by George Evans
Over the course of my 30+ years working in healthcare IT, I have participated in hundreds of improvement initiatives as a provider CIO and now as a consultant. I, along with my team, have reduced expenses, streamlined workflows, improved quality metrics, increased cash flow and more—all to take better care of patients in the most cost-effective, high-quality manner possible. Every now and then the tables get turned and I find myself a patient rather than a supplier. At those times, I intensely observe what I’m experiencing with an eye toward making healthcare better.
I recently had an emergency room visit and minor surgery in two separate encounters at the same organization. In both cases I was registered and seen promptly, cared for by pleasant staff, and pleased with the outcome. If I had received a patient satisfaction survey upon discharge I would have given my provider top scores.
But my attitude soon changed. I received my first bill. And another bill. And another. And then three more. The six bills came from five different companies, only one of which was the provider that had performed the services. Every bill contained at least one error or unintelligible description of charges requiring a call to their customer service line. I waited on hold an average of 15 minutes, and several items took more than one call to resolve.
How can things go so well for most of the encounter and wind up unraveling right at the finish line? Billing and collections ought to be the easiest part of the whole process. As an insider, I understand how scenarios such as the above occur, but that doesn’t make them any more acceptable. To the average person the lack of coordination is baffling.
Several factors can contribute to the dysfunction:
Set and forget outsourcing – Out of sight shouldn’t mean out of mind. Don’t hide behind the vendor. Outsourcing is a great option but you still own the process from the patient’s perspective. All outsourcing vendors should be held accountable through mandated performance metrics and service level agreements. Make sure patients know how to get in contact with you if they have issues.
Perpendicular structure – Most organizations are organized vertically (registration, surgery, imaging, etc.), but patients interact with the organization horizontally. Coordination across functional units is critical to ensure optimal patient outcomes and experience. Governance that includes representation from all areas and cross-functional teams supports an integrated process and timely reaction to any hiccups.
Compartmentalized colleagues – No one owns the entire encounter (although in the patient’s mind the hospital does). In many organizations, anesthesia, emergency room physicians, radiologists and others each bill for their own services. The involvement of multiple, separate parties makes it difficult to provide a patient with an accurate estimate of total charges. A unified bill, whether accomplished by employing all the providers or via a web-based user interface (e.g. patient portal), can make you stand out from the crowd.
In their 2017 Digital Health Technology Vision, Accenture notes that “healthcare enterprises are increasingly integrating their core business functionalities with third parties & their platforms. [Healthcare organizations] have begun to realize that healthcare should be organized around the patient, not the enterprise.”
Many healthcare organizations prioritize initiatives such as expense reduction, regulatory compliance, operations improvement and quality. While these are all worthy pursuits, you can never lose sight of who you’re there for: the patient. Take the time to look at the entire care process from their perspective.
About the Author
As the son of a physician, George Evans has been in and around healthcare his entire life. He has over 30 years of experience in healthcare IT, over 20 of them as a Chief Information Officer. He’s now a Senior Manager with Sagacious Consultants, part of Accenture.