Why HCAHPS should consider patient financial experience
In the new patient-centric healthcare environment, perception is reality.
Healthcare increasingly operates as a consumer market, catering to patients who, now more than ever, have a choice in where they go to receive care. The quality of that care is tracked and measured, not only in clinical outcomes, but in the results of key satisfaction surveys, such as the Hospital Consumer Assessment of Healthcare Providers and Systems. HCAHPS is the first national, standardized survey of patients' perspectives that is shared with the public, and has a significant impact on a hospital's reputation in the community, as well as its bottom line. Under CMS' value-based purchasing program, the patient's care experience comprises 30 percent of a hospital's overall performance score in the survey. More importantly, this score is tied to the organization’s reimbursement.1
The survey asks patients to rate their experience across several broad clinical experiences, including communication with nurses and physicians, staff responsiveness, pain control and the hospital environment. What it doesn't consider, however, is the patient's financial experience.
The influence of billing
The rate of growth of patient financial responsibility has increased dramatically over the past five years, as evidenced by the increased number of high-deductible health plans. These plans offer less expensive premiums than traditional ones but shift a significant portion of the costs to consumers, therefore requiring patients to pay thousands of dollars in out-of-pocket costs and saddling hospitals with more unpaid bills. As a result, about one-third of physicians’ incomes and one-quarter of hospitals' revenue is now tied directly to patient payments.
In an era where patient financial responsibility is continuing to grow rapidly as a percentage of overall provider revenue, it is increasingly critical for hospitals to process patient payments both efficiently and effectively. It is also crucial that they understand the huge impact that activities related to patient payment, such as collections, can have on patient satisfaction, engagement and outcomes. A 2013 survey by TransUnion Healthcare evidences this, finding that patients who have a positive billing experience give higher marks for the quality of care they received than patients whose experience is negative.2
Therefore, when it comes to customer satisfaction, the patient statement has the final word. The patients' financial experience is often a provider's final touch point with them following a care encounter and can wield a disproportionate influence on patient satisfaction results. In a Connance consumer impact study, nearly 40 percent of patients said their interactions with hospital billing groups influenced whether they would recommend the hospital to a friend, and patients who have a negative billing experience are five times more likely to complain about that experience to another patient.3
In other words, just as patients have come to expect that nurses and doctors will communicate clearly, respond to their clinical needs and provide ample information, they expect those aspects to follow through in their financial experience as well. Shifting to a patient-centric payment process will be required for success in the new consumer-directed healthcare world in order to successfully improve an organization's HCAHPS scores.
Improving the experience of care
To enhance these results, providers need a patient financial engagement solution that offers proactive, targeted communications and automated tools that help patients understand, manage and pay. For example, one way to improve the experience of care is to simplify the patients’ statement. Providing a unified bill that combines treatment across providers inside an IDN and translates treatment codes into plain language makes it easier for patients to understand. If they understand, their satisfaction increases. This translates into a very important result for all providers, and that’s the decrease in self pay debt which is so hard to improve.
It’s no secret that informed patient-consumers want more transparent information beyond what is currently provided by their health plans, to make more informed decisions. Therefore, another way to enhance their experience is to include financial information that is outside the episode of care. For example, including details about Point of Service co-pays, insurance payments and adjustments, and deductibles go a long way toward helping patients better understand their financial obligations.
As consumers, patients want to experience healthcare in the same way they experience service in other industries, such as retail and banking. They expect on-demand conveniences, from short wait times and extended hours of operation to technology that allows them to understand and pay their financial obligations before, during and after their episode of care, all in a manner that treats them like a consumer whose business is appreciated and sought after. Having all this information available online and accessible via modern technology platforms, including monthly payment reminders, is yet another way to stay in continuous communication and increase patient satisfaction after the episode of care.
Most importantly, patient financial engagement solutions not only advance a great patient experience — they can facilitate better health outcomes. Among the key findings of the 2013 TransUnion Healthcare survey was that consumers who experienced problems with healthcare billing were far less likely to use non-critical health services, such as regular check-ups and preventative cancer screenings. This is obviously a problem that must be confronted. If patients have a difficult and frustrating financial experience, they may be less likely to return for subsequent care, and this increases the risk of health issues associated with less care. Even more importantly, hospitals that perform well on patient experience measures also have lower 30-day readmission rates,4 so the incentive is present to focus on this important aspect of healthcare.
The opportunity
The financial experience is a critical yet often overlooked component of a hospital's patient engagement strategy. As such, it deserves to be a component of patient satisfaction surveys. Not only are more providers beginning to include meaningful discussions about financial options before and during treatment, but the patient financial experience can extend for weeks after treatment — providing numerous opportunities to improve communications and positively connect with patients who should be repeat customers time and time again.
Given that patients measure quality more on their perception of care than on the reality of clinical success means that patients will also measure their perception of care their last impression of that hospital, which is often the financial experience. In this critical time in healthcare where patient satisfaction scores can literally change a hospital’s financial stability, hospitals that provide the tools for financially engaging their patients as consumers — clearly, directly and with no surprises — will have the means to improve the experience of care, increase revenue and promote patient loyalty to gain a competitive advantage to thrive as we move into the future of healthcare.
Bird Blitch is chief executive officer of Patientco.
1 HCAHPS Fact Sheet. May 2012. http://www.hcahpsonline.org/files/HCAHPS%20Fact%20Sheet%20May%202012.pdf
2 TransUnion press release. April 29, 2013. http://online.wsj.com/article/PR-CO-20130429-903495.html
3 2013 Connance Consumer Impact Study press release. December 10, 2013. http://www.connance.com/files/2113/8738/4131/2013_Connance_Consumer_Impact_Study_FINAL_on_12-10-13.pdf4
4 Clark, Cheryl. “Higher Readmission Penalties Linked to Low HCAHPS Scores.” Health Leaders Media, Dec. 12, 2012. http://www.healthleadersmedia.com/page-1/FIN-287372/Higher-Readmission-Penalties-Linked-to-Low-HCAHPS-Scores##