Out­sourc­ing pa­tient in­ter­ac­tion,

cap­i­tal plan­ning pays off for some hos­pi­tals

Modern Healthcare - - NEWS - By Alex Kacik

The Univer­sity of Alabama at Birm­ing­ham rolled out reg­is­tra­tion kiosks at its or­tho­pe­dic clinic that in­creased its col­lec­tions nearly 60%, kept pa­tients en­gaged and bet­ter co­or­di­nated care.

The kiosks, which are pro­vided and man­aged by Clear­wave Corp., re­sem­ble those at air­ports and fast-food chains. They ag­gre­gate pa­tients’ in­sur­ance in­for­ma­tion, de­mo­graphic data, co­pays, de­ductibles, med­i­cal scans and other test re­sults.

Af­ter the April 2016 in­stal­la­tion of the kiosks, the amount of pa­per­work for or­tho­pe­dic clinic check­ins de­creased dra­mat­i­cally, the amount of time to

The Univer­sity of Alabama at Birm­ing­ham has in­creased its or­tho­pe­dics clinic’s col­lec­tions and im­proved care co­or­di­na­tion with the as­sis­tance of check-in kiosks.

check in dropped, up­front pay­ments rose 57% and, ul­ti­mately, pa­tients were hap­pier, said Rob Crab­tree, ad­min­is­tra­tive di­rec­tor of or­tho­pe­dics at UAB.

UAB now plans to in­stall pa­tient reg­is­tra­tion kiosks at its Kirklin Clinic, the largest mul­ti­spe­cialty clinic in Alabama. Pa­tients will have a bet­ter idea of the cost of care and physi­cians will be more pre­pared with all X-rays and per­ti­nent pa­tient in­for­ma­tion at their fin­ger­tips prior to treat­ment. “Pa­tients check in in a more timely man­ner; (the kiosks) re­duced the bur­den on staff and sig­nif­i­cantly in­creased col­lec­tions,” Crab­tree said. “This has ma­jor po­ten­tial for the health­care in­dus­try, which has a lot of waste and pa­per­work.”

Other health sys­tems have adopted reg­is­tra­tion kiosks in­clud­ing Sioux Falls, S.D.-based San­ford Health, which saw sim­i­lar re­sults with its par­tially out­sourced kiosk. San­ford’s pi­lot pro­gram, which the sys­tem plans to ex­pand to more clin­ics, has in­creased the sys­tem’s up­front col­lec­tions dra­mat­i­cally and helped pa­tients bet­ter un­der­stand the cost of care, said Michelle Bruhn, San­ford’s se­nior vice pres­i­dent of fi­nance for health ser­vices.

“We are try­ing to look at other ways to treat our pa­tients and help them un­der­stand the over­all cost of health­care so they feel em­pow­ered to meet that fi­nan­cial com­mit­ment,” she said. “We want to bring in­for­ma­tion to pa­tients in a fa­mil­iar way.” An ap­petite for out­sourc­ing

The kiosks are one ex­am­ple of ser­vices that providers are out­sourc­ing to re­duce costs and im­prove op­er­a­tions. Many hos­pi­tals and health sys­tems are find­ing that ven­dors or part­ners are bet­ter suited to man­age cer­tain pro­cesses. Yet, pro­tec­tions are needed in th­ese ar­range­ments to en­sure promised cost sav­ings and out­comes are de­liv­ered (See side­bar, at right).

“Be­cause of the fi­nan­cial re­al­ity of hos­pi­tals, stones are be­ing turned over in out­sourc­ing that a few years back weren’t be­ing looked at,” said Neil Ol­der­man, a part­ner at law firm Drinker Bid­dle & Reath. “The big­gest driver is be­ing able to buy sup­plies and buy tal­ent at a level that is less costly than what a sys­tem could do on its own. That, cou­pled with the knowl­edge a ven­dor brings around man­age­ment, op­er­a­tions, re­cruit­ing and train­ing, is at­tract­ing providers.”

Wayne Me­mo­rial Hos­pi­tal in Hones­dale, Pa., hired Ves­taCare to help turn around its col­lec­tions. The hos­pi­tal was col­lect­ing about $40,000 a month in pa­tient rev­enue, but boosted that to about $300,000 by out­sourc­ing parts of its billing and pa­tient pay­ment process, said Tom Brekka, CEO of Ves­taCare.

Ves­taCare also guided Wayne Me­mo­rial’s pa­tient-fac­ing staff through the cul­tural change needed to cap­ture pay­ment prior to

“In an age of ac­qui­si­tions in the provider and am­bu­la­tory space, to make things ap­ples-to-ap­ples so ac­cu­rate de­ci­sions are made is a ma­jor need. The idea is to have all the rel­e­vant info as­so­ci­ated with a piece of equip­ment and then to pre­dict fu­ture place­ment and re­pair needs.” Mike Rozen­feld CEO At­tainia

treat­ment and help pa­tients avoid re­ceiv­ing mas­sive hos­pi­tal bills or col­lec­tion agency calls.

In­creas­ing up­front pay­ments means Wayne Me­mo­rial can buy new equip­ment, re­cruit more spe­cial­ists or ex­pand its emer­gency room, said Michael Clif­ford, chief fi­nan­cial of­fi­cer of Wayne Me­mo­rial.

Cap­i­tal man­age­ment

An­other area of grow­ing out­sourc­ing in­ter­est con­cerns cap­i­tal spend­ing. As­cen­sion Health, which spends around $300 mil­lion a year on rou­tine equip­ment ex­penses across its 141 hos­pi­tals, hired soft­ware provider At­tainia to drive ef­fi­ciency in cap­i­tal and con­struc­tion pro­jects, said Mike Rozen­feld, CEO of At­tainia.

“In an age of ac­qui­si­tions in the provider and am­bu­la­tory space, to make things ap­ples-to-ap­ples so ac­cu­rate de­ci­sions are made is a ma­jor need,” he said. “The idea is to have all the rel­e­vant info as­so­ci­ated with a piece of equip­ment and then to pre­dict fu­ture place­ment and re­pair needs.”

The data re­veals what equip­ment is un­der­uti­lized or un­nec­es­sary, which helps providers avoid friv­o­lous pur­chases, Rozen­feld said. As­cen­sion could not be reached for com­ment. Ed­ward-Elmhurst Health­care, based in Naperville, Ill., out­sourced its equip­ment man­age­ment, which helped im­prove care and lower costs, said Jeff Fri­ant, vice pres­i­dent of fi­nance. The sys­tem hired OpenMar­kets, which uses a plat­form sim­i­lar to At­tainia’s to help hos­pi­tals and sup­pli­ers cre­ate a bet­ter equip­ment pro­cure­ment process.

Look­ing for spe­cial­ists

Amid na­tion­wide la­bor short­ages in ar­eas like pri­mary care and nurs­ing, out­sourc­ing has also ex­tended to spe­cial­ists.

Providers that can’t find qual­i­fied med­i­cal pro­fes­sion­als or don’t want to get tan­gled in em­ploy­ment is­sues are con­tract­ing out in cer­tain spe­cial­ties, one of them be­ing OB-GYNs. OB Hospi­tal­ist Group has a net­work of more than 600 ded­i­cated ob­ste­tri­cian hos­pi­tal­ists serv­ing 120 ac­tive and on­board­ing part­ner hos­pi­tals across 28 states.

It han­dles all the re­cruit­ment and staffing re­spon­si­bil­i­ties while re­duc­ing a hos­pi­tal’s risk ex­po­sure, which can al­low a provider to fo­cus on its core ser­vices, said Jami Walker, di­rec­tor of hos­pi­tal op­er­a­tions at OB Hospi­tal­ist. A ded­i­cated 24/7 group of on-call hos­pi­tal­ists can re­duce vari­a­tion in safety and qual­ity, im­prove pa­tient sat­is­fac­tion and re­duce physi­cians’ work­loads, Walker said.

“Form­ing part­ner­ships with each hos­pi­tal al­lows us to un­der­stand the needs from a pa­tient stand­point and a com­mu­nity stand­point,” she said. “The tra­di­tional model is not sus­tain­able, es­pe­cially with an ag­ing med­i­cal staff.”

Con­tract­ing out spe­cial­ists can also help man­age the ebbs and flows of de­mand for cer­tain pro­ce­dures, Walker added.

Many in­de­pen­dent physi­cians and smaller physi­cian groups that can’t keep up with com­pli­ance costs and changes to pay­ment mod­els are mi­grat­ing to big­ger groups or health sys­tems.

But some ver­ti­cally in­te­grated mod­els will in­evitably fail given the added ex­pense and the com­plex­ity of man­ag­ing physi­cians, said Joel French, CEO of SCI So­lu­tions, which of­fers web-based ac­cess man­age­ment prod­ucts that con­nect pa­tients, re­fer­ring physi­cians and hos­pi­tals. “Physi­cian com­pen­sa­tion is one of the fastest-grow­ing ex­penses in health sys­tems,” he said. “It has be­come as high as 10% of to­tal ex­penses for some sys­tems.”

Some providers are turn­ing to vir­tual in­te­gra­tion, which al­lows a physi­cian to re­main in­de­pen­dent while cen­tral­iz­ing ad­min­is­tra­tion, spread­ing risk and gain­ing lever­age with health plans, French said.

Part­ners in health

Hos­pi­tals and sys­tems are look­ing to pro­vide treat­ment and in­still healthy habits on a pa­tient’s terms, hop­ing that will lead to bet­ter en­gage­ment and out­comes. So providers are search­ing for new ways to reach pa­tients to keep them healthy and en­gaged in their care. Many have found that com­mu­nity or­ga­ni­za­tions are more ef­fec­tive and quicker, so they’re out­sourc­ing parts of their outreach.

Bay­lor Scott & White has teamed up with the city of Dal­las to pro­vide nu­tri­tional and phys­i­cal ed­u­ca­tion ser­vices to the com­mu­nity that have helped cut hos­pi­tal ad­mis­sions nearly 40%.

Bay­lor Scott & White works with city-owned recre­ation cen­ters to co­or­di­nate phys­i­cal ac­tiv­ity plans and part­ners with lo­cal churches that of­fer healthy foods and nu­tri­tional ad­vice at farm stands in food deserts, said Dr. Don­ald Wes­son, pres­i­dent of the Bay­lor Scott & White Health and Well­ness Cen­ter at the Craft Recre­ation Cen­ter.

It took sev­eral years for the sys­tem to learn from its mis­takes and let the com­mu­nity di­rect its health­care needs, Wes­son said. With the help of its com­mu­nity part­ners, Bay­lor Scott & White re­duced its emer­gency depart­ment ad­mis­sions by 17% and in­pa­tient ad­mis­sions by 37%.

“We rec­og­nized that we needed to part­ner with peo­ple in the com­mu­nity to best de­liver care,” Wes­son said.

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