Standardizing Patient Financial Communications to Improve Consumer Experience

About Lowell General Hospital

Lowell General Hospital is a not-for-profit community hospital serving the Greater Lowell, Massachusetts, area and surrounding communities. The system offers a full range of medical and surgical services with two primary campuses located in Lowell, two Emergency Departments and series of satellite locations. Lowell General Hospital is a member of Circle Health, which along with Tufts Medical Center and Hallmark Health, comprise the Wellforce Health System.

Lowell General’s mission, “Patients First in Everything We Do,” was the foundation for its efforts to improve the consumer experience. No matter what role or position, the team strives to take the best care possible of patients, and meaningful financial conversations is a significant part of that.

Population Snapshot of Lowell General Hospital [FY2016]

Patient Discharges


Patient days of care provided


Average length of stay

3.93 days



Diagnostic imaging procedures


Laboratory procedures


Surgical procedures


Radiation therapy procedures


Emergency services


Outpatient clinic visits


Lowell General’s Patient Access Structure

Patients First: Where are the gaps?

At the start of its journey, Lowell General began to examine barriers to achieving its mission of putting patients first. In the revenue cycle, leaders identified the following gaps in its efforts to standardize patient financial communication:

  • Staff is not following standard procedures
  • Patients are told different things by different staff members
  • Varying levels of staff buy-in to the process
  • Lack of knowledge among staff about what to say to patients
  • No clear approach to teaching staff how to talk with patients about financial obligations

A Lean Journey in Action

As a lean hospital, Lowell General created a plan to hardwire patient financial conversations by helping staff understand what to say to patients and why.

Hardwiring Staff Buy-In >

Knowledge Enhancement >

Workflow Improvement >

  • Why should you have financial conversations with patients?
  • What should you say?
  • How should you say it?
  • When should you say it? (especially important in the ED)


Conversation: Staff Buy-In

Efforts began in the ED, which can be one of the most difficult areas to manage patient financial conversations and collections.



Leaders planned to start in the ED and then roll out efforts to the rest of the organization. They faced the following challenges at the start of the project:

  • Lack of buy-in from clinical areas; patients told not to worry about financial obligation
  • Patients with high copays and lack of knowledge about what they owe
  • Patients surprised when copay letter arrives stating their obligation
Revenue cycle leaders sought to gain buy-in from clinical staff by focusing on the why, sharing stories about the importance of these conversations in the patient’s overall experience.

  • Inform staff that part of building a relationship with the patient is discussing cost
  • Build a culture where ALL staff consistently talk about cost with ALL patients
  • Educate patients about payment even when they do not have a payment


Education: Staff Knowledge

Training: Workflow Optimization

Lowell General initiated a mandatory education program teaching staff how to have these conversations with patients.

The program includes four modules:

  • Customer service/laws and regulations
  • Culture competency
  • Technology
  • Financial conversations
A consistent revenue cycle training schedule was created for new employees as well as a culture of ongoing training for all staff members.

  • Front end > Registrars, Scheduling, Financial Counselors, Insurance Verifiers (every 14 days)
  • Back end > Billers, Collectors, Cashiers, Financial Representatives (every 14 days)
  • Ongoing > Everyone (every 4-7 days)


Leveraging Technology

Lowell General is leveraging technology to standardize patient financial communication and improve the revenue cycle consumer experience. The following are the key technology capabilities that support the process.

Upfront Patient Estimates

Giving patients accurate upfront patient estimates requires access to patient benefits such as copays, coinsurances and deductibles. This process depends on a consistent approach to documenting the following activities: *

  • Verifying demographics
  • Conducting QA of registration
  • Securing authorization and notification

*Gathering this information upfront and documenting it minimizes initial denials and write-offs, reducing workload for the billing office as well as the cost to collect.

Payment Access Points

A positive consumer experience depends on providing a variety of options for patients to make payments. Examples include:

  • Online payment portals
  • Pre-service education
  • Point of service reinforcement

Payment Options

Being able to offer robust financial assistance with payment plan options and discounts is a must. To do that, hospitals need the ability to:

  • Search for insurance coverage options and charity opportunities
  • Set up payment plans that fit within a patient’s household budget

Monitor Patient Touchpoints

To ensure consistency across departments and facilities, providers need methods to monitor financial discussions with patients. Technology that supports this includes:

  • Recording phone calls and in-person conversations with patients
  • Indexing recordings to the patient for retrieval and playback
  • Scoring interactions for quality assurance/performance improvement

Point of Services Collections

As part of its efforts to standardize patient financial communication and reduce bad debt, Lowell General closely monitors point of service collections and makes continuous efforts to improve.

Patient Access Team


  • Inform patients of benefits and financial obligations prior to scheduled service
  • Attempt to collect out of pocket during pre-service conversation
  • Reference call recordings for issue resolution and to ensure staff appropriately request payment
  • Deliver patient estimates by email and mail prior to services
  • Provide staff training on financial vocabulary and conversations
  • Reference recordings to ensure staff use correct terminology
  • Provide system access to see estimates/outstanding balances and process payments
  • Send daily report to clinical leadership showing missed collection opportunities



Lowell General’s efforts to standardize patient financial communication and improve the consumer experience have resulted in improvements in point of service collections and reductions in DNFBs. The health system was also recognized by HFMA as a MAP Award recipient for two consecutive years.

  • 1-2% monthly overall improvement in POS collections
  • Reduction in DNFB (Discharged not final billed) from 4.5 at FY2015 to 2.5 at FY2016 due to reduction in outpatient coding delays
  • Recipient of HFMA’s MAP Award for high performance in revenue cycle for two consecutive years, recognizing achievement of industry standard benchmarks, patient-centered best practices and outstanding patient satisfaction.