During the Spring of 2020 at the height of the pandemic in New York City when everything all but shut down and in-person appointments turned to telehealth visits, “self-pay at the time of service plummeted” for Mount Sinai Doctors, says Richard Nagengast, VP of Revenue Cycle.

“The most remarkable thing though,” Nagengast adds, “has been our self-pay cash collections has remained strong throughout all these months. I would have expected it to plummet during the pandemic but that has not been the case.”

Even still, the past year has been an enormous challenge for the organization to not only deliver exceptional care during a pandemic but also to financially keep things afloat.

Mount Sinai Doctors consists of nearly 30 primary care, urgent care, and specialty care groups throughout the greater New York City area, even including a few practices in Florida. It spans hundreds of clinical relationships in order to expand the health system’s footprint into the communities surrounding its eight hospital locations.

AccessOne sat down with Nagengast to discuss the physician group’s current challenges with collecting patient payments, delivering revenue cycle innovation, and improving the patient payment experience all under that backdrop of a years-long pandemic that has hit the healthcare industry particularly hard.

Aside from Covid, what challenges does Mount Sinai Doctors have with the patient payment experience?

We always joke that healthcare is 15 years behind other industries from an innovation standpoint. I’m looking for ways to do better with cash collections because it’s an increasingly challenging part of the receivables puzzle. In New York, especially, it’s highly regulated and more challenging to do self-pay collections than other states. And, my environment is so complicated: multiple billing platforms, general inefficiencies, and we’re moving toward an integrated practice model.

And then how has the pandemic impacted things for Mount Sinai?

I have 300 employees and maybe 20 need to be onsite to do various functions. We’ve maintained productivity based on how we define it, but beyond that when we took a fully engaged team that is working remotely how do you establish relationships, train, maintain, hire. All these things. What is the impact on innovations and personal relationships the longer this goes on? It’s been a challenge to be under duress for as long as we have.

During this time, however, you launched a text-based patient payment experience. Why were you interested in launching this now?

What attracted me to the solution was its simplicity. Simplicity is tried and true in other industries so why not healthcare. I am living at home with millennials who don’t even know what a paper bill is or how to make a phone call. We could call our kids three times in a row with no response from them. But, when we text them they are immediately like “what?”. I thought to myself, this has been a gap in our patient payment strategy that I’ve been aware of because of my kids. So, how do we reach out to the next big generation of patients that aren’t used to paying their bills like other people. How can we connect with them? It didn’t feel like a risk at all. For me to have to look through my mail to pay a bill? I hate it. I have all my bills automated and digital anyway so why not healthcare?

What’s been the impact on cash collections since rolling this out to patients?

It’s been such a smashing success. We haven’t even had a chance to do patient education around it but it’s so intuitive that it just worked. But, during Covid, the most remarkable thing has been our self-pay cash collections has remained strong throughout all these months. I would have expected it to plummet, but it hasn’t. Text-to-pay has been remarkably resilient as a patient payment channel in this regard.

Finally, has there been any downstream impact?

We’ve been understaffed in customer service this past year but we saw an immediate reduction in calls to the call center because patients didn’t have to call to make payments. We get something like 25,000 calls a month from patients and I don’t think we’ve ever had someone call to complain about paying by text. Our patients are very vocal so it’s been overwhelmingly positive in that regard. For us, the impact really has been the patient payments coming in during a time of great duress. Especially when they are probably not prioritizing healthcare bills in light of everything else.