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AUTOMATED APPOINTMENT REMINDER SYSTEMSIn 2003, appointment reminder systems (ARS) for telephones began saving practice staff valuable time while reminding patientsof their appointments 24 to 48 hours prior to a visit. In these older systems, patients were prompted to call back if they had tocancel their appointment. Vendors can now offer automated systems that prompt text message or voice-activated responsesthat instantly provide scheduling changes to practice staff. In many automated systems, the patient is connected to a liveoperator after cancellation to reschedule an appointment, helping to fill all available appointments, including same-day openingopportunities, which have been proven to contribute to patient satisfaction. For Mike Milewski, MBA, executive director, LakeForest Pediatric Associates, Lake Bluff, Ill., identifying ways for staff to use ARS to refill cancelled appointment slots startedwith picking the right system and training.“First we spoke to the most impacted staff to uncover their suggestions to use ARS to improve workflow. We followed that witha long process of evaluating vendors and systems that would incorporate into our EHR properly,” Milewski says. The team paidspecial attention to change management processes for staff and patients, ensuring that an email blast introduced the newsystem and additional front desk personnel were available to manage communication preferences and ease the transition.According to a 2019 MGMA Stat poll, nearly 90% of healthcare leaders said their organizations use automated appointmentreminders. Such was the case with Lake Forest Pediatric Associates, as these reminders resulted in more rescheduledappointments, adding to revenue while eliminating missed revenue from no-show appointments.DOES YOURORGANIZATIONUSE AUTOMATEDAPPOINTMENTREMINDERS?88%YES11%NO1%NOT SUREFEBRUARY 26, 2019 POLL1,475 RESPONSESMGMA.COM/STAT#MGMASTATKeep in mind: Take time to train staff prior to implementing the system, review vendors thoroughly and speak to practices thatuse the system before investing in the technology.Automated appointment remindersystems keys to success:#1 Engage key staff at the vendorreview stage.#2 E valuate systems in relation to easeof integrating with an existing EHR.Make sure you can modify after initialimplementation.#3 T he practice IT manager must workclosely with the vendor and your EHRtechnician to ensure information isaccurate and secure, and patient privacyis maintained. 2019 MGMA. All rights reserved.RESOURCES Read more about how text message appointment reminderscan contribute to patient scheduling success. “No-shows hurt patients as well as healthcare providers.” Learnhow an automated appointment reminder system can help. Discover what one clinic learned from a year of textingpatients. Explore strategies for improving appointment scheduling,increasing patient portal adoption, reducing appointment waittimes and staffing for optimal patient access in MaximizingPatient Access & Scheduling, an MGMA Research &Analysis report.8

CHECK-IN TECHNOLOGIESOnline, kiosk and/or iPad/tablet check-in options have becomeincreasingly used by practices because they avoid the dreadedclipboard and pen lag time, especially when patients do not show upearlier than the scheduled appointment. During check-in, front deskteams greet and guide patients to a kiosk where they can sign financialresponsibility and other forms and staff can flag patients who needto re-sign or input new health insurance information. Joy Schwartz,RN, DNP, MBA, HCA, office administrator, Atlantic Surgical Group,Oakhurst, N.J., says her practice had more than a dozen documents fornew patients to sign. iPad tablets tethered to the waiting room seatswere integrated to EHR systems and prompted each patient for theappropriate updates — freeing front desk staff to expedite check-in.Patients can also log into patient portals prior to their visit topreregister via their tablet, laptop or cell phone. Schwartz reports75% patient uptake for preregistration vs. 20% of patients completingregistration when they come in for their visit. Patient engagement hasskyrocketed, and the system enabled the practice to implement anelectronic billing system, meaning more payments collected in atimelier fashion.Check-in technologies keysto success:#1 Create a strategy for communicating topatients about the new process.Many vendors can help.#2 Keep your super-user community frontand center as the audience you need toplease. These key stakeholders and thepatients they serve will be interactingmost frequently with the technology andshould be solidly on board.#3 Talk to a practice similar to your ownthat adopted the technology you arereviewing to find out what they wouldhave done differently and what theysuggest you replicate.Preregistration and in-office tablets helped the practice save money and freed staff from time-consuming paperworkreview and revision. They now focus on their patients, which has improved the practice-patient relationship. Patientswho preregister report feeling empowered and can get help from friends or family if they’re unable to use the systemthemselves. The system itself will kick out missing or illegible fields until they are complete, resulting in more complete recordsoverall. Then, data analytics from the system provides insight and prompts staff to make additional improvements for betterusage statistics. Additionally, capturing patient medical information during preregistration can provide a more complete andaccurate look at medical history and medication, leading to improved patient care.Within six months, 75% of patients preregistered online for visits, creating more complete forms and allowingthe practice to quickly incorporate electronic billing, resulting in a better bottom line.Keep in mind: Develop a plan to address issues that may pose barriers to check-in technology adoption. Issues may include: Privacy concerns as others may be able to see the entries on the iPad or kiosk Technical barriers with patients who may not be comfortable using the new system Maintenance costs of tablets/kiosks Wi-Fi connectivity and security issues, especially in many rural settingsSchwartz also cautions that the testing and implementation phase must be carefully managed, as they can determine thesuccess of the integration. “Take your time,” warns Schwartz. “Don’t move forward until key stakeholders are totally satisfied andhave approved the new workflow process.”RESOURCES Learn effective and simple patient registration best practices, as outlined by Kenneth T. Hertz, FACMPE, consultant,MGMA Consulting. Read “End of the line: Implementing patient registration kiosks” by Christie L. Dando, FACMPE, in MGMA Connectionmagazine, March 2019. Consider how healthcare kiosks can improve care delivery.9 2019 MGMA. All rights reserved.

TELEHEALTHAt one week old, Avery Griffiths was alarmingly sick — in severe circulatory distress — and rushed to the emergency room atSonora Regional Medical Center, Sonora, Calif. The transport team from UC Davis Children’s Hospital, where she could receivespecialty care, was two hours away.Sonora’s Donald P. Dudley, MD, emergency medicine, and Kelley W. George, MD, pediatrics, used a telehealth cart at theirfacility to connect with Francis Poulain, MD, pediatric neonatologist and associate professor, pediatrics, UC Davis Health, whowas working via laptop at his home.In the time it would have taken the transport team to arrive, Poulain worked with the providers at Sonora to evaluateAvery and begin treating her ailment, offering what all providers agreed was life-saving care.Jim Marcin, MD, MPH, director of pediatric telemedicine and interim director, Center for Health and Technology, UC Davis Health,has practiced pediatric critical care medicine since 1998 and has used telemedicine in his clinical work since 2000.While the UC Davis telemedicine program first was intended to provide nonurgent, outpatient subspecialty consultations to ruraland underserved clinics, the clinical programs developed out of the needs and opportunities determined by the different clinicaldepartments. For example, the obstetrics and gynecology department started with remote fetal monitoring while the pediatricsdepartment started with critical care tele-emergency consultations to sick children in rural emergency departments. Thepediatric tele-emergency program network now includes more than 30 emergency departments throughout northern California.The key uses of the telehealth program were for outpatient specialty consultations and remote consultations to keep patients intheir local communities. Marcin says that a pediatric endocrinology patient may travel five hours one way to see the specialist.The ability for the specialist to connect with those patients and check a glucometer remotely has positive outcomes for thepatient in addition to decreasing emergency department utilization, decreasing patients’ reported A1C levels and improving careagainst national benchmarks.“You’re doing it to keep patients in their own clinics and out of the hospital, as well as [offering] a service toreferring practices, which provides marketing and a competitive edge. Working with other clinics and hospitalsstrengthens a relationship with that hospital,” Marcin says.35%29%WILL YOUOFFERTELEHEALTHSERVICESIN 2019?NOCURRENTLYDO17%19%PLANNINGTOUNSUREFEBRUARY 19, 2019 POLL1,220 RESPONSESMGMA.COM/STAT#MGMASTAT 2019 MGMA. All rights reserved.10

Keep in mind: Integrating telehealth into existing processes is a keymethod to increase provider buy-in: The less change to implement, thebetter. It also helps to understand which areas will be the easiest to addtelehealth services. Mental health often is an easily achieved, one-onone encounter, whereas multidisciplinary encounters such as diabetesmanagement are more difficult to implement via telemedicine becauseof the number of providers, support staff and testing required.RESOURCES The above was an excerpt from Telehealth: Adoption BestPractices, an MGMA Research & Analysis report. Download thefull report to learn how to plan, implement and bill for telehealthservices, understand the operating requirements and billingand reimbursement guidelines to ensure successful adoption oftelehealth services.11Telehealth keys to success:#1 Review your reimbursement options.#2 Consider how telehealth might apply toyour specialty and current workflows.#3 Understand your patient demographics.Practices with a largely rural and/ortech-savvy patient population may findtelehealth offerings especially effective.#4 Pilot the technology with one physicianbefore investing in the technology for theentire practice. 2019 MGMA. All rights reserved.

DIGITAL PAYMENT OPTIONSIt’s estimated that multispecialty practices collect only slightly more than half of accounts receivable (A/R) within 30 days and thatup to two-thirds of physician practice revenue is lost because of billing leakage.iii Digital payment options can permit practicesto close the gap between A/R and receiving payment directly from the patient. About two years ago, Roger Hovis, operationsmanager, El Paso Pediatrics Associates, and his team implemented digital payment options for patients via credit card on file(CCoF) pages in their patient portal. After working with the new portal payment process, the front desk freed up thepayment bottleneck they’d been experiencing as well as reduced seasonal A/R via mail, thanks to taking payment upfront via credit card as well as offering payment options on the portal.In doing so, Hovis and his staff left the increasingly expensive paper trail for payments behind. In the 2018 Advisory BoardResearch Annual Health Care CEO Survey, 58% of providers reported that paper statements were still the primary methodof collecting payment from patients. This “reliance on an outdated way of billing may be a major contributor to why 73% ofproviders report that it takes longer than 30 days to collect from patients.”iv Further, most respondents in a 2017 MGMA Statpoll indicated that they collect a combination of payments up front (59%) to include copay (98%), deductibles (78%) and majorprocedure estimates (54%).WHAT DO YOUCOLLECT UP-FRONT?MAJOR PROCEDUREESTIMATE ONLY1%DEDUCTIBLE ONLY98%COMBINATION59%1%78%54%NOTHING5%COPAYS ONLYAPRIL 4, 2017 POLL1338 APPLICABLE RESPONSESOUT OF 1434 TOTAL EFOR MORE INFORMATION,VISIT MGMA.ORG/POLLS.“We have gained the ability to turn each wait station into a credit card processor,which helped us reduce overhead we spent ‘chasing the money’ every month,”Hovis says. He counsels practices to take their time while preparing for implementation.Time well spent means everyone is included in the process of creating new workflowsfor the payment system. The practice also conducted extensive research into thebottom-line benefit of the portal payment option to gain buy-in. Payments automaticallypost into the billing platform, removing personnel from manually posting into the system.Parents of the patients report that they like to sign up directly through the portalat home — it’s convenient and they appreciate being able to pay bills withoutopening mail or mailing checks.“We promoted the portal heavily with patients, who ended up really liking that they hadtheir kids’ vaccination records and other medical data such as refill requests in oneplace,” Hovis says.Today, 75%-80% of families in their pediatric practice have an account. They have suchhigh patient adoption, they plan to include check-in options on the portal soon, as well.Hovis reports that the patients in his practice were eager to use digital bill payment.They’re not alone: “Consumers are seemingly ready for healthcare to jump on thedigital revolution. While 79% of consumers still receive a paper medical bill, only21% of consumers want to use checks to make healthcare payments.” v 2019 MGMA. All rights reserved.12Digital payment optionskeys to success:#1 Heavily promote the portalamong patients for highadoption rates.#2 Research workflowscarefully and use changemanagement best practicesto ensure staff buy-in.#3 Offer additional reasonspatients would want to visitthe portal, for vaccinationand prescription refills,for example, to help withuptake in portal payments.

Keep in mind: Practices that don’t have the staff to fully promote digital payment options will take longer to reap the benefits ofthe new system. Some technology vendors have low-rated support for their solutions, are too expensive for smaller practices(they only sell platform-based payment technologies with proprietary tech) or do not support debit payments. In addition, somepatient groups are wary of CCoF options due to highly publicized data breaches.PRACTICE SPOTLIGHT: PATIENT BILLING GAINS GROUND IN SATISFACTION, REVENUEWestmed Medical Group, managed by Westmed Practice Partners, was tracking many billing-related complaintsand questions on its patient relations service hotline. In the age of the empowered consumer, Westmed recognizedthat providing the best patient experience required new, updated payment methods. They evaluated multiplevendors and chose Cedar, a patient payment and engagement platform powered by machine learning to deliver apersonalized, convenient digital experience. “We were very focused on choosing an innovation partner we couldtrust — one who was willing to incorporate our changing needs into their technology,” said Vicki McKinney, COO,Westmed Practice Partners.Key Benefits and Features Personalized communication driven by machine learning creates greater likelihood to engage: Once a claim isprocessed and the patient balance is identified, patients receive customized payment notifications and remindersabout what they owe via their preferred method — email, text or a traditional paper statement. Algorithms arecontinually refined to ensure optimal outreach methods based on patient preferences and past behavior. Patient-centered interface delivers a better, faster payment experience: Once patients are on the onlinebill-pay platform, they are able to view all items and services for their visit, as well as for other authorized familymembers associated with their account, all on one easy-to-read screen. Confusing billing codes are translatedinto clear human language, and patients can choose to pay the full amount using a variety of secure paymentmethods or click on a customized payment plan. Online chat feature provides real-time support for patients: Westmed patients utilize the live chat functionalityto get quick answers to their questions, helping to speed up the payment process and alleviate call center burden.ResultsAfter a successful pilot in spring 2018, the Cedar solution was rolled out to Westmed’s entire patient population.Patient satisfaction, online adoption rates and collection rates continue to surpass benchmark goals. 95% patient satisfaction 67% patient payments made digitally 44% reduction in time to collect (from 39 to 22 days*)“It’s important to remember that the patient experience extends beyond office visits and hospital stays. Unpleasantbilling experiences can greatly impact patient satisfaction and revenue, so you want to make the process as easy andtransparent as possible,” says McKinney.*22 days to collect represents Q1 2019 averageRESOURCES Explore the Eighth Annual Trends in Healthcare Payments Report. Uncover opportunities in patient billing by examining the following areas: patient payment responsibility, transparencyand flexibility. Listen to Sheila Augustine, director, patient financial services, Nebraska Medicine, Omaha, N.E., and Wendy Hanson,support manager, Nebraska Medicine, Omaha, N.E., discuss how new patient financing options have improved patientexperience in the MGMA Industry Insider podcast: Utilizing patient financing to drive patient experience. Read HIMSS19 practice insights: Deirdre Ruttle on convenient patient payment options. Deliver a modern patient billing experience by taking cues from other industries.13 2019 MGMA. All rights reserved.

DATA ANALYTICSData analytics keys to success:When back-office decisions are enabled by a stream of actionable,#1 Create data programs to solve practicefront office data, practices can uncover opportunities to enhancespecific issues such as same-daythe patient experience, uncover cost-saving opportunities in theircancellations and provider scheduling.patient flow processes and increase employee morale. Wendy Disbrow,MBA, RN, CMPE, vice president, physician network, Finger Lakes Health,#2 Have regular meetings with staff toGeneva, N.Y., and her team understand the importance of data in poweringreview key performance indicatorsdecision-making from experience. While completing certification as atracked by your analytics work.patient centered medical home (PCMH), Disbrow identified a need to#3 Find ways this technological enablementincrease same-day appointment availability. After analyzing appointmentcan grow into other programs thatdata from their EHR, she realized that while her providers' schedules wereimprove patient engagement such asbooked each week, the practice was also experiencing high cancellationportal technology.and no-show rates. Disbrow knew they needed to make improvements totheir provider scheduling processes to streamline day-to-day operationsand better serve their patients. To address this need, she generated a"prospective tool" in Excel to plan her providers' schedules and capacity asfar as one to two weeks in the future. The practice's front desk staff began utilizing the tool for scheduling patients and cancellations,which has resulted in a dramatic improvement to b

consumer remains a top 10 challenge in the 2018 Healthcare Executive Group (HCEG) survey. Moreover, healthcare leaders surveyed in the most recent HCEG poll shared a determination to explore how digital health solutions can help respond to consumer needs and improve the patient experience pre-, during and post-visit. 2019 MGMA . All rights .