HIMSS Review Part 1 aka Hey Isn't Money Something Serious?

I've had a full week to recover from the recent HIMSS 2016 conference.  We made a lot of visitors to the booth uncomfortable because we talked about the two dirtiest things in healthcare MONEY and EFFICIENCY.

Today is MONEY

Look up there ^ Read that article...welcome back.
Consumers generate 3.6 Trillion dollars in healthcare expenses.
15% of the US working population have no access to 'accounts.'
This means that at minimum over 500 Billion dollars of care is being delivered to people with no ability to pay electronically.
We know these patients as customers. We service them in several other industries.

Members of this group are euphemistically referred to as the cash-preferred, working poor, un-banked, un-derbanked.
In reality they are the over-exploited, under-served, the marginalized.  

They are well aware of this fact. They aren't happy about it.
No matter what happens in November (TheHer, TheHair, or TheWayTooFair) neither the needs nor plight of this group will change significantly.
They will look at you as another data point in a repeating series of demeaning problems or a refreshing solution. Regardless of what you choose, they are coming through your door.
How they leave is up to you.

Here is a quick intro on how their finances typically work:

1. Generate monthly expenses.
2. Work
3. Get handed payment 
4. Convert handed payment to useable form (3-7% loss)- Cash Check, buy money orders with, reload prepaid card with cash
5. Pay monthly expenses
6. Generate non-monthly expense
7. Pay non-monthly expense at time of service - cash or check.
8. Work more
9. Repeat

To the rev-cycle people:

Where are you in this cycle?  Where do you want to be?*
If you are taking counter payments, are your transactions with these folks really a net positive?
Counter transactions at utilities clock in at $6-12 per transaction.
This addresses the costs of employee time required for- greeting, lookup, averaged time of discussion, handoffs, and goodbyes typical in utility payments.
The issue with healthcare is that every payment is a discussion, a reschedule, a medication question, a something.
Your FTE cost may be lower but the time per transaction is likely higher.
With all of this in mind...is a counter payment - cash, check, or otherwise actually a net-positive for your organization?

To the medical people:
Physical MONEY is dirty, very dirty, tucked who-knows-where dirty.  It isn't the only offender - Pens and clipboards are grimey so are doorknobs...add money to the mix though and there is a perfect storm brewing for secondary infections.
Think of the process of reaching your hand into your pocket after touching the grimy stuff...did you sanitize your hand? Great, how about your pocket where you'll soon be jamming your hand again. How about the last guy who was at the counter, placed his sweaty hand right where your's now sits.
It is enough to unleash the Howard Hughes in any of us.

Would you ever hold a dollar bill or handful of coins before touching a patient?*

MONEY as a tool is scary when you feel like you have no control over it....what will you do when you can't pay your bill, how about your child's?
Medicine or Rent? Is it 'worth' the money to get the care? Will it be fine? Will anyone see the scar, will it matter?  Will you sacrifice your own health for something your family needs?  Does your blood pressure go up? Do you feel even more helpless? Do you turn your fear to resentment and anger? How does your family react?
Do you carry this into your doctor? White-coat Hypertension has a name. What do we call this other thing?* Co-pay-co-morbidity, helplessness-hypertension, no-choice nausea, 

What is the best way to understand, quantify, and address these concerns for healthcare?
We don't bother...we don't know...we probably can't know with any certainty...if we did come up with an answer or insight it would at best be an egg
looking for a chicken, at worst a disease looking for a cure.

Instead we Try.

What we do know is how these same people react when companies m make things a little easier.
Make it easy for people to pay, and they do.
Make it easy to promise to pay, and they will.
Nobody wants to be a deadbeat...especially not the working poor, they prove it every day by going to work when not working would get them a bigger check. 
We have seen it repeatedly.....give these people a means to maintain their dignity and they will not disappoint you.
If they can't pay, give them a way to plan to pay.
Offer them a deal or schedule, or a simple, shame-free way to sit and meet with someone to work  through this most difficult and personal problem.
No matter who they are, patients are usually genuinely thankful for their care.
My guess is the perpetually marginalized are even more thankful. In no other part of their lives are they using the same services as the best off of us are.

What makes people seem ungrateful, unhappy, and angry are is all of the crap** associated with the service.
Separate your people, staff and your corporate identity from the crap.
Why make a human employee be the bearer of bad news or the taker of money.
Why perpetuate an inherently adversarial condition.
Let a machine do it, let the machine be the bad guy, let the machine ask for payment, let the machine deny the request.  Let the machine be confrontational all day long and not get a migraine or get burned out or snap.

Let your employees, smile, understand, collaorate, and solve the problems; exercise their humanity with the human who needs their help.
Leave the money, confrontation, monotony and messaging to the machine. It is what they excel at, what we create them to do.

Of course there are always bad actors, patients, and customers, but if we let them inform policy or commercial decisions then we have given up and collectively decided to bury something important in all of us.
The something that makes us human the something that got us into healthcare ......empathy...the care part.

*All questions are non rhetorical. Please add to the discussion.
**Highly technical term understood by all.

You can message me privately if you would like me to edit / credit something I missed.

Commenting below is fine but keep it a-political there is plenty of 'discourse' available to anyone who wants it.

If you would like me to send you a report on the un-banked send me a note and I'll forward it to you.  There are some good reports findable out there.

Interestingly there is a gap between un-banked and cash-preferred....no perfect explanation, it is just there.