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As patients take hospital bill issues public, hospitals take stock of their practices

But regulations and the rise of high-deductible plans are making a difficult job even harder.

Jeff Lagasse, Associate Editor

A hospital bill can be a complicated endeavor for a patient, prompting a backlash if it's not easily decodable.

Recently, four hospital systems in Colorado --  Centura Health, Health One, SCL Health and UCHealth -- found themselves on the defensive after 9News, based in Kusa, ran a piece that was critical of their billing practices.

The news station had invited viewers to email copies of their medical bills to give reporters an idea of what consumers were dealing with when it came to their bills. The station then invited the four health systems to their newsroom to answer on-air questions based on patients' complaints.

[Also: Geisinger CEO says health system has given $80,000 in refunds to displeased patients]

While they declined that invitation, the systems collaborated on a written response to the piece, telling reporters they understood patients' concerns and were continually working to improve and learn from best practices. Their response also highlighted many other concerns that are making it difficult to for patients to clearly understand their financial responsibilities.

Healthcare is one of the most highly regulated industries in the country, and that the complex billing process is largely a product of federal law, state regulations, industry standards and insurance regulations and contracting, they said.

"In recent years, the insurance market has shifted to more high-deductible plans, which can offer lower premiums while placing far greater financial burdens on patients when they need care," the systems wrote. "Many patients are unaware of this shift and of the specifics surrounding their current coverage."

[Also: Geisinger CEO calls for an end to ER waiting rooms, advocates for consumer-centric model]

Barbara Tapscott, vice president of revenue management at Pennsylvania-based Geisinger Health System, is a champion of her organization's billing approach, which has adopted some of the practices of the broader consumer industry in terms of providing easily digestible information. She said there are a number of reasons why a patient's bill can be overly complex.

Regulatory complexity certainly plays a part; some people covered by government programs may experience different costs, depending on the event. Another factor, said Tapscott, is how third-party insurers process claims and how they divvy up the share of costs to the patient. A patient covered by a commercial plan may not be fully aware of the intricacies of their coverage until that coverage is actually needed, and meanwhile the hospital is billing patients based on what the insurance says the patients owe. That can be complex, said Tapscott, because it's rarely the same for two different people.

Then there's misunderstanding in the industry regarding pricing.

"Today, what people pay is more the result of what insurance plans have selected in terms of coverage and deductibles," said Tapscott. "It's a multi-faceted challenge for providers to get hospital bills right. Then we go into what some providers impose on themselves by providing the patient an estimated bill, which may not reflect the real amount owed. It's very complex for the person receiving the bill to determine, 'Which one do I pay?'"

To get the billing right, Tapscott said a health system needs to make it a strategic priority, paying close attention to how it presents itself to its patients. 

Importantly, the technology needs to be robust as well. When the technology a provider already possesses is inadequate to generate the sort of information or strategic approaches it needs, there are plenty of options for outsourcing those functions, said Tapscott. Geisinger has outsourced certain of its billing processes for years.

"Everything we do in revenue cycle management has got to be supported by a strong technology base, and then the rest of it is people and process," she said. "As a provider becomes larger and expands its services, you cannot expand humans at the same rate, so technology provides economy of scale."

The biggest barrier to that kind of approach, of course, is cost. But Tapscott said the upfront investment is worth it.

"The issue is investment in resources, whether the resource is human or technology or process or all of the above," she said. "The investment and strategic direction need to be there."

Whether it be the four health systems in Colorado or a far-flung outfit in deepest Alaska, Tapscott said there are things can be done in the short term to mitigate billing confusion. One simple approach is merely to collect and aggregate data to determine just what the patients' billing concerns are -- how the customer base wants its concerns addressed.

"Hospital providers serve a very diverse population," said Tapscott. "There is a young person who wants to do everything on his or her smartphone. There is a more mature person like me who will occasionally go to the web, but wants to talk on the phone. And then there's the person who has chronic conditions and visits the hospital regularly, and wants answers to their problems in person. The only suggestion I would have here is to understand your customer base, and what is your response to your customer base, and put action behind it."

Attempts to get a comment from the four Colorado systems were unsuccessful, but one, UCHealth, told 9News that it would be willing to sit down for an on-air interview to discuss the matter. 

The letter UCHealth co-signed encouraged patients to contact their insurer before they seek care to understand their financial responsibility, and implored them to research and understand an insurance plan before signing up. The letter also suggested patients consider health savings accounts or flexible savings accounts to help plan for potential medical bills.

Earlier this year, David Feinberg, Geisinger's CEO, said ultimately the onus behind a simplified billing experience is a stronger relationship between provider and patient.

"These families, these people, all of a sudden have a wrench thrown into their life," he said. "And then you get home, and you're not sure if you're supposed to pay it or not. It doesn't match the explanation of benefits. What piles up are these bills that don't ease their way at all. They increase their anxiety. They increase their stress. If we're really caring about people, that shouldn't happen."

Twitter: @JELagasse

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