BoulderCentre for Orthopedics & Spine is dedicated to providing patients with the highest possible level of care. It also is committed to improving the healthcare system and the quality and experience patients in the state of Colorado receive.

THE PROBLEM

A challenge that threatened these goals was its process (or lack thereof) to pre-collect payments for surgeries and communicate estimates with patients in the modern ways used in other industries – such as email and text.

"While we lacked an effective process, we did have a full-time employee who was solely responsible for pre-collections," said Sherri Lewis, director of revenue cycle management at the BoulderCentre for Orthopedics & Spine. "The job required many manual steps and the navigation of multiple portals and software. Because of the operational inefficiencies inherent in our technology, this employee averaged five orders per day, according to our reports in Athenahealth.

"To compound the challenge, the pre-collections our office did garner were never based on a contractual rate," she explained. "The Current Procedural Terminology codes were not matched up with our payer contracted rates and subtracted from the deductible and coinsurance to come up with an accurate estimate. Ultimately this meant our process was very unstructured and tended to be inaccurate."

PROPOSAL

When Lewis started at BoulderCentre, the CEO had purchased a revenue cycle acceleration platform called Rivet. She wanted something that was easy to use and that would also integrate with the Athena EHR.

"Unfortunately, when I first joined, the team had not adopted the technology yet, so my job was to dig in and convert the team to a streamlined technology," Lewis said. "I quickly gathered the technology would help us rethink our back-office payment process to help our team find our money, or said a different way: 'Stop leaking revenue.'

"One of the ways Rivet does this is by providing an accurate patient cost estimate, bringing insurance benefits, the right codes and BoulderCentre’s unique contracted rates with payers into consideration to deduce a good faith cost estimate," she continued. "With a good faith cost estimate, we could effectively facilitate prepayment with our patients."

Additionally, Lewis learned Rivet offers revenue recovery to address any underpayments from payers. Rivet would address all the common challenges to getting paid, and by simplifying back-end accounts receivable work, the healthcare organization would save both time and money, she added.

"As is often the case when learning a new technology, at first, my team was reluctant to learn how to use it," Lewis recalled. "They expected the new technology to create additional work, which could not be further from the truth.

"Our leadership team communicated the value-add of the platform and how it would make their jobs easier by removing the manual element of the pre-collection process," she continued. "Unlike our old process, Rivet didn’t require the team to spend the day jumping through different portals and making phone calls to insurance companies."

To galvanize the adoption of the technology, staff highlighted that through automated workflows, the team could maximize both productivity and revenue, she added.

MEETING THE CHALLENGE

The revenue cycle acceleration platform is integrated directly with the Athena EHR platform, which was nonnegotiable for Lewis when the team initially was seeking a platform to implement.

"When scheduling a surgery, an order is created in Athena by one of our medical assistants who has visibility into our physician's operating room schedule," Lewis said. "Once the date is confirmed, and the order has been approved by prior authorization, it goes to our pre-collection person.

"Once we have authorization, the person responsible for pre-collections inserts the information into Rivet to get an estimate," she explained. "While that used to be a clunky and manual process, it now is seamless and easy to use. The estimate is sent to the patient via email and text, where they can pay directly through a secure link before services are rendered."

While scheduling the surgery, the medical assistant will ensure the patient has the correct contact information and lets them know to expect a cost estimate to come their way. Patients appreciate this level of proactivity and transparency into the cost of their medical care, Lewis said.

"Though patients receive their cost estimates immediately, patients are not expected to pay immediately," she noted. "Ideally, we aim to have the prepayment collected at least five days prior to surgery. The Athena integration makes the process of gently reminding patients to pay at this point easy, ensuring no collections are missed."

Once an estimate is created, it is saved in Athena under a patient case. When a patient comes in for a pre-op appointment, the receptionist can print it out and hand it to them. In Rivet, there is a status feature where one can see if a patient has received the estimate, opened it or downloaded it.

"This has been a helpful feature and gives the team a clear understanding of where the patient is in the payment process to help mitigate any difficult conversations," Lewis explained. "Effective collections management is all about managing expectations and over-communicating with patients."

RESULTS

"Financially, implementing the platform was and continues to be a big win for BoulderCentre," Lewis stated. "Since we started leveraging it in September 2022, we’ve conducted 4,759 estimates and we’re up to $898,000 in pre-collections. It is a huge cost-effective tool in our practice that has paid for itself again and again.

"Patient AR on the back end has improved significantly, as well," she continued. "We are collecting more and collecting it faster."

From a workforce perspective, the revenue platform has increased efficiencies so that it is no longer a full-time position to just collect and run estimates.

"While we previously had multiple people working on pre-collections, the person we have on staff now has additional bandwidth to do not only all the pre-collections and estimates but also prior authorizations and work for the MRI department," Lewis said. "These workforce efficiencies are invaluable when dealing with the staffing shortages currently impacting the healthcare industry.

"Although it is not as easily quantifiable, we’re hearing feedback from patients that they value this new payment method," she noted. "When patients receive an estimate, it includes the CPT codes and diagnosis codes that are being projected, so patients can contact the surgery center for more information."

Patients do call with questions about their estimates, which staff welcome, as it means they are looking at the estimates and want to understand their care process.

"The more educated patients can be and the more information they have, the better," Lewis said. "With this improved transparency and communication with our patients, we’ve built significant goodwill for our practice in the community.

"While less measurable, the value of satisfied, happy patients cannot be overstated," she continued. "These patients are the ones helping to bring the next patient through our door."

ADVICE FOR OTHERS

"If your organization is looking to implement a revenue acceleration platform, it’s imperative to help your staff see the technology’s value so they don’t resist implementing it," Lewis advised. "New processes tend to inspire pushback because they are concerned about increased workflow.

"Help your team see that the initial learning curve and training is well worth the benefits the technology will provide the practice," she said.

Practices are operating on thinner margins than ever before, so it is essential for all sized practices to ensure they are providing the best quality of care possible while maximizing revenue, she added.

"If practice employees must spend three days manually gathering data, when they could be using more automated workflows, the practice has lost its revenue buffer," she concluded. "Leveraging technology to maximize revenue and improve the patient experience will be essential to success long term, especially as the economy continues to struggle."

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