Data Mining Helps Hospitals Pry Fees from Patients

Even the Sisters of Charity sometimes need help collecting bills. That's where Conifer Health Solutions comes in. Conifer is among a handful of software companies that hospitals, like those run by the Catholic order, hire to collect payments from patients. The goal: to catch patients before they leave the hospital and eliminate collection headaches down the road.

Conifer, a unit of Tenet Healthcare (THC), and Accretive Health focus on collecting from "self-pay" hospital patients who make too much to qualify for charity care. In elective procedure cases, the companies may ask patients to fill out questionnaires. These provide data for software that assesses health and life insurance policies, income, credit reports, house ownership, even memberships in groups that may offer supplemental coverage, and helps determine how likely patients are to pay.

Self-pay patients are the biggest source of rising levels of bad debt at hospitals, said Milton Silva-Craig, executive vice-president of TransUnion's health-care business unit. Many may have lost insurance coverage after a layoff or have an increasingly popular type of health plan with lower premiums but high deductibles of $1,200 or more.

"We know that 30 percent of the population won't pay because they can't afford to, and 30 percent will pay," said Stephen Mooney, president of Conifer's Revenue Cycle Solutions unit in Frisco, Tex. His company aims to identify the remaining 40 percent who have some assets but need help figuring out whether and how they can afford their bill.

One measure of Conifer's success is the portion of patients' out-of-pocket costs, such as deductibles, that are collected before they leave the hospital or clinic, when administrators can still deal with them face-to-face. According to Tenet, about 38 percent of the total cash collected in 2009 by hospitals it owns was received at the time of service, up nearly one-third, from 29 percent, in 2006, when it started using Conifer's system.

This type of software also helps people find ways to pay, says James Connelly, chief financial officer of the Henry Ford Health System in Detroit. When a patient decided to forgo an elective procedure recently because he couldn't pay the $100,000 cost, Accretive's software discovered a medical codicil in the patient's life insurance policy that "never would have surfaced by pure chance," Connelly said. The codicil ended up covering much of the cost, he said.

Stories like that are answered prayers for many hospitals, especially those pinched by losses on charity care. "One of our main values is to take care of the poor and vulnerable," says Mary Jo Gregory, chief operating officer of Sisters of Charity of Leavenworth Health System, which operates 11 hospitals west of the Mississippi and is using Conifer software. "How do you fulfill that role and still have a sustainable ministry? Our bad debt is high, and we're facing the same issues as everyone else in terms of collections."

The bottom line: For hospitals, talking to patients upfront about fees means they can recoup more. Data mining provides the information to do that.

    Before it's here, it's on the Bloomberg Terminal.