Photo: Wayne Memorial Hospital
For Wayne Memorial Hospital in Jesup, Georgia, the care staff gives patients is personal. The hospital’s financial assistance program was created to ensure patients were not forgoing life-saving treatment due to costs. Because of this, the hospital has generous specifications to qualify.
THE PROBLEM
However, the hospital has to pay attention to its expenses as much as its revenue as it has thin financial margins. Rural hospitals can go down quickly if they are not attentive to these trends. Everything counts.
“We were only able to dedicate one employee to search manually for possible programs to assist our patients with their out-of-pocket expenses,” said Greg Jones, CFO at Wayne Memorial Hospital. “This was time-consuming and could be emotionally stressful as our team member was determined to assist each patient.
“Every patient had someone depending on them to provide food or shelter, to nurture or love,” he continued. “It was very frustrating not being able to come through for all of them. We were able to assist maybe 10-20% of our patients through a select few programs, while the remainder of the patient’s out-of-pocket responsibility was written off to the hospital’s charity or bad debt.”
As the hospital accrued costs for patient care, it was not seeing the revenue to cover it. It implemented a few policies and procedures to decrease any possible revenue barriers on the front end, like ensuring prior authorizations are in place for high-cost infusions, accurate processes at registration, and specialized, knowledgeable staff reviewing all claims in billing.
“Changes like this can really help prevent denials that ultimately cost the hospital, but for the long run, it may not be enough,” Jones noted. “The worst thing to happen is to be faced with not being able to help our patients or the hospital failing. Something had to be done.”
PROPOSAL
Jones and his team turned to health IT vendor Atlas Health. Because of a previous implementation with a partner hospital, Atlas knew the pressure points for a rural hospital with limited resources to assist patients, Jones said, and the company seemed dedicated to helping the community as much as the hospital was.
“The solution was straightforward,” he said. “Our hospital would have more than 10,000 programs at its fingertips to assist patients with their out-of-pocket expenses. The platform would proactively match the patients up to those programs without a person searching manually through all of the information, and the enrollment process would be automated.
“With this level of transparency and automation, we could leverage all possible sources of patient assistance prior to writing off these debts to charity or bad debt.”
Greg Jones, Wayne Memorial Hospital
“Atlas explained how one team member could do the work of three and screen all of our patients prior to leveraging our charity program,” he added.
“Another part of the solution that was proactive was that the system would be integrated with our EHR so when a patient was scheduled for an infusion, the Atlas platform would match patients up to programs prior to the patient having a balance.”
This would allow for the team to identify patients for state programs like Medicaid or MSPs and optimize the financial navigation for all patients, he added. The hospital would go from assisting 10-20% of patients to advocating for the entire infusion center’s census, he said.
“With this level of transparency and automation, we could leverage all possible sources of patient assistance prior to writing off these debts to charity or bad debt,” he explained. “That would allow us to assist our community in other charity projects outside of the infusion center. The solution Atlas offered was aligned with our mission and focus. It was an easy decision.”
MEETING THE CHALLENGE
The way Wayne Memorial Hospital’s team uses the technology to assist patients now is fairly simple. A list is created daily by Atlas for the hospital’s advocate to review. The platform automates everything needed for the patient’s enrollment.
If there are any other documents that are needed for a patient’s enrollment, the team can collect these electronically from the patient using Atlas. There is a spot for different departments to tag and communicate with each other so all stakeholders are aware of each patient’s status.
When an enrollment is completed, all of the post-enrollment awards and ordering can be tracked from the platform. “It’s a one-stop shop for all parties involved in a patient’s treatment and care,” Jones said.
The implementation was easy, he added.
“Atlas already had the code needed to pull the necessary information from our EHR to match patients in programs within the platform,” he noted. “After a few calls between our IS and their engineers, the connection between our patient accounting system, Paragon, and the Atlas platform was set up and fully ramped.
“They were even able to connect to our pharmacy dispensing system to capture provider orders without our team members having to reach out for this information each time,” he added.
RESULTS
Atlas paid for itself in the first month, Jones said.
“Within the first 90 days, we exceeded our philanthropic goal by 185%,” he said. “Every patient infused at our center was screened and enrolled in a program if one was available. Some previous balances that were written off to charity or bad debt were retroactively eligible to be submitted to certain programs for payment. Our patients were able to sit in their infusion chairs and focus on getting better instead of worrying about how they were going to pay for that visit.
“The next 90 days we exceeded our goal by 134% as we were maintaining the patient’s programs and enrolling new patients proactively,” he continued.
“At that time, Atlas had enough data to find that roughly 30% of our infusion center’s patients might be eligible for the state-funded program, Georgia Cancer State Aid. And, they facilitated our hospital becoming a participating provider. This step will alleviate even more financial burden for our patients.”
The hospital anticipates it will exceed its goal for the year by at least 110% as it’s on track to capture more than $1 million in philanthropic aid for patients. This is for balances that would have otherwise been written off to charity or bad debt. This is funding that it can use for other projects to better serve the community.
ADVICE FOR OTHERS
“Do the research and include all parties that would be involved in the process,” Jones advised. “It is instrumental to the success of a new process to pull in everyone so you can get a clear picture of what your present state is, what energy is being used and the real pain points of your current program.
“In the end, you always want to do what is right for your patients and community,” he added. “No one will know this better than the team that works with them daily.”
Once one finds the right healthcare information technology company, be a champion, he suggested.
“With so many different team members and departments often involved in decision making, someone needs to take the lead and champion the change and solution integration for the benefit of their patients and community,” he concluded.
Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.
Source: Read Full Article