Patients are used to paying bills online in almost every area of their lives—credit cards, utilities, rent and Netflix, to name a few. That’s a convenience Shannon Leffler, Great River Health System’s manager of patient financial services and patient billing, wanted to add when she took on her managerial role seven years ago.
“Everywhere you go … there was an online payment option, and here, we didn’t have anything,” Leffler said. “That’s one of the things I knew I wanted to put in place.”
Back in 2013, Leffler estimates that almost all of the patients at Great River—a regional health system based in West Burlington, an Iowa city with fewer than 3,000 residents—were paying their bills by mailing checks.
But it wasn’t an immediate change. Leffler said her team tried implementing various payment solutions, and in some cases, even attempting to “piece together” their own generic one. But after five years, the team was still fielding roughly 6,000 calls each month, many of which were from patients confused about navigating the site or asking about other payment options.
It wasn’t until late 2018 that Great River implemented a patient payment portal that cut that call volume.
With the new system, patients receive an email or text alert when their billing statement is available to view online. That leads them to a portal, where they can pay medical bills online and, if they want, enroll themselves in monthly payment plans.
If a patient doesn’t respond to the email or text alert within six days, then they get a paper statement.
That process has helped Leffler’s team get more time out of their day, cutting out hours spent on the phone with patients having trouble navigating the payment process. In total, her team has seen a 60% decrease in patient call volume since implementing the system, as well as reducing time spent manually entering payments that are mailed into the office.
Keeping the team’s processes “lean” has helped scale their work, she added. Leffler noted that when Great River partnered with Fort Madison Community Hospital in 2018, the system was ultimately able to take on managing the hospital’s self-pay collections without adding additional staff because of the saved time.
In Great River’s first year of using the online system from Patientco, it saw a 33% uptick in online payments. That’s led the system, on average, to receive payments nearly 40% faster.
That speaks to patients’ desire for electronic payment options, according to Leffler. She estimates that more than half of patients use the online payment system today, which can include paying bills directly online as well as through processes like interactive voice response, an automated system to pay by phone.
But Leffler said she doesn’t ever expect to see all patients move to paying bills online. Instead, it’s about providing more options.
“We have a very high Medicare community,” she said, which accounts for nearly 40% of the system’s patients. “A lot of those patients still prefer the mailed-in payments.”
Interest in online billing is increasing nationwide. An estimated 45% of payments from patients seen at providers using Athenahealth’s electronic health record were completed online, according to recent research from the vendor, which also offers tools to pay bills online.
Digital payments as a percentage of total patient dollars increased 6% between 2017 and 2019, according to Athenahealth’s findings.
The rise in online and mobile billing services is part of a growing emphasis that health systems have put on becoming more consumer-friendly and “looking a lot more like other non-health-related services” in the past five years, said Todd Nelson, director of partner relationships and chief partnership executive at the Healthcare Financial Management Association.
That includes hospitals making moves to improve communication about medical bills and offering estimates of patients’ out-of-pocket costs, as well as making different payment options available to patients.
Nelson said he encourages health systems to get processes in place so that “when they’ve got someone who is interested in making a payment, that they can be flexible with those options (and) meet the patient where they are. Some patients like to walk to the front desk, talk to a cashier ... others would just as soon (use) a credit card, either entering that online or calling in a payment over the phone.”