Zafar Hasan is posting the attached slide deck on self-payment in hospitals. Its a great deck.

1. HFMA’s Healthcare Financial Pulse
The Changing Face of
Self-Payment in Hospitals
November 2009
HFMA’s Healthcare Financial Pulse is sponsored by:

2. Impact on Self-Pay Receivables
• Part I. What hospitals are experiencing
• Part II. What hospitals are doing
• Part III. Keys to success
• Appendix A. Additional resources
• Appendix B. Survey methodology
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3. Part I. What Hospitals Are Experiencing
Overview of Findings
• 97% of hospitals surveyed have experienced an increase in
self-pay accounts receivable compared with prior fiscal year
• Small hospitals were most likely to experience a self-pay
increase of greater than 10%
• Receivables are growing faster than patient revenue at
almost one-third of respondent hospitals
• Emergency departments and unscheduled outpatient
services are experiencing the most self-pay growth
• Difficulty estimating the cost of charges is a significant
barrier to point-of-service collection
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4. Self-Pay Trends: Accounts Receivable
97% of respondents experienced an increase in self-pay accounts
receivable compared with the prior fiscal year. Of these hospitals:
• More than one-third have
experienced an overall
increase of 10% or greater
• 39% have experienced a
growth in self-pay balance
after insurance of 10% or
greater
• One in five have had a 10%
or greater increase in bad
debt write-offs
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5. Self-Pay Trends: Hospital Size
Small hospitals (1-100 beds) were most likely to experience a self-
pay increase of greater than 10%. Of these small hospitals:
• 45% experienced a
greater than 10%
self-pay increase,
compared with 36%
overall.
• 64% saw self-pay
balance after
insurance rise by
more than 10%,
compared with 39%
overall.
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6. Self-Pay Trends: Receivables Growth as
Compared with Patient Revenue
Receivables are growing faster than patient revenue at almost
one-third of hospitals. Only 10% indicate that patient revenue is
outpacing receivables.
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7. Self-Pay Trends: Service Area
Emergency
departments and
unscheduled
outpatient services
are experiencing the
most self-pay
growth.
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8. Part II. What Hospitals Are Doing
• 72% of respondents report that they are devoting
moderate or substantial efforts toward point-of-
service collections in their facilities
– Only 50% of hospitals that are shifting resources toward
point-of-service collections are seeing decreases in their
cost-to-collect performance indicator
• Respondents are indicating that difficulty in
estimating the cost of services to be received
remains the most significant barrier to more
extensive point-of-service collections
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9. Self-Pay Trends: Barriers to Point-of-
Service Collection
More than half of
respondents say
difficulty estimating
cost of charges is a
significant barrier to
collecting at time of
service.
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10. Revenue Cycle Response to Market
Trends
Respondents have
increased accessibility
of financial counselors
and have increased
collection activity
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11. Part III. Keys to Success
• People
– High standards for hires
– Compensation structures aligned to business goals and
employee satisfaction
– Devote resources to education
• Process
– Use formal structures to obtain stakeholder input
– Target improvement around areas most affecting customer
experience
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12. Part III. Keys to Success
• Technology
– Selectively use technology for high volume transactions
– Maximize value of technology investments by improving
processes before automation
– Consider dedicating IT staff to revenue cycles systems and
support
• Metrics
– Seek the customers’ perspectives through surveys and
customer advisory panels
– Develop and regularly report measures that span the entire
revenue cycles operation
– Consider non-traditional metrics such as customer
satisfaction and employee turnover
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13. Part III. Keys to Success
• Communication
– Support a positive scheduling/registration experience
– Provide estimates of financial obligations early in the patient
interaction
– Publicize financial assistance
– Provide clear and simple billing and collections materials
• Culture
– Organizational leadership support for the revenue cycle at the
highest level
– Demand high performance from staff across the revenue cycle
– Make innovation a priority
– Celebrate success
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14. Appendix A. Additional Resources
HFMA’s Healthcare Financial Pulse
• Research, how-to guidelines, industry
analysis, and case examples
• New resources added regularly
Visit www.hfma.org/pulse
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15. A sample of the resources available
Leadership and planning
• Key Legal Issues … as a Result of the Financial Meltdown (how-to guidelines)
• The Next Wave of Mergers and Acquisitions: What’s Your Organization’s
Position? (how-to guidelines)
Cost and quality
• Benchmarking Tools for Reducing Cost of Care (how-to guidelines)
• Case Study: Seamless Service Line Management (case study)
Preserving cash
• Leveraging Business Intelligence for Revenue Improvement (case studies)
Capital
• Financing … A Guide for Small Hospitals (how-to guidelines)
• Navigating Today’s Opportunities for Capital (how-to guidelines)
Visit www.hfma.org/pulse
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16. Appendix B. Survey Methodology
• E-mail survey sent October 2009 to revenue cycle leaders and
executives in hospitals and health systems
• 92 responses received. Summary of hospital respondents:
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17. HFMA is the nation’s leading membership organization for more than 35,000
healthcare financial management professionals employed by hospitals,
integrated delivery systems, and other organizations. HFMA’s purpose is to
define, realize, and advance the financial management of health care by helping
members and others improve the business performance of organizations
operating in or serving the healthcare field. For more information about HFMA’s
Healthcare Financial Pulse, visit www.hfma.org/pulse.
HFMA’s Healthcare Financial Pulse project is sponsored by:
McKesson Corporation is the world’s leading provider RelayHealth connects providers, payers, pharmacies,
of healthcare supply, information, automation, financial institutions, and patients to support quality care
connectivity and care management solutions designed improvements and reduce administrative costs.
to reduce costs and improve care quality. McKesson RelayHealth’s proven financial clearance and settlement
solutions empower healthcare professionals with the services enable you to effectively manage your payer
tools they need to improve patient safety, reduce reimbursement and self-pay patients from inception
variability, and better manage their revenue stream and through resolution. RelayHealth securely processes over
resources. 12 billion financial and clinical transactions each year.
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