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David Henderson: Hey, everybody. Welcome back to another episode of Time-out for Anesthesia. I'm excited to tell you that we have back with us, Courtney Franco or Franco, depending on how you want to pronounce that, with Imagine Healthcare. Great to have you back, Courtney. How are you? 

Courtney Franco: I'm awesome. I hope you are. Thank you.

David Henderson: I am awesome. I'm ready to be done with winter.

Courtney Franco: Preach. I'm in Charlotte. It's already snowed here three times. I moved away from Michigan. Snow is a four-letter word to me, so.

David Henderson: So yeah, born and raised in Texas. So it's like 40 degrees outside right now and I'm really whiny about it.

Courtney Franco: Yeah. [0:00:58.4] ____.

[laughter]

David Henderson: Like you are at four layers and...

Courtney Franco: Yeah.

David Henderson: It hailed. It hailed last night, so there was that. Yeah. Okay, well...

Courtney Franco: I'm so grateful for an electric blanket in these months.

David Henderson: There's nothing like it.

Courtney Franco: My husband not so much, but me, totally in.

David Henderson: Okay, gotcha. Taking notes. So Courtney, last time we trailed off on a topic that I wanna pick back up because I think it's extremely important and I think it really comes back to the heart of why we're all doing what we're doing. And we talked broadly about revenue cycle management billing. Specifically, we talked about data and what all it can do for healthcare providers and what it can do for practices at large and things like that. But ultimately our conversations tend to narrow down towards this one topic and that is, "What is it that we're doing that's gonna impact the patient?" Because everyone that we talk to, that's why they're doing what they're doing in a way, right? And it's great. If we're affecting the bottom line, fantastic. Do people need to make more money? Definitely. Do they need to be making accurate money? Yes, absolutely. But by and large, if we only focus on the bottom line, we'll all get burnout. So important to focus on our why and our why I think for all of us is the patient experience. And both of our companies, Graphium and Imagine, are in the software field and so we deal with technology on a day-to-day basis. So I wanna talk a little bit about how technology is affecting the patient and especially I wanna bring that into the context of post-COVID or... Can we call it the post-COVID world? 

Courtney Franco: I would. Yes. I would like to start doing that.

David Henderson: Okay. It started to...

Courtney Franco: I would like to assume the best here.

David Henderson: So anyway, post intra-COVID, wherever we are, inside of the... Now that COVID has come around, what do you think... How have you seen technology begin to affect patients in a different way now that COVID has come about? 

Courtney Franco: Yeah. Well, look, you have a great point, David. At the end of it, we are all patients. You're a patient, I'm a patient. So we can never lose sight of that because the data that we protect is so important, the people that we serve are so important, and nobody is immune from this condition of being a patient at some point. So making the patient experience better can be really challenging from a billing side, especially in a medical situation if the procedure is not elective and it's something that's traumatic, then following up with a traumatic experience with all of these bills that a patient might receive. And certainly if they're not well-informed of the hospital space and how many different bills they might receive as a result of a trauma visit can be really challenging and overwhelming to navigate. So there are a couple of things that I've seen that I think have really done a nice job with increasing maybe a patient satisfaction score. First is just the ability to properly communicate patient balances in a better patient-facing statement. So that can be really important, making sure that there's clarity on those statements as to what lies with the insurance, what lies as patient responsibility, and then giving the patient an easy way to make that payment.

Courtney Franco: My husband and I kinda joke around, it's like the QR code was sitting around with the pager and neither one of them were doing anything and then COVID hit and QR code was like, "I'm tapping in again. I've been around for years, nobody has used me, but now is my time."

David Henderson: Right.

Courtney Franco: Everyone knows how to use a QR code, from my kids taking pictures of things on toys, which is... We'll talk about it later. That's probably [0:05:32.0] ____, to my mother-in-law, who is the least technical-savvy person that I know, taking pictures of QR codes in restaurants. So when people are receiving bills and trying to navigate a patient portal and things of that nature, that QR code has been really critical in terms of getting them online and getting them to the correct resources. So I think that's part of it, right? 

David Henderson: Okay.

Courtney Franco: I also think that the ability to look at a patient holistically and say, Hey, based on some of the propensity to pay data that we're able to find on the patient and reaching out to patients who might be struggling financially to proactively offer payment plans and things of that nature is also just a really great gesture, right? 

David Henderson: Yes.

Courtney Franco: And it's something that practices that are independent really have to be mindful of because they don't necessarily have the luxury in their community of being deemed insensitive to what's going on in that community.

David Henderson: Right. Yeah. Yeah. And you see the struggle on both sides, right? We have... We've began working with a lot of facilities who have a high volume of self-pay patients, and collections along those lines become really complicated. Because on the one hand, well, you need to get paid for your services, but on the other hand, how do I at the same time express compassion for the person I've just provided the service for in the middle of this trauma and now they're gonna get a bill and everything like that? And I can think about that from the Graphium perspective, and I can think about that from a patient perspective. Like you said, "We're all patients." And I remember having a procedure done, paying for some things up front, thinking I was good, and then I get home and there's an anesthesia bill in the mail, and I don't... "I paid for this, what are you talking about?" And it was a surprise to me. So I love the language that you're using, that it's not probably ever gonna feel good to bill anyone, but you can make that such a better experience by being, and you used this word beautifully, by being proactive in the billing.

David Henderson: So when we think about Graphium as right in the middle of delivering pre-payment collections for anesthesiologists, which if you're familiar with the anesthesia billing cycle, that's how... Nobody cares if anesthesia gets paid up front. And so what we're trying to offer is instead of surprising your patient after their surgery once they get home with some bill in the mail that honestly, if it's me, I'm gonna be like, "I don't know you." And rip it up and throw it in the trash. [chuckle] Maybe I'll pay it. I'm being hypothetical.

Courtney Franco: Probably pay it. Maybe.

David Henderson: [chuckle] I definitely would. But I would feel so much better about it if I knew what was coming ahead of time and was even offered, "Hey, you can make a payment up front if you want." So you already know some things, you already know what's coming. Yeah, it doesn't feel good to bill, but you are helping the patient experience by being proactive about your communication.

Courtney Franco: Yeah, absolutely.

David Henderson: I think your point is huge.

Courtney Franco: Yeah. So at this point, I think the statistic is that the patient is the third largest payer in the country. So right after Medicare and Medicaid, it's the patient. Because so much of that responsibility has been shifted to the patient that... And oftentimes I feel like they may be ill-informed. They think they've signed up for coverage and the coverage... They either don't understand the term of co-insurance or deductibles or... Because if you're not in the space every single time...

David Henderson: I don't understand that, Courtney.

Courtney Franco: [chuckle] It's like me trying to apply for a mortgage. When you only have to deal with those things like once every five, 10, 30 years, hopefully you're not waiting 30 years, go to the doctor, that's just a really bad plan. But anyway, using those benefits can be challenging to understand the bills that you're receiving in the mail. I mean, gosh, at the time, my 18-month-old needed tubes in his ears and just the sheer number of bills that we received from that, and we had wonderful insurance, but we were still paying a tremendous amount out of pocket. And they did a really great job of explaining what was going to happen, the process upfront, what I could expect, who I could expect those bills from, because the ear, eye, nose and throat, the ENT was different than the anesthesia group that was serving them, was different than the surgery center in which it happened. And so they actually gave me a list of all of the places that I could expect bills from, right, wrong or indifferent, but at least I wasn't surprised when it happened. And I do think we could... The hospital systems could probably do a better job of that, and yet I do understand that we can't put all of the onus on them, we have to have some shared responsibility in all of this, but it can be challenging to navigate, to just understand.

David Henderson: Right. And bringing us back to kind of our core topic, the advances in technology are making this all possible because early on, and even most of the way it works still right now is, if there's not a person standing at the front desk to greet the patient and to physically take a payment from them, how is it gonna happen? And for anesthesia, specifically, they don't see the patient until they are in pre-op and they're talking through them, "Do you have any allergies?" Things like that. "I see you're in your gown, great, can you also swipe your credit card right here." Is a really awkward way to go about that, right? But now, you've mentioned QR codes, things like that, we have this little device that everybody carries around, and it's just made everything... And if healthcare could catch up to it a little bit, which I think both of our companies are so committed to helping them do, then all of a sudden you're taking... You don't need a person standing at the front desk anymore, somebody can get a text message, and it says, "Hey, you should be anticipating a bill from this anesthesia group who's gonna be helping you during your upcoming procedure that you know about, and you could actually make a payment right now. Just click this button." Right? 

Courtney Franco: Yeah, and...

David Henderson: And all we need is the phone number and we're good.

Courtney Franco: Yeah, and furthermore, the more you can integrate things like eligibility in there, and you start talking about where the patient stands with their deductibles and things like that, then you can even further educate the patient to say, "Here's where you stand on the annual deductible that you have to meet. You can expect to receive these bills. It would probably be in everyone's best interest if you go ahead and pay something upfront. That way there's no surprises, you understand you'll see this payment on your statement when it comes in the mail, you'll have a very firm understanding of where you stand with us." I think there's just so many opportunities for us to use. The problem is, perhaps, is that... Not the problem, the opportunity lies in the idea of bringing all of those systems together, all of these kind of disjointed systems that we have, making them all talk to one another will result in a much better patient experience all the way from registration to collection of balance.

Courtney Franco: And that's kind of where our two companies come in, is that you all are kind of on that front-end clinical aspect of it, and then we're on the back-end billing aspect of it, trying to kind of tidy things up at the end. So I think if there's any type of collaboration between the clinical system, the clearing house, to know more about the patient benefits, the billing application, and any time where you can get more than two systems talking to each other for the benefit of the patient, the better off you're going to be.

David Henderson: And you can correct me if I'm wrong here, but that has been our constant communication and constant hurdle since our inception, is, "Hey, will your system please talk to our system." And there's so many just alarms go off in people's minds of, "Well, what about HIPAA compliance? And do we have a BAA signed, and are you SOC 2 compliant, and well, how secure is this gonna be?" And all of this stuff, not realizing even HIPAA regulation, their original purpose was to give you a method to speak to one another.

Courtney Franco: Yeah, operability, remember that one? 

David Henderson: Right, and that all got, I think, mis-translated over time, and here's all the ways not to do things. And maybe we've kind of gotten stuck thinking that way of here's how not to communicate ever, as opposed to thinking, "Look, here's a wonderful road map for how we could all collaborate and communicate and then make the patient experience kind of cohesive and normal."

Courtney Franco: Yeah, here's the challenge. We all face a tremendous amount of liability for the data that we have, not only to keep it safe from bad actors, so company, all these different threats that are trying to infiltrate our systems independently, but then also making sure that those data connections are secure enough to meaningfully transfer that data back and forth between our systems. So I think if everyone just approaches this a little bit more from, "Hey, we're all patients. How can we make this experience even better for ourselves going forward?" If everyone approached it, all of us, all of these companies, with that mindset, we would probably get even farther faster. We certainly have to be cautious in how we approach things and make sure that we're doing our due diligence, and that we're monitoring for intrusion threats and things of that nature. But with all of the ransomware and all of the technology challenges that we face, I understand where people can be a little skittish and shy about, "Let's pump the break. Let's figure out how to share this data securely." We just can't allow that to be a stop play for us. We have to continue to push forward for the benefit of the patient.

David Henderson: Right. Yeah, totally agree. Once again fantastic points, Courtney, and thank you so much for being here. We always get so much accomplished.

Courtney Franco: Yes, my pleasure.

David Henderson: I feel like we are solving all the world's problems.

Courtney Franco: I haven't had all of my tea yet, but just give me another half cup.

David Henderson: I can't imagine. I cannot imagine.

Courtney Franco: No pun intended, right? 

David Henderson: Yeah, I mentioned it twice for a reason. Thank you so much and give our thanks to Imagine Software for letting us borrow you for a little bit. Always a pleasure and I hope to have you on again soon.

Courtney Franco: Thanks so much.

David Henderson: Take care.

Courtney Franco: Bye.