How Erlanger Boosted Self-Pay Collections and Patient Satisfaction


With all the attention on high medical costs, increased regulatory oversight of medical debt collection, and the resulting revenue cycle challenges, it’s easy to forget that most patients want to pay their medical bills.

By providing a simple solution focused on the patient experience, Chattanooga, TN-based Erlanger Health System was able to dramatically increase self-pay collections and maintain high patient satisfaction.

In a March webinar hosted by Becker’s Hospital Review and sponsored by CarePayment, Brian Brown, Vice President of CarePayment, and Chris Spady, Vice President of Erlanger Health System, discussed how Erlanger used CarePayment as part of its financial transformation.

Four key pieces of information:

1. The ongoing patient financial crisis is forcing providers to focus on the patient’s role in the financial journey of the healthcare system. According to Brown, about half of all households have some degree of medical debt, and 35% of patients said their bills kept them from seeking treatment in the past year. “As a result, providers have really started to focus on the patient’s role in their financial journey,” Brown said. This has included reviewing complex new and existing government regulations, improving the patient experience, reinventing the collection process, and creating personalized payment models.

2. Erlanger began its financial transformation with a six-month strategy focused on five key areas. Erlanger is a system of seven hospitals in Tennessee and North Carolina. Its financial transformation strategy was to “reinvent patient collections and increase our financial strength, while building patient loyalty through a new financial experience and patient engagement strategy,” Spady said.

Strategy goals included generating more cash, reducing complexity and time spent managing internal payment plans, streamlining processes, changing culture, and changing the community’s perception of a hospital with a safety net. Erlanger’s five focus areas were:

  • Patient Access: Submitting infusion requests per session instead of monthly, resulting in $8 million in cash acceleration
  • Coding: Hired a new coding lead and invested in contract coders, reducing invoice hold from five days to three
  • Business Office: Adopted Epic’s Financial Pulse reporting program, which increased engagement
  • Self-pay: Engaging CarePayment, which helped manage patient accounts receivable (AR) self-pay days and patient satisfaction
  • Reduced refusals: Moving from non-surgical stays of one or two days to outpatients has reduced refusals

3. As a result, Erlanger reduced total RA days in hospital from 68 to 45 days, increased cash by $84 million, and reduced self-pay balances from $145 million to 55 millions of dollars. CarePayment helped Erlanger recognize a tremendous opportunity to increase collections through interest-free payment. plans. “CarePayment used its metrics to show us how much of a hole we had,” Mr Spady said. “To take advantage of this opportunity, CarePayment qualifies each patient without any request. At the time of service, patients can immediately pay a discount or sign up for a payment plan.” If we can’t get them to commit to either, we start calling on day one, offering the CarePayment program,” he added. “If they don’t commit after 60 days, we automatically enroll them in CarePayment at instead of going to collections. It’s a gentler, more compassionate request for recovery.”

4. CarePayment generates significant financial benefits as well as patient satisfaction. Erlanger’s self-pay initiative generated $54 million in total patient collections, including $33 million from accounts older than 60 days; 40% of participating patients would not have qualified for traditional funding programs. “In addition, 93% of patients were satisfied with the CarePayment billing process, and 84% said they would return to Erlanger in the future,” Brown said.

CarePayment provides an environment to help both providers and patients resolve their financial obligations, leading to better revenue cycle management and higher customer satisfaction.

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