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Pricing estimates: Automate your process

Patient Access Weekly Advisor, February 20, 2008

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No matter how often your patient access staff explains the myriad of variables that could affect the bill that the customer must ultimately pay, the customer won't be happy if your ballpark guess winds up nowhere near the ballpark.

In 2006, officials at the Mayo Clinic took proactive steps to mend this process when they realized that their manual approach led to time-consuming and inconsistent estimates. "We had a significant growth in our self-pay volume, and we have a pretty high degree of folks who come here for a second opinion," says Kelly White, section manager of PFS patient services and special accounts at the Mayo Clinic in Jacksonville, FL.

At the time the Jacksonville campus decided to redesign its price estimation process, the Rochester campus was using an automated database. But that, too, was far from perfect.

"It was a maintenance nightmare," White says. "They had to make sure the numbers were correct, and that was very time-consuming."

Meanwhile, the Mayo Clinic in Scottsdale, AZ, was using the same database, but to save time, staff didn't perform manual updates.

"They would just tack on 8% for price increases. So it wasn't an exact science," says White. "All three sites have an opportunity to improve the way they provided estimates."

White helped put together an enterprise team in Jacksonville to develop the following wish list of five qualities they'd like in a software product:

1. Estimates based on historical claim information, not just from the information that the physician provides. "The physician may say that he'll do a total hip replacement and that it will take him two hours, but in reality it took him five hours," says White. "We wanted the estimates based on the actual claims-what was actually going out the door."
2. The ability to add individual items from its charge description master. "So if the physician wants to do an MRI, as well, you can just easily add that into the estimate," says White.
3. Customizable software. Because each Mayo Clinic site had to work with different regulatory issues, this feature was important. Additionally, the team wanted to customize the prices to the work of individual surgeons. "One surgeon may complete a procedure in two hours, another in three. And one surgeon may prefer one more expensive supply over another," says White. "There were many variables."
4. The ability to provide the most accurate estimation at that time. "Rochester was only updating annually and Scottsdale wasn't updating at all, but we wanted the estimates to reflect the current increases and decreases in product prices," says White.
5. Software that could also help facilitate the quality assurance process. "We wanted it to show us what the variance was, and if an employee wasn't translating the information correctly," White says.

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