or quarterly meetings with the SSA help advocates monitor patients’ eligibility statuses and ensure that efficient progress is made.

Affordable Care Act (ACA). The patient advocates are ACA-certified application counselors who excel at linking qualified patients with subsidies. If the enrollment period is open, the advocate guides patients through the entire enrollment process or refers them to the local patient navigator program. During non-enrollment periods, patients may have a qualifying event that allows them to sign up for coverage.

Local programs. We serve three counties, all of which have indigent programs with different requirements. Our advocates have become experts in these programs. They help qualifying patients get direct funding or uncompensated care reimbursements for their hospital services.

Charity care. As a not-for-profit hospital, BHSET provides a certain amount of charity care. Advocates know the charity care program’s eligibility requirements. They help connect patients with financial assistance while helping the organization to meet its goals and building solid documentation to support its policies.

Employ Start-to-Finish Financial Counseling

Much like screening, effective, empathetic financial counseling also requires great customer service skills. For example, when advocates talk to underinsured customers, often they must explain that the customers have large deductibles and coinsurance payments. The effective advocate, serving the interests of both patients and the hospital, may have to explain that certain patients qualify for only partial assistance or none at all, which means that some patients will receive bills.

In those cases, advocates set payment expectations and guide patients through collection processes. Our advocates might explain discounts provided by BHSET for uninsured and underinsured patients. Patients learn about the installment plan options, as well as the advantages of flat-rate payments. Advocates also collect the point-of-service (POS) payments, including copayments in the emergency room or coinsurance and deductibles for inpatients.

Track the Numbers

Hand in hand with the high-touch work of our advocates, BHSET has implemented technologies to streamline payer applications and tracking, to give us the metrics we need for decision making, and to make collections as efficient and automated as possible.

Shared documentation is uploaded to the hospital’s billing system. Staff can review the status of each person awaiting eligibility approval. The system alerts them to follow up on outstanding applications and unpaid bills.

In the business office, we quickly pull up the numbers on pending applications and billing totals. Our reports deliver such metrics as accounts or dollars converted as a percentage of net, accounts in progress, accounts returned, and charity submissions.

By implementing a patient advocacy program, BHSET has improved customer service, collections, and self-pay conversions. In fact, a three-month sample showed a 20 percent increase in POS collections. Conversion rates increased 20 percent as well, from 37 percent in 2014 to 57 percent in 2015.

Baptist Hospitals of Southeast Texas Patient Advocacy Impact on POS Collections
Baptist Hospitals of Southeast Texas Patient Advocacy Impact on POS Collections

Baptist Hospitals of Southeast Texas Patient Advocacy Improves Conversion Rates
Baptist Hospitals of Southeast Texas Patient Advocacy Improves Conversion Rates

Recognize a Worthy Investment

Clearly, the patient advocacy program at BHSET requires plenty of hands-on time, but the results speak for themselves. Uninsured and underinsured patients are treated with respect. They get the care they need with the lowest, most convenient payments available. At the same time, the hospital maximizes its collections for patient care services.

Jerry Thompson is director of patient access at Baptist Hospitals of Southeast Texas in Beaumont.

Publication Date: Sunday, May 01, 2016