Hospitals face all kinds of bad publicity, from accusations of demanding payment the night before surgery to charging thousands of dollars from seemingly minor ED visits to suing patients for unpaid medical bills. Few stories focus on how hospitals help patients financially.
“Revenue cycle leaders can put the good stories out there by communicating how they are advocates for patients,” says Richard L. Gundling, FHFMA, CMA, vice president of healthcare financial practices at the Healthcare Financial Management Association (HFMA).
The importance of consumer-friendly billing practices is only growing. As of January 2021, hospitals will be required to disclose the cost of all items and services: gross charges, payer-specific negotiated charges, and the amount the hospital is willing to accept in cash.1 “Price transparency will lead to increased competition among all hospitals and health systems,” predicts David Shelton, CEO of PatientMatters.
Price-shopping patients want to know the cost in advance. They also want problem-free authorization, accurate price estimates, and no surprise bills. “For hospitals with good financial practices, it’s an opportunity to set themselves apart,” Gundling offers.
However, the work of patient access is not well-known to the public. “Work with marketing to communicate the consumer-centric work that is being done,” Gundling suggests.
Before that can happen, revenue cycle leadership must know how their hospital measures up. “Once there is an assessment of the current state, a revenue cycle leader can develop a consumerism process improvement plan,” Gundling says. “Integrate the plan with the organizational budgeting process and marketing.”
Revenue cycle departments can ask the hospital’s patient and family advisory council for feedback, or put out a survey. “Find out how patients feel about their financial experience,” Gundling recommends. If it turns out many dissatisfied people all carry the same health plan, which denied claims unfairly, that is a valuable piece of information. “The hospital can use it as leverage during contractual negotiations to streamline preauthorization and get claims paid faster,” Gundling explains.
Good financial experiences start with good front end processes. “Practices such as verifying insurance way ahead of time and telling people costs upfront are ways to avoid bad surprises,” Gundling says.
Unexpected bills are huge dissatisfiers, even for those who enjoyed a great clinical experience. “Patients don’t realize all the complexity that goes into the bill. The patient is stuck in the middle and blames the hospital,” Gundling notes.
Patients may not care as much about service level, timely notification, or medical necessity. All they know is the claim was denied. “Let’s face it: None of us really fully understands our health benefits until it’s time to actually use them,” Gundling admits.
Patient access staff can help by simply conveying the message that, “We are committed to helping you thorough this. I’m here for you.”
“People need to feel like the revenue cycle is acting as their advocate,” Gundling adds.
Before hospitals can market their positive financial experience, leaders need some convincing evidence. Asking patients a simple question (e.g., “How happy were you with the financial communication we provided?”) is one way of doing this. “If 95% were very pleased, that’s a very marketable metric. It would definitely be a differentiator in positively positioning a healthcare system or hospital,” says Kirk Stahl, VP of account service for Caldwell VanRiper, an Indianapolis-based marketing agency specializing in the healthcare industry.
Patient access also can broadcast the fact their financial counselors received advanced customer service training. “Hospitals should promote their positive results on all patient-facing tools and materials,” Shelton says.
Hospitals conveyed the message it was safe to receive needed care during the pandemic. “People were comforted by very transparent practices,” Stahl notes.
Patients saw chairs roped off to offer more space in waiting rooms and saw staff disinfecting rooms. There was no confusion about what was happening to keep everyone safe. “People want the exact same thing when it comes to their hospital bill,” Stahl says.
Clear language in price estimates and bills allows people to compare what they are told to what they owe. “It takes the mystery out of hospital costs vs. going in for surgery and getting a mega bill afterward,” Stahl explains.
Patients already know they are going to owe something. Most people understand that it is hard to predict costs of complicated procedures. “All of us know there is a financial aspect to care,” Stahl adds. “If hospitals are open and honest about this up front, it will engender trust.”
- 84 Fed Reg 65,524 (2019).