How are patient payment methods evolving? 4 health systems weigh in

Payment methods for patients continue to evolve as health systems adapt to new technology and the rising popularity of high-deductible plans.

Four health systems recently spoke with Becker's Hospital Review about the payment methods they offer and how their methods could change in the future.

Ochsner Health System

New Orleans-based Ochsner Health System, an organization comprising more than 17,000 employees and nearly 3,000 affiliated physicians, offers all patients internal and external interest-free payment plans with a minimum balance of $150.

"That's a huge patient satisfier for us because even if you know you have a high deductible and something happens, that's a lot of stress for someone. Not a lot of people can afford $5,000 they weren't planning, so the fact they can pay out over time, that's really helped," says Katherine Cardwell, assistant vice president of revenue cycle.

One of the payment programs Ochsner is continuing to ramp up is an Infusion Drug Out of Pocket Assistance Program, Ms. Cardwell says. She says the program is primarily for Ochsner's commercially insured patients. Through the program, drug companies pay the patient balances comprised of copays, deductibles and co-insurance. "Drug companies offer these programs to help ensure patients are prescribed the best possible drug regardless of the cost to the patient. They want to expand access to eligible patients and work to limit the cost burden," Ochsner says.

"While it is always better from a financial standpoint to receive the payment in full, we assess each patient individually and work out a plan," Ms. Cardwell says.

Ms. Cardwell says she would like to see patients provided with more information about the insurance plan they've chosen before signing up for it. Patients who don't understand their insurance benefits can be left with unexpected expenses, says Ms. Cardwell.

"So they're picking a plan that has a fairly low premium every month and something happens and they end up owing $2,000 or $3,000 and it comes as a complete shock to them," she adds.

"We have brochures in our waiting rooms about understanding the patient liability — just as an example, if you have this insurance and this happens, this is how you break down what you will owe. But I think the education piece really is important," says Ms. Cardwell.

Virginia Mason Medical Center

Seattle-based Virginia Mason Medical Center, a nonprofit organization comprising a multispecialty physician group practice, a hospital, clinics and various other integrated health services, uses a banking payment option for patients.

In the past, Virginia Mason accepted up to nine-month payment arrangements at no interest. However, with greater patient out-of-pocket expenses, there were situations where patients couldn't pay all their expenses in the nine months, says Steve Schaefer, senior vice president of support services. So he says the medical center formed a relationship with a bank to allow patients to arrange interest-free installment plans up to 24 months in length for paying off their debt.

"So we've had that in place for several years now. We've found that our installment plan options coupled with our financial assistance program have been of service to our patients," he says.

Mr. Schaefer says Virginia Mason has no plans to initiate or sponsor crowdsourcing efforts but acknowledged that might be an option individuals may choose for themselves.

"We are a nonprofit organization and we do know healthcare's unique scenario when it comes to financial impact to the patient in the sense it oftentimes is acute and unplanned," he says. "So I do think we need to be open about how to collect that debt for the services we provided. But we always want to work with our patients. Especially when you get into high out-of-pocket costs, everybody's story is a little bit different, so we want to take that story into account. Some people can afford to pay cash upfront, some people can afford to pay it off in a matter of months, and some might need a longer period of time. But I think it's incumbent on us in healthcare to be flexible and understand that story. So we're constantly balancing the need to be paid for our services and being sensitive to our patients' stories."

Intermountain Healthcare

Salt Lake City-based Intermountain Healthcare, an integrated system comprising hospitals, the Intermountain Medical Group of employed physicians and insurance arm SelectHealth, does not consider its payment options unconventional. However, like many health systems, it leverages technology to help patients pay their medical bills, says Todd Craghead, Intermountain's vice president of revenue cycle organization.

"We've introduced technology that allows the patient to pay their bills online, to go ahead and set up payment plans online using the criteria that we have defined [as] acceptable. And it can self-service that in a way that allows them [patients] to do it on their clock, when it's the most convenient for them," he adds.

Mr. Craghead says Intermountain has seen great response from patients with this online option, and with the technology the organization recently deployed in the last six months, more patients are going online to pay their bills instead of calling hospital staff to help them set up payment plans.

As patient's liability continues to go up, the system is trying to explore ways to help the patient understand how to best satisfy that financial obligation, says Mr. Craghead.

"On the front end, [Intermountain is] reinforcing and doing our best to create an accurate estimate that the patient can then leverage and determine on the front end how [they] would ... like to plan for that financial obligation in the future. We are working to investigate that further," he adds.

Montefiore Health System

Bronx, N.Y.-based Montefiore Health System, an organization comprising 11 hospitals, and close to 200 outpatient care sites, currently offers payment plans and is considering adding patient financing interest-free loan programs as well.

"Our first preference is for patients to satisfy their financial responsibility either prior to or at the time of service. We do understand that many patients cannot afford their out-of-pocket expenses and so we do offer payment plans as well as financial assistance to help patients pay their hospital bills," says Cynthia Kaufhold, associate vice president of health services receivables.

Noting there will be an increased need for more payment options as high-deductible health plan enrollments continue to rise, Montefiore is reviewing patient finance options and hopes to add new payment methods in the future. Additionally, the health system is working on a patient estimation tool "that will help us better communicate and prepare patients for what their out of pocket expenses will be prior to services being rendered so that they can make informed decisions," says Tina Martinez, senior director of the single billing office.


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