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By Hal Stern
Many people have been talking lately about the importance of patient engagement in healthcare. But this conversation is taking place wholly around the actual delivery of care which, while incredibly important, does not include the entire picture, namely the billing process.
This is one of those topics no one really wants to talk about. Many people see the relationship between the patient and the healthcare provider as only taking place in the exam room and not outside of it. Money is generally something healthcare providers don’t want to talk about with the patient. And it is true that there are appropriate times and places to bring up the topic. But, with healthcare reform on the mind of every hospital in America, billing issues and revenue are becoming impossible to ignore. And just like the policies are changing, the ways hospitals approach this issue are going to have to change.
With the implementation of patient satisfaction scores impacting Medicare reimbursements, hospital executives must begin to recognize that a lousy billing experience could ruin whatever pleasant experience is provided to the patient at the front door. Spending millions of dollars on a lobby and having a concierge are all well and good. But how much of all that money and effort spent delivering a positive experience is wasted by putting the patient through a bad billing experience?
The truth is that most hospitals do not have sufficient internal systems in place to provide the best customer service to their patients once they leave the hospital. Patient telephone calls that aren’t returned or not returned for days leads to patient dissatisfaction and resistance to voluntary, timely payment. And having a cumbersome payment process only leads to greater resistance to payment. How many hospitals provide patients with payment options other than writing a check, getting a stamp and an envelope, and mailing it in? How many hospital executives pay their bills this way anymore?
What this all really comes down to is the necessity to engage with the patient during the billing process just like you engage them when providing healthcare. Many items go into make this process better and more effective. Better registration and better cost estimation are among them. But here are the three biggest issues:
This is where it all starts – the bill. It’s fives pages long and incredibly complicated. Half the time, a patient doesn’t understand it or even look at it twice because it’s along with a blizzard of other paper bills. Some hospitals are trying to make them more manageable by breaking it up into categories like pharmacy, medical, and equipment. But is the patient actually being better served by this? The fact is that the average patient doesn’t understand everything that went into their healthcare and isn’t going to take the time to sit down and try to understand it themselves. This situation has only been made worse as the result of the highly publicized recently published Time magazine article on hospital bills.
The nature of a hospital bill is complicated. Simply cutting it from five pages to one isn’t going to make a difference in helping the patient. What will make a difference is someone from the hospital explaining the details of that bill to the patient. Most patients are more than happy to pay a bill if they understand what is on it. This requires engaging with the patient on this issue and working closely with them to help them understand what went into the healthcare they received.
There is no way around the fact that this is a very confusing business and hospitals have to work closely with patients to help them understand the process. Hospitals have just as much of a duty to the patient to educate them on what they are experiencing as providing them with quality healthcare.
Patients will tend to think, “I thought my insurance pays 100 percent.” Of course, few, if any insurance policies pay 100 percent so every patient is going to get an EOB and then a bill. Hospital executives must face the simple reality that most consumers do not know what is covered under their plan and what isn’t until they get the hospital bill. Most consumers also don’t know where to go to find the answers, either. Hospitals need to accept the fact that they must provide this information to their patients. It is no longer acceptable to simply send out statements, answer some of the patient calls and send unpaid accounts to collections. This traditional work plan is obsolete in the 21st century and is a major patient satisfaction killer. So hospitals need to effectively educate patients on their payment options and their insurance benefits and coverage. This situation is even more critical starting in 2014 with the expansion of Medicaid and mandated health insurance coverage.
You provided healthcare and it cost money. But your obligation doesn’t end there. Now help your patients find options on how to pay their bills. Someone has to do it and the more hospitals can provide that type of financial counseling and advice to a patient, and the closer it is to the time care is provided, the more satisfied your patients will be.
Hospitals need to see themselves in a collaborative relationship with their patients. Engage patients in conversations about payment at the appropriate times during the healthcare delivery process. If patients are admitted in the middle of the night and a financial counselor isn’t there, follow up with a phone call. Assist patients with enrollment, and whatever needs to be done to aid the patient in settling the debt quickly.
As with any human relationship, thoughtful communication is the key to success. Engaging patients in this conversation, talking respectfully with them about their bills, third party coverage and payment options will make a significant difference in helping patients settle their debts as well as increasing their satisfaction with their overall hospital experience.
Hal Stern is the founder and CEO of Financial Health, a hospital billing and Medicaid enrollment company, with more than 30 years of experience in the healthcare finance industry. He is also a member of the District of Columbia and Maryland Bars.