Collecting on the Patient Experience

According to a Commonwealth Fund brief, 41% of under-insured U.S. adults report delaying needed care because of cost, and nearly 50% of under-insured adults report having problems with medical bills and debt. This is about twice the rate as is seen in U.S. adults who are adequately insured while reporting such problems. These unnerving statistics suggest that millions of healthcare consumers require care they can't afford and receive care they can't pay for, factors that obviously contribute to increases in hospital bad debt and decreases in profit margins. And since the announcement of these data, an already fractured and chaotic healthcare delivery system and its consumers have been plunged into a financial abyss deeper than anyone could have ever imagined.

"Those who are hospitalized with COVID-19 can expect to pay anywhere from $42,486 to $74,310 if they are uninsured or if they receive care that’s deemed out-of-network by their insurance company."

~FAIR Health

There is nothing more disheartening for a healthcare provider than to deliver on the promise of high quality clinical care - perhaps even to save a life - only to be reimbursed at a deeply discounted rate or perhaps receive no payment at all. At some point our institutions of healing have resigned themselves to value-based payments from public and private payers. Arguments of the high cost of healthcare (and how to pay for it) aside, we know that competent medical treatment isn't free - can't be free. Adding insult to injury, healthcare providers are regularly maligned on social media with unfair, ill-informed criticisms by disgruntled patients who are likely acting out in frustration because they either can't or don't think they should have to pay for the healthcare services they received. Again, I'm sidestepping the political implications of America's entitlement to healthcare or the human inclination to try to get out of paying for something. I'd like to raise a more constructive question...

"Is there such a thing as compassionate collections?"

I flat out couldn't do it. I struggled with selling Girl Scout cookies; I hated asking for money. It really should come as no surprise that individuals whose jobs it is to ask for payment day-in and day-out might eventually retreat into survivalist mode. Whom among us doesn't have at least one sordid collection story? I don't imagine too many young people have written a paper entitled "Why I Want to be in Collections When I Grow Up." The stories they hear must be, at times, gut-wrenching. I've no doubt that most of the explanations for not paying a bill are understandable - even excusable. But it's a beat-down to be on the receiving end of vitriolic rage and inconsolable sadness over something of which you have no control.

The great pandemic of 2020 is sure to etch itself indelibly on the balance sheets of healthcare organizations worldwide. But in its wake, we have an opportunity right now to assess our current processes and systems in anticipation of some very challenging collection days ahead. Looking at the way we currently do things through the lens of both our staff and patient experience may lead us to a better place. Incorporating just one or two new solutions might be a prophylaxis for some serious heartburn around the bend. I ran across a good infographic entitled How Patient Liability Management Helps Improve the Patient Financial Journey. It can be accessed at https://www.changehealthcare.com. The talking points are as follows:

1. Invest in real-time eligibility and pre-authorization services to avoid surprise :medical bills due to out-of-network or medical necessity claim denials.
2. Manage expectations by offering an upfront out-of-pocket estimate so that staff are better equipped to seek payment prior to care and follow-up on unpaid financial obligations.
3. Screen patients for possible eligibility in supplemental, undisclosed or unannounced insurance coverage, particularly with patients who present as uninsured or self-pay.
4. Ensure that your front-line registrars, clerks and financial counselors are adequately trained to engage, educate and support patients in discussions around payment plans and/or billing options.
5. Make your after-visit-summaries and billing statements understandable and accessible through delivery modes that reflect patient preferences as well as their unique needs (portal, mail, electronic, etc.)
6. Differentiate your billing and collections departments on superb, sincere customer service. Hire the right people who can consistently demonstrate empathetic communication skills in explaining costs and seeking payment.
7. Modernize payment options to include credit, debit, check, or e-check that can be submitted via mail, electronically, or phone.
8. Innovate the patient experience in collections with smart tools like IVR or chatbot functionality.

"The reason our patient experience scores suck is because the hospital bill is beating the satisfaction survey to the mailbox."

Some years back, a hospital executive shared this revelation with me and his direct reports. I had just concluded a rather dismal overview and analysis of the organization's patient experience metrics. Heads around the boardroom table nodded in quick affirmation (it was a big table). There may have been a muffled chuckle or two. Sadly, there was likely a bit of truth in his statement. We all grasp the subjective nature of satisfaction surveys and no doubt righteous indignation creeps into some patient responses. But I'd like to think that the larger truth is that revenue cycle, like every other aspect of the patient experience - and for that matter employee engagement, is positively impacted when individuals feel supported with human compassion, adequate resources and transparent communications.