Robert LeWinter
Vice President
Regional Claims Recovery Service
North Shore-LIJ Health System
New Hyde Park, NY
Could you describe your work for North Shore-LIJ?
I’m an attorney licensed to practice in New York State since 1975 and I’ve been in the healthcare receivables business since 1976. I started Regional Claims Recovery Service for North Shore LIJ Health System in 1992 and we currently have approximately 175 employees and handle over $500,000,000 of receivables each year.
You recently completed a study on out-of-pocket medical expenses and patient ability to pay. Could you describe your findings?
One of the biggest challenges in collections is dealing with people you can’t contact. Patient cooperation is critical in receivables, especially on the self-pay side. So although we have our own collection agency, and we have the latest technology to reach out to patients, the biggest challenge is still communication with patients. We wanted to determine a way to communicate with those patients who aren’t able to pay – patients who would be eligible for charity care. So we decided to add a new analytic to the charity care identification process that analyzes out-of-pocket medical expenses as a percentage of family income. We worked with TransUnion healthcare on an algorithm that would pin down at what point patients do not have the ability to pay. We examined tens of thousands of records, and it became clear that when patient responsibility exceeded 3.5 percent of income, our recoveries dropped significantly. Since we had good confidence in our income projections, we targeted these patients for charity assistance.
How did you communicate their status to them?
About two-thirds of the way through the active A/R cycle, we send a letter to patients. One letter is geared to those patients with insurance who are used to dealing with copays and deductibles. The other two letter types are divided between collectible versus non-collectible debt. Using the new analytic, we could determine if a patient would be unable to pay, so those particular letters encouraged patients to ask for charity care. The other letter indicates to patients that we will work with them on payment plans, or offer other financial assistance programs – a full gamut of payment options. Customizing the communication approach to the likely outcome begets a greater response from patients. You have to realize that you don’t have an equal opportunity to collect on each account. Recognizing that, your focus is on communicating options to people, and the result is an improvement in collections.