As the consumer's responsibility for health care costs increase, the financial obligations tied to care can be confusing and get in the way of what matters most.
At the 2020 Annual Leadership Conference, Rodney McKendree, chief financial and business services officer, Nemours Children's Hospital in Orlando, Florida, shared how the organization improved financial processes and education efforts among staff and families.
"Within our organization, we felt like we had a problem communicating with patient families about the financial side of health care," McKendree says. "We wanted to hone our practices and think about where we were in terms of patient responsibility."
To address this problem, Nemours focused on the organization's mindset, the methods by which they educate and advocate for patients, and the overall management system.
Continuous improvement mindset
In line with the hospital's dedication to continuous improvement, the project kicked off with training and workshops for the 2,500 employees involved the financial process.
The hospital also placed emphasis on engaging frontline staff involved in the financial side of care. Leaders acknowledged the sensitivity around financial conversations and the importance of listening to and understanding staff experiences with families was an integral part of this shift in mindset.
"As managers, we needed to provide influence, but not command, over this conversation." McKendree says. "We acknowledged that frontline staff are the experts in this work and shifted to how we can remove burdens and barriers for them."
To accomplish this change in mindset, they educated staff on the reasons why and technicalities of how they planned to make these changes for the families' benefit.
Involving families from the start
Nemours wanted to see their work from the families' point of view, including interactions at the front desk, preparedness for appointments and collections' efforts. Through surveys, direct interviews and a family advisory council, they were able to learn more about the families' experiences.
"We wanted to get as much feedback as possible and not get caught up in making it too sophisticated," McKendree says. "We had to make sure we were gaining insight from our families."
Video interviews with parents provided a tangible resource to share with staff and stakeholders. The videos also highlighted a need to improve the communication about cost before appointments, so that parents could come better prepared.
Nemours moved away from financial counseling or charity qualifications and moved toward a financial advocacy role. McKendree noted they wanted to think of the financial relationship with patients as more of a partnership.
By keeping the patients' perspective in mind, they were able to change how they thought about this work and the methods by which Nemours improved its financial care.
Final outcomes
To measure the project, Nemours determined which actionable metrics to focus on, such as bad debt calculations, copay collection, estimate accuracy and preservice deposit collection.
The team also enacted daily huddles among the frontline staff, departments and executive leadership to assist with and focus on metrics, progress and problem-solving.
As a result of this work, Nemours decreased bad debt by 6%, reduced its Medicaid eligibility processing costs by half, and saved $750,000 annually by using fewer vendors.
Families now enroll for Medicaid by the first appointment on average, and 99% of eligible patients are enrolled in Nemours charity work.
