The business side of caring

Heard about "patient payment clarity" yet? If not, you'll hear more soon.

This new concept is winning fans at forward-thinking hospitals and raising eyebrows with executives as they learn about the term.

For hospitals, patient payment clarity is getting visibility into when and how much they will be paid, by whom and the ability to better navigate the obstacles to payment. For patients, payment clarity goes beyond transparency to promote satisfaction and instill loyalty.

To gain insight into this trend, we tracked down Cathy Dougherty, vice president of revenue cycle management for Lawrenceville, Ga.-based Gwinnett Medical Center, a 553-bed, two-hospital system serving the Atlanta suburbs. Ms. Dougherty is an unabashed advocate for patient payment clarity and rarely misses an opportunity to point out how it works, how it can improve financial performance and how it promotes positive patient experiences.

If you distill her advice, reaping the benefits of patient payment clarity is the result of six essential elements:

  • An estimation tool at the point of registration
  • Patient (or consumer) education about insurance coverage
  • Highly trained financial counselors who act as patient advocates
  • Crystal-clear billing statements that patients can understand
  • Multiple convenient payment options, including online bill pay and financing
  • Direct access to payment services that bypass the usual customer service queue

Gwinnett Medical Center has seen great results using this approach, including online patient payments of $45 million over five years, a 38 percent compound annual growth rate for online payments over four years, significantly reduced call center volume and a 10 percent decline in call abandonment.

While the tools and processes used at Gwinnett are working well, Ms. Dougherty notes there's still work to be done. Healthcare providers must play an ever-more active role in educating consumers before they become patients, market use of technology to showcase consumer benefits and gather feedback from patient-facing employees.

Here's more of what she has to say about how to give patients payment clarity so your hospital can be healthier financially and better able to serve its community.

Question: What does the concept of "patient payment clarity" mean to you?

Cathy Dougherty: There's nothing more complicated to a patient than healthcare services. To me, clarity is the patient understanding what's involved from a financial perspective. There's no shortage of clinical communication, but I want our patients to know what to expect from a financial standpoint. I call this 'the business side of caring.'

It goes beyond transparency. It's what to expect when you leave. What kind of bills are there going to be? How will that work? On the way in, we estimate what the patient might owe based on insurance and our contract with the insurance company, using the RelayClearance estimator tool. That gives the patient more insight into what their responsibility will be, because otherwise, most of the time, they just don't know.

If they're like me and don't use the healthcare system much, and suddenly need to use it, then they have no idea how it all works and what to expect. They've had things like screening mammograms that are covered 100 percent, but when they need real care, suddenly it's a new world and they don't know the impact of the dollar.

So, patient payment clarity means ensuring we let them know their financial responsibility upfront, and telling them what to expect on the way out. And along the way, helping them with convenient ways to pay — whether it's an online web portal, phone, check, dropping by, a payment plan or credit card.

Q: Does patient payment clarity also mean being able to know who's going to pay, when and how much?

C.D.: Yes, of course we want insight into how likely it is that they will pay for their services and procedures. So if we all are on the same page and know more about what is likely to happen, it sets proper expectations and makes for happier people on both sides of the relationship.

Q: What role does the hospital need to play in educating patients?

C.D.: Before the patient is a patient — when they're a consumer — we should be engaged in the community, educating the public about hospital bills and insurance, and answering questions. The lingo we use is not always familiar to patients. What's a pre-auth? What are deductibles? What are co-insurances? When do they apply? What's an EOB? Educating the consumer is crucial.

We should also engage employers and work with them to educate their teams. We can reach a lot of people and make a big difference quickly that way. We actually started a community education network through local churches, as part of our parish nurse program. I've been to many health fairs with them. We'll have an open booth, where folks stop by and talk about the business side of healthcare. It's been very well received.

We work closely with local charity clinics so they understand our billing practices, how to file for financial assistance, and so on, so those patients are prepared when they come to a hospital. And we started a graduate medical education program in family practice and internal medicine, where newly covered people are often referred after they've been to the ER. That's another population we're educating at point-of-registration.

Q: Speaking of registration, it seems the ability to furnish accurate estimates up-front is becoming a necessity. How does this capability help with point-of-service and pre-service collections? And how do you go about securing them?

C.D.: With the rise of high-deductible plans, we realized that we needed to spend time with that patient who is going to have a fairly large bill. Patients have choices, especially with scheduled outpatient work, and they want to know what they'll owe after insurance. Without an estimator tool, you can't estimate anything other than gross charges, and that's not really helpful.

We use our estimator tool to determine patients' eligibility, deductible and co-insurance. Later, we go to the bedside and let them know that we validated their insurance, so they don't need to worry. If they have an unmet deductible, we'll ask if they would like to set up a payment plan. After the discussion, the patient can choose from multiple options on a "payment options form" — online, check, credit card and payment plans — and we record it in the document imaging system.

Q: At the other end of the care cycle, what's the role of statements today? Are you simplifying them, making them easier to understand?

C.D.: Absolutely. I look at the billing process as the pre-registration for the patient's next visit to my hospital. When someone's had a good clinical visit and is happy, and then our statement is hard to understand or there's a billing problem, then they're no longer happy. Statements must be really simple and say, 'Thank you for using us. We billed your insurance. This is your portion. Let us know if this is not right.' If they owe $500, it should be clear that they owe $500, without a bunch of other noise. Simplification is what we do first.

Every statement refers patients to our website, where they can pay online and get answers to frequently asked questions.  And everything we send lets them know financial assistance is available.

Q: What about your financial counselor? How do they work with patients?

C.D.: We refer to financial counselors who visit patients at the bedside as financial advocates. They're advocating for the insured patients. So the same person you see at the bedside discussing insurance will call and say, 'Hey, your insurance is paid now.' Or, 'Claims came in and a refund will be mailed this week.'

We're trying to establish a personal business relationship with patients. I want patients to know that person is their financial advocate and is going to work with them through any issues, and they can contact that person instead of calling customer service and waiting in the queue.

Q: Has this helped reduce your call volume?

C.D.: Oh yes. Online bill pay through RelayAccount and the use of financial advocates has reduced our call volume and resulted in a 10 percent drop in call abandonment. More patients are going online to see what their bill is and paying right there — we now collect 40 percent of patient payments online and have collected $40 million online to date.

Q: If you were to offer other best practices for supporting patient payment clarity, what would they be?

C.D.: All employees with patient contact must be knowledgeable about insurance, payments and processes. And you need a good marketing plan for your online bill pay portal, your statements and your use of technology. Be sure employees understand your estimation tool. It's crucial to understand how to estimate payments and the conversational scripting that goes with it.

Be certain that what you tell patients is the same thing they'll get in writing, and that your employees are saying all the things that you need them to say. You want everything to be clear, simple and personalized. Don't assume that the patient knows what you're talking about.

Listen to your employees. They are on the front line with patients. Get their feedback on things that are confusing or concerning patients. They know where they need better answers, more education or more support. Make sure they're trained to help a patient in any way possible, instead of saying, "You need to call the billing office."

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars