HFMA ANI 2009: Case study - Adventist Health implements self-service payments

Increasingly, hospitals are under pressure to recover as much as possible from self-pay patients and collect co-pays and deductibles on the spot. One way to do this is to make it easy for patients to pay--especially through retail-style self-service options like kiosks and web portals--but most non-profits haven't picked up the ball.

At this week's HFMA ANI conference, however, attendees learned how at least one large non-profit health system has gotten on board with the patient self-service trend. The net seems to be that even without much marketing, self-pay options are so popular that their use is outstripping predictions.

Adventist, the largest not-for-profit Protestant healthcare organization in the U.S., has 37 hospitals in 10 states. Over time, executives with the chain began to notice that consumers were very attracted to self-service options. In fact, a BuzzBack market research study released this year concluded that 62 percent of consumers were more likely to select a self-service provider offering mobile, kiosk and online self-service channels, according to the presenters.

Of course, with bad debt levels growing massively, new ways to increase cash flow are a big plus for hospitals. What's more, going paperless for even some payments cuts costs, said Ken Ursin, corporate director of patient financial services for the system.

In response, Adventist has built out a patient portal that includes online bill payment, pre-registration, appointment requests and a personal health record. In the future, it plans to add other payment functions, including web-based check processing and authorization for future payments.

To give attendees a sense of how this worked out, a financial manager from Adventist's Florida Hospital Fish Memorial gave a rundown on its results. FHFM, a 139-bed hospital, has deployed three patient kiosks in its facility.

Patients check in by authenticating themselves with a credit or debit card, or manually entering their name; they then verify that their demographic and insurance information is correct. When they check in, patients are notified if they owe FHFM money, and are given the option to pay some or all of the balance, or to speak with a financial counselor.

With self-service options in place, wait times at FHFM have decreased, with about 50 percent of all outpatient registrations being run through the kiosks. Data accuracy has been improved, staff can handle multiple patients at one time, and upfront cash payments and overdue balance collections have gone up.

In 2008, the kiosks and portals processed more than $4.87 million in revenue, or 4 percent of all revenue. Executives expected the total to hit 6 percent in 2009, but it appears that it will be more like 8 percent, even though "we've done a very bad job of marketing this option," says Danny Du Bosque, director of patient access for FHFM.

If your hospital wants to add kiosks, make sure they're in a high-traffic area and close to the check-in desk, Du Bosque warns. Also, brace yourself for changes in staffing patterns, as the role of registrars and front-desk personnel is likely to change. But if his experience is any guide, the effort seems to be worth the price.