Four Steps to Manage the Risks and Rewards of Patient Payments

Steve Scibetta,
Ontario Systems

The increasing number of high-deductible health plans (HDHPs) indicates a clear shift in healthcare’s financial responsibility from insurance to patient. At this point, everyone’s asking the same questions:

What risks does that shift present? And what are the opportunities?

Those involved in strategic receivables are likely aware of the 2013 Black Book survey of more than 1,900 healthcare leaders, which indicated an intentional redirection of time, resources, and talent in response to altered payment models and regulations. As a result, 2014 stands to offer the greatest focus on revenue cycle process improvement, technology, and alliances the U.S. has seen in quite some time. Most hospital CFOs are contemplating more advanced tech and services to address their growing, and more risky patient payment portfolios, looking for solutions instead of incremental enhancements to help raise the bar on their own performance.

Those moves are a direct response to a couple of facts: First, that even with financial tools like HSA accounts, patients are still generally unprepared to pay for significant medical episodes. And second, that providers continue to believe collecting patient payment is somehow in conflict with their mission or commitment to the community. Hospitals continue to drive their revenue cycle management (RCM) partners to help reconcile the two, through product and service advances, as well as fresh alliances. Everyone understands that without fiscal responsibility, more doors will close, and the community at large will suffer.

Perhaps the biggest lesson here is that for the foreseeable future, patients will play a central role in the unfolding drama – we’ve already seen the direct connection between patient satisfaction and Medicaid and Medicare reimbursement. So what steps should be taken to help self-pay patients meet the financial obligations imposed by their care, in a way that encourages financial well-being to the same degree as physical care?

1. Walk in their shoes. RCM employees should be able to see themselves in the patient’s circumstance through their personal experience or the experience of a loved one. A similar shift in thinking might be to view today’s workload not as a group of accounts, but as an opportunity to serve the patient in the same manner as the clinical team.
2. Listen, inform, and direct. Set your mind to intentionally discover financial resources available to the patient, and fairly and consistently apply opportunities for financial assistance. Clarify the patient’s financial responsibility in light of available insurances and assistance, and recast your own responsibility to that of an advocate, rather than a collector. This renewed perspective will continue to assert the importance of payment with a better, more consistent result.
3. Clarify and educate. Years ago, healthcare executives adopted patient-friendly statements as a first step toward teaching people about the cost of medical care. Similar measures can be adapted to clarify financial responsibility in light of available insurance and assistance. Many patients “wait for the insurance dust to settle” before considering their own portion. Instead, set clear expectations during the scheduling and registration process, and wash-rinse-repeat for the duration of their care.
4. Be where they are. The best retailers respond to changing demographics and buyer behavior – The best providers should too. Meet your patients where they are by making your services available 24/7 with online portals, interactive voice response, and social media.

Perhaps more than anything, RCM leaders in 2014 will best manage the risk of patient payments by meeting the consumerism of today’s patients with a consumer-minded strategy. Platforms, analytics, dashboards, automated workflow, contact management solutions, payment card processing… All important pieces of the infrastructure that helps sustain efficient practices – But they’re not central. Placing the patient experience as the guidepost by which technology and talent decisions are made will be central to your evolving receivables strategy.