How you can address price-shopping patients
Offer help before patients ask
Executive Summary
Patient access departments are offering financial counseling and online price estimates to patients who call with questions about cost. Staff members from provider's offices also are calling to get estimates on behalf of patients.
- Ask patients directly if high out-of-pocket costs will create a financial hardship.
- Remind staff that prices can vary depending on the level of care given at the time of service.
- Designate top-performers in the admitting department to assist patients inquiring about cost.
"How much will it cost me?" seems like a simple enough question to patients, but patient access employees know it can quickly get complicated.
"We are seeing more patients ask for our costs. With higher out-of-pocket responsibilities, this is very important for patients to be aware of prior to having the service," says Terri Miles, patient access manager at Wheaton Franciscan Healthcare in Glendale, WI.
If a patient has a high out-of-pocket cost, Wheaton Franciscan Healthcare's registrars don't wait for the patient to ask if help is available. They ask the patient right away if the amount will create a financial hardship. "If so, we get them to a financial counselor," says Miles. The financial counselor starts working right away on assisting the patient with possible government programs that might be available or setting up a payment plan.
The biggest challenge when giving price quotes, says Miles, is that patients often are completely unaware of their benefit levels. "Staff provide patients with a self-pay estimate, or if they are willing to provide their insurance information, we can make it specific to their carrier and any contractual details that might come into play," says Miles.
Patient access staff members use an online tool to supply price quotes to patients (Emeryville, CA-based MedeAnalytics). "For services that are not yet scheduled, we require a CPT code," says Miles. "There is much variation, and we'd like that shopping quote to be fairly close in reflecting the service to be provided."
Sticker shock alleviated
At Cape Coral (FL) Hospital, patients aren't the only ones requesting estimates.
"We are also seeing staff from provider's offices calling to get estimates on behalf of the patient," says Jamie Bruner, manager of registration services. "In our region, we have a large self-pay population."
Patients are better informed with price information, "alleviating sticker shock on the day of their service," says Bruner. "It makes the check-in process smoother for both the registrar and the patient."
Prices for most diagnostic services can be found on the hospital's website, but prices for surgical procedures are "much more complex," says Bruner. Even if two surgery services are classified as the same procedure, prices might vary depending on the level of care given at the time of service. "Because of this, staff avoid telling a patient that the quote they are being given is a final price," says Bruner. Staff members are trained to inform patients:
- that the prices they are quoting are estimated prices only;
- that any additional procedures, tests, supplies, medications, and or ancillary services utilized or performed per their physician's request would be additional charges to be included on the final hospital bill.
Designated individuals in the admitting department are responsible for educating patients about cost. "These reps are identified by their leadership as top performers," says Bruner. "They are promoted from a selection of highly skilled registrars who apply for these positions."
Once promoted, the reps are trained by patient access managers on quoting difficult estimates and financial screening. They also inform potential patients about discount programs for the uninsured, self-pay deposit requirements, and installment payment arrangement options.
"All these efforts are geared toward making the process easier for the patient, in hopes that they see us as a provider of choice," says Bruner. (See related stories on online estimates, below, and how customer service skills can affect a patient's decision, p. 42.)
- For more information on providing price quotes to patients, contact:
- Jamie Bruner, Manager, Registration Services, Cape Coral (FL) Hospital. Phone: (239) 424-2659. Fax: (239) 424-4075. Email: [email protected].
- Terri Miles, Manager, Patient Access, Wheaton Franciscan Healthcare, Glendale, WI. Phone: (414) 447-2610. Fax: (414) 447-2768. Email: [email protected].
- Susan Smith, CHAA, Benefit Representative, Patient Access, Cox Medical Center Branson (MO). Phone: (417) 348-8940. Fax: (417) 348-8029. Email: [email protected].
