Experts say consumerism means hospital revenue cycle team must try harder to engage patients.
The U.S. healthcare system has taken a dramatic turn in recent years, as patients increasingly bear more costs in the form of higher-deductible plans and bigger co-payments. As a result, hospitals and health systems are evolving their approaches to collecting self-payments from patients who, given the costs they are bearing, increasingly view themselves as consumers and have greater expectations of the customer experience.
Healthcare administrators must start to think of their patients in this light, said Austin Kirkland, principle and founder of healthcare consultancy Outperform, LLC, and a member of the National Society of Certified Healthcare Business Consultants. That means going beyond just verifying eligibility to making sure that cost information and financial counseling is part of the upfront process for non-emergency care, he said.
"Just as patients expect proper clinical consultation early on, there needs to be financial consultation as well," agreed Munzoor Shaikh, a director at consulting firm West Monroe Partners' healthcare practice. "I think there is fundamentally good will on the side of most patients to pay, so give them the ability to talk about how they can handle payments."
But helpful financial counseling is just a start when it comes to improving collections. Providers also need to "actively look at customer service as an aspect of their business" in other respects, Kirkland said. That includes giving consumers greater control over their healthcare choices by providing them with more account information either before or at the point of care.
As patients increasingly shop around for the lowest-cost services with the highest-quality outcomes, Kirkland said it would be important to provide data about a service's costs, patient deductibles and co-pays, as well as healthcare spending trends and total spending – all on demand. Customized service options based on tracking aggregate and individual data for different consumer groups will become important, too.
Making this information available requires ongoing investment in technology infrastructure. That might mean upgrading EMR systems as they advance in usability, interoperability, and communicability with other systems to aggregate and risk-stratify clinical and financial data, Kirkland said. "The technology is more available today than in the 1990s," but by and large it's still not up to the job of giving patients access to the information they need in real-time to help them make their decisions, he said. But that will likely change over the next decade.
Nonetheless, technology is just part of the picture. Achieving success at collecting self-payments while maintaining a pleasant provider-consumer relationship means revenue cycle teams must communicate better with patients.
"You have to back this all up with customer service on the backend, which includes retraining lots of staff," Kirkland said. Or hiring new personnel with customer service experience who can better support the consumer's whole relationship with the provider, rather than simply mastering the mechanics of collecting co-pays and other fees.
"At most healthcare organizations, the people dealing with the financial aspects of patient accounts are not really customer service people. They're account representatives," he said. "You need someone who can handle the 'touch' aspect, to help create the service environment the provider wants."
Banner Health Network in Arizona is exploring alternative techniques for self-pay collections at its 13 acute-care hospitals and affiliated physician groups, said Greg Wojtal, BHN's chief financial officer. "Self-pay after insurance payments has grown substantially for Banner," he said. The health system has policies and procedures in place for conducting upfront collections, leveraging to estimate a patient's overall bill and determine a patient's individual responsibility. BHN financial advisors visit patients and their families near discharge to discuss settling their account.
"Collecting upfront payments is critical, but difficult to do in emergency situations, so we're always looking at different alternatives," Wojtal said.
According to Shaikh, some providers are investing in online self-pay portals to help collect fees in advance of services. "Self-pay portals and cost transparency would get us really far on the revenue cycle side," he said.
In most cases, patients don't seem to be alienated by conversations about their financial responsibilities, Wojtal said. "I think patients understand what they've signed up for when they use insurance plans with higher deductibles or co-payments, and they have accepted more accountability," he said. "Consumerism is the big trend in healthcare and we have to deal with it on the financial side."