Price estimates have become a big priority at the University of Texas Southwestern Medical Center in Dallas.
“The landscape is shifting away a bit from point-of-service collections toward financial transparency and patient education,” says Kimberly Huffman, CHAM, director of patient financial experience and hospital access.
Patients still can pay up front. “But culturally, we do not place a heavy emphasis on payment in advance at our organization,” Huffman reports.
At first, the department expected this change would result in less upfront revenue. “Interestingly, it has not resulted in a decrease in point-of-service collections, even though that is not what we start with anymore,” Huffman explains.
Previously, staff started conversations by asking for payment. Now, staff offer some education on the basics of insurance: copays, deductibles, and policy exclusions. Next, they explain what all this means for the patient’s out-of-pocket costs. Fifty-four percent of patients receive price estimates currently. “This includes both current patients and ‘not yet’ patients who obtain self-service estimates via the patient portal,” Huffman says.
Many patients choose to pay something up front. “We set minimum standards, depending on the services they’re receiving,” Huffman says.
For instance, patients might be asked to pay 50% of the quoted estimate before proceeding. “They’re much more likely to pay up front if they trust the numbers,” Huffman notes. “The educational conversations are yielding good results.”
The following are some changes Huffman’s department made to improve price estimates:
• Estimates are much more accurate. The department now uses a single estimator tool. When imaging services are ordered, the correct CPT codes are used.
“Automatic — or as I like to say, ‘auto magic’ — estimates are created once an order is entered. There’s nothing more for our folks to do,” Huffman says.
Price estimates are immediately visible to patients via the online portal. Staff can engage in financial conversations without worrying about incorrect CPT codes causing problems.
“We are moving toward guaranteeing our estimates for some of our services,” Huffman reports. “When we get to that point, it will be something the marketing team can make a big deal about.”
• Estimates are handled the same way at all sites. Previously, price estimates were handled differently depending on the location. Some sites used a standardized tool; others used a spreadsheet developed internally. Some clinics handed patients a folder with a paper estimate. Others informed patients the estimate was only available through the patient portal.
“It caused a confusing patient experience,” Huffman acknowledges.
• Estimates now include all charges — hospital, providers, anesthesia, drugs, and other ancillary services. This makes the hospital unique in the region, according to Huffman. Competitors give estimates only for the hospital portion of the bill, so patients end up receiving multiple separate bills.
• Estimates are much easier to read. “We have really revamped the physical appearance of our estimates,” Huffman says.
The electronic version includes boxes to click that explain all the charges and instructs patients on the next steps to take. Patients can choose to pay when they arrive or contact someone for more information.
The new price estimate processes prevent unpleasant surprises. “Waiting until the day [patients] show up, when they fasted, is not the time to have that conversation,” Huffman says.
Some patients end up delaying elective services to save money. Others choose to pay in full or set up payments. “Our whole attitude and approach is that we are here to help you any way we can,” Huffman says.
To reflect this mindset, “financial counselors” are called “financial wellness advisors.”
“Clinical care is not a one-size-fits-all. We want everybody to get exactly what they need,” Huffman says. “The same is true in terms of the financial experience.”
Steady progress is happening in the number of patients who receive price estimates at Olmsted Medical Center in Rochester, MN. “People are picking places to go for healthcare like they do with retail. We need to be more open with them so they understand the cost,” says Robyn Berg, patient access manager.
Until recently, price quotes were not given at all. “In the old days, we just verified eligibility,” Berg reports.
Tools for real-time eligibility response give the amounts of unmet deductibles and coinsurance. Preregistration is occurring, but only for some patients. At most, about 80% of patients are preregistered. The percentage sometimes falls to fewer than half. “Preregistration is still a new concept for my staff, and they struggle to maintain a consistent percentage,” Berg says. “We are adjusting our workflows to focus on this important process.”
A team of patient service representatives handles scheduling, preregistration calls, and check-in. They now perform those tasks for telehealth services, too. “We need to ensure accurate registrations are completed prior to check-in to reduce rework and lost revenue,” Berg says.
Just giving everyone a price estimate is not enough. Staff still need to explain how they came up with the numbers. “It’s very scary to talk about money with a patient,” Berg admits. “But if you don’t, you’re setting them up to be worried about the bill.”
At Chandler (AZ) Regional Medical Center, all patients receive price estimates before scheduled services. It is usually handled by phone, but if staff cannot reach the patient, it is covered at registration.
“This ensures patients can make an informed decision about their healthcare and financial needs,” says Linda Burke, patient access director.
Accuracy of the price quotes depends on many factors. Sometimes, a contractual agreement changes. Issues also can arise if new medications or procedures are not loaded in the estimate tool, or because of human error. The important thing is to know what is happening. “Data on identified trends motivates our teams to move to the next level,” Burke adds.