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Health care providers may experience a very unwelcome change in the near future if they don’t make it easier for patients to access care, warns Jack Duffy, FHFMA, director and founder of Integrated Revenue Management in Carlsbad, CA. Under the federal Employee Retirement Income Security Act of 1974, Duffy points out, insurance coverage for employees is voluntary, and employers have the ability to go to a "defined contribution" benefit plan.
Under such a plan, he explains, employers provide a fixed benefit amount, and employees have to go out and buy their own insurance. "If we as an industry persist in making it so difficult to use our service, we shouldn’t be surprised if employers withdraw [from providing insurance coverage]," Duffy says. "If we have trouble collecting copays, just think what trouble it would be if we had to collect [entire] balances."
Employers spend more and more money chasing satisfaction with health care coverage, which is ever elusive, he notes. They may begin to ask themselves, Duffy says, "Why should I put $800 a month into a health care benefit, only to be told daily that it’s the biggest source of [employee] complaints?"
For years, he adds, health care providers have enjoyed the reputation of being more difficult to use than any other service provider in the community. "It shows up every time we poll our populations. We have a universal spot in our heart for the failed transaction. We tend to discount that, ignore it. When you put [hospital] bad debt on your credit report, the general view — including lending officers — is that the health care industry is so bad at this that a medical debt that failed won’t count against you. Everybody’s got them. A rational person would not condemn valued customers to 12 months of suffering, trying to [determine] the relationship between their portion of the cost and that of the insurance while failing to explain how they work together."
This scenario between registrar and patient, Duffy suggests, reflects the current situation:
Registrar: "Did you read your policy?"
Patient: "No. Did you?"
Registrar: "No, but you’re sick and I’m not."
What consumers would celebrate is a recognition of the deficiencies in the current way of doing business and a dedication industrywide to correct those deficiencies, Duffy says, "so that patients don’t have to struggle for months and years after a health care event just to handle the basic function of payment. We don’t want to optimize a transaction which is in general viewed by our customers as onerous. We don’t want to make it better pain. We want to eliminate the pain."
It’s important, Duffy stresses, for access managers to participate in, perhaps initiate, discussions on removing what some call the hassle factor of health care. Even many of the chief financial officers and chief executive officers he meets with, he says, are amazingly unaware of what makes a good access department and why its function is crucial to the institution’s financial well-being. "They’ve never matured," he adds. "They’re still judging the quality of their access departments by the length of the line. [The thinking] is still very primitive at their level."