POINT OF SERVICE COLLECTIONS OUR JOURNEY Scripps Memorial Hospital Encinitas May 4, 2015 Bessie Bennett, Access Manager - SMHE

Our Mission Scripps strives to provide superior health services in a caring environment and to make a positive, measurable difference in the health of individuals in the communities we serve. We devote our resources to delivering quality, safe, cost effective, socially responsible health care services.

Scripps Memorial Hospital Encinitas

SMHE – By the Numbers 194 Licensed Beds Patient Days – FY15 Annualized 45,822 (average 3,818 per month) Discharges – FY15 Annualized 11,234 (average 936 per month) ED Visits – FY15 Annualized 45,704 (average 3,808 per month) Surgeries – FY15 Annualized 4,798 (average 400 per month) Deliveries – FY15 Annualized 2,054 (average 171 per month)

POS Collections FY 08 - $2.5M (52% increase from FY 07) FY 09 - $2.7M (8% increase from FY 08) FY 10 - $2.8M (6% increase from FY 09) FY 11 - $2.9M (4% increase from FY 10) FY 12 - $3.2M (9% increase from FY 11) FY 13 - $3.2M FY 14 - $3.0M FY 15 - $3.0M annualized $3M POS Collection Milestone - on track for 4 th consecutive year

SMHE POS vs Best in Practice Academy of Healthcare Revenue

Healthcare Transformation Healthcare Industry Changes The Healthcare Reform Increased Health Care Costs Higher Patient Financial Obligations Stringent Regulations Payer Requirements Patient Expectations

Identifying Stake Holders Senior Leadership Nursing Leadership Case Management Social Workers Clinical Staff Patient Financial Services

Point of Entries Outpatient Rehab Radiology Imaging Center Maternity Main Admitting Emergency Department

Challenges High Healthcare Costs –Insurance to Employers –Employers to Employees –Premiums, Limited Benefits, Higher Out-of- Pocket Costs ED Unpredictable Environment EMTALA Regulations ED Utilization as Primary Care Setting

Challenges Cont.. Technology Collecting Revenue while Reducing Cost Budget Patients Cannot Afford to Pay Patients Unwilling to Pay Patients High Expectations Staffing – High Turnover Hiring the Right Staff

Collaborative Efforts Executive Leadership Nursing Leadership –Staff Meetings Case Management and Social Workers –Revenue Cycle Management Clinical Staff Participation and Feedback Patient Financial Services Public Resource Specialist

Emergency Department Redesign Reduce Overcrowding in the ED Provide Timely Patient Care Decrease Patient Wait time Improve the Rate of Patients Leaving without Treatment Patient Satisfaction

Emergency Department Redesign Hospital Leadership, clinical and non-clinical participation in early planning of the ED. The redesign improved relationships among Access, physicians, nurses, etc.

Point of Service Collections Program Assist Patients in Understanding their Financial Obligations Collecting Revenue while Reducing Cost Increase Cash Collections Improve the Patient Experience by Assuring that “We Care” Screening Patients for State Programs, Charity or Payment Arrangements

Enhancing POS Collections Program Financial Counseling Policies Prompt Pay Discount Policies Monthly and Fiscal Year Targets Team and Individual Goals State Programs –Identify patients who qualify for Financial Assistance, Increase Enrollment and Net Revenue Know your Payer Mix

Continue… Hiring the Right Staff –Utilize Behavioral Interviews –Positive Attitude, People Skills Staff Professional Development –Access Career Path Training, Scripting Clear Expectations Patient Satisfaction - Press Ganey Survey Standardize Financial Counseling Process Payment Options

Continue… Communication Boards –POS Collections Report Weekly Monthly s –Collection Tips –Top Collectors

Celebrate Success Incentive Programs –Monetary Bonuses –Quality and Human Resources Policies Non-monetary Rewards Recognition Program - Excel Together –Top Collectors –Top Performers –Customer Service

Celebrate Success Promote Healthy Competition –March Madness –Games Mile Stones –Quarterly –Semi Annual –Fiscal Year End

Final Thoughts Always have a Contingency Plan Adjust to Industry Have the Right People at the Table Explore Best Practices Persistent, Flexible, Diligent Creativity, Innovation and Fun!