July 2016

Taking Control of Transparency
By Stephanie M. Giberson, RHIT, CRCR, CPHE, MS
For The Record
Vol. 28 No. 7 P. 32

Transparency is one of health care's buzzwords for 2016. However, the term is quite familiar to the professionals at Henry County Health Center (HCHC) in Mount Pleasant, Iowa. Working with patients and helping them understand their insurance as well as copays, deductibles, and medical necessity has been how business has been for years, but with the new Iowa Hospital Associations Initiative, transparency has become front and center for almost all Iowa hospitals.

The Iowa Hospital Association (IHA) has been Iowa's most trusted, respected, and influential leader in health policy and advocacy as well as a valued resource for information and education since its inception in 1929. As a condition of membership in this esteemed organization, it is asking member hospitals to adopt IHA's transparency principles and have an implementation in place.

HCHC was awarded the Healthcare Financial Management Association's MAP award, which requires hospitals to have patient-friendly billing as well as a transparency process. It took a small team of the CFO, patient access director, and patient financial services director discussing how to be more customer oriented and proactive about the revenue cycle process to realize that this was much bigger than just front-end and back-end processes being "friendly"—it was the services being transparent as a whole that patients needed and valued.

Once the transparency initiative was placed on the docket at the state level, it became a little easier to convince the clinical departments to take a more active role in the process. The small team was then expanded to not only clinical departments but also to IT, quality, and public information. This new task force, which was implemented in September 2015, meets bimonthly to discuss all issues and requirements to move the organization forward over the coming months. For the new members, it was eye-opening; because it was being done for the most part behind the scenes or within the patient access and patient financial services departments, many had no idea what transparency even meant or that it involved them in the process. Those members who serve on their own external memberships and participate in information sharing among their colleagues found that the processes in place at HCHC have not even been discussed at other facilities; this meant HCHC would once again be on the forefront of making the path easier for others.

For HCHC's patient access department and patient financial services department, it was not a big procedural change. For the clinical side, it was quite a different story. Clinical departments were used to providing only the service, not have to think about whether the patient has insurance, whether they will have a bill, or whether the service will need to be precertified before it is provided. Another daunting task has been to get the word out to patients prior to their service that we are here to help them avoid receiving an unexpected bill afterward. Most patients thus far have been receptive to receiving the information before they have the service provided, while others still tend to be apprehensive.

Patients who went to the health information exchange and signed up for insurance when the Affordable Care Act went into effect have been some of the most appreciative of the transparency process—some had no idea of their deductibles. Once the patients find out that their insurance plan is not as comprehensive as they thought, they try to find one that is more helpful or conducive to their needs; this causes organizations to be more diligent in asking about their insurance and requesting a copy of their card more often. Some patients who do not answer our calls and come in on the day of service are escorted to a private area where financial counseling can be offered as well as new options to help them keep their finances on a positive trend. This process also allows the patient to have more of an informed choice in their health care and whether they want to have services that may be beyond what their insurance company deems medically necessary.

Change, which is now a permanent part of the vocabulary in health care, is something that can no longer be looked upon as a negative. In order for an organization to provide the best quality, most efficient, and most cost-effective care for its patients, rolling with the punches and adjusting to change proactively and positively is the most logical solution.

— Stephanie M. Giberson, RHIT, CRCR, CPHE, MS, is director of health information/communications/patient access and privacy officer/credentialing coordinator at Henry County Health Center.