Patient Cost Estimating: Three Challenges to Implementation

(Editor’s note: This is the second of a two-part report of a case study presented by Beth Israel Deaconess Medical Center in Boston at last month’s Healthcare Financial Management Association’s annual conference. Read part one, “Patient Cost Estimating: Five Benefits Every Healthcare Provider Should Know,” here.)

Understanding the benefits of implementing process and tools for estimating patient bills in advance of service is one thing; implementing it is quite another.

Beth O’Toole, senior director of revenue cycle, and Charles Messinger, director of training and QA for revenue cycle, led attendees at last month’s HFMA ANI conference through the steps they took to win approval and install a patient cost estimating tool at Beth Israel Deaconess Medical Center.

Internal buy-in
As with any project in any organization, internal buy-in is a critical component to success. Support needs to begin at the top, and then matriculate down to the stakeholder groups.

In the case of Beth Israel Deaconess, the project team was able to win the support of the executive team. “I report to the CFO and after I had his buy in, it was easy,” says O’Toole.

O’Toole and Messinger then set out to win the hearts and minds of other stakeholders within the organization, but placed special emphasis on one group in particular. “One of the key things is to get your physicians involved,” says O’Toole. “Why is that? Because patients will talk to physicians and believe they have the right answers.”

“You have to engage physicians because they know better than anyone else how patients will react to the process,” adds Messigner.

It will come as a surprise to no one that as a group they required convincing. “They were hesitant at first, but got on board,” says O’Toole, because they came to understand that the project’s goal was to educate patients and decrease patient satisfaction.

Scaling the tool and implementation
The hardest decisions to make are those that are done in the initial stages of the project. For Beth Israel Deaconess, they had to examine carefully of the implications of building or buying a tool, rolling it out enterprise-wide or in phases, and whether or not it should be used to provide information to patients or generate collections up front.

In the end, they decided to buy a tool, “because the time to build internally was daunting but the price to buy was attractive,” says O’Toole. They found an off-the-shelf product that had all the features they were seeking, she says.

The size and complexity of their organization led the project team to decide to roll out the project in phases, and careful consideration was made in selecting the departments that would go first. “We thought it was prudent to start small … and improve and learn as we went,” says O’Toole. The project team also elected for a more cautious approach, deciding to use the tool in the beginning to inform patients of their financial responsibility “and not go gangbusters and collect.”

Adds O’Toole, “You want to make sure whatever you do is not an affront to the patient. You’re trying to increase patient satisfaction, not reduce it.”

Accuracy, accuracy, accuracy
One of the biggest challenges for a patient cost estimating tool is accuracy.

Once you overcome the technical challenges of integrating the tool with internal systems (such as chargemaster, which according to Messinger was not easy), it becomes all about testing. According to Messinger, a tremendous amount of resources and time has been spent on quality assurance, making sure the estimates are as accurate as possible.

Concern about accuracy and its impact on patients also contributed to the decision to not collect balances in advance of treatment. “We wanted to get the reaction from patients and departments to see if estimates help with dissatisfaction,” O’Toole says.

Beth Israel Deaconess initially launched its project in the obstetrics department because the lead time was by far the most generous and would enable the project team to fine-tune the accuracy. Over the course of their respective treatments patients will receive two estimates, the first at their initial scheduling session, and a second, revised estimate 32 weeks into their pregnancy. According to Messinger, the patient estimating tool went live in May, and today is producing 80 estimates per week.