Why the patient financial experience should matter to revenue cycle management leaders

The cost of healthcare continues to shift toward patients. Around 30 percent of workers are now covered by high-deductible health plans — a percentage that increases every year.[1] Now more than ever, patients view the billing cycle as part of the total healthcare experience, and it's top of mind. Paying for unexpected healthcare expenses is the top financial concern for most Americans, according to a recent Gallup poll.[2]

At Becker's 5th Annual Health IT + Revenue Cycle Conference in Chicago, CareCredit sponsored a workshop to explore why a positive patient financial experience is essential for revenue cycle success. Morgan Haefner, editor with Becker's Healthcare, moderated a panel that explored how patient-centric financial solutions can improve outcomes for both patients and providers.

Debbie Welle-Powell, MPH, Essentia Health's chief population health officer, represented the provider perspective. Jan Oldenburg, FHIMSS and principal of Participatory Health Consulting, shared patient-related insights. Chris Morris, CareCredit's senior vice president and CFO, offered perspectives on solutions.

The patient as payer shift creates barriers to care

Patients may face affordability issues with high-deductible health plans. In a recent CareCredit survey, 40 percent of Americans indicated they had delayed or refused necessary treatment due to its cost or fear of the cost.[3]

"We hoped high-deductible plans would make people more rational healthcare consumers and turn them into shoppers," said Ms. Oldenburg. "However, that requires a rational marketplace. When people don't get the care they need, it has detrimental effects on their health."

Forgoing care because of cost is problematic for both patients and healthcare providers. Financial incentives for providers have evolved over time — before, they were tied to aspects of care that a payer could measure through a claim. Now and in the future, the economic reward structure is focused more globally on health outcomes. "As a provider organization, we are trying to prove that we are delivering the right care at the right time and the right place. The financial piece is affecting our ability to deliver on that," said Ms. Welle-Powell.

While the customer has long been king in other industries, the same can't be said for healthcare, which has not traditionally focused on customer experience. That's changed in recent years as the patient experience directly affects a larger portion of hospital reimbursement. Under the CMS Value-Based Purchasing Program, for instance, one of eight questions related to patient experience is, "Did the physician focus on the stewardship of resources of the patient?"

Essentia Health is finding that the government and even some commercial carriers want healthcare providers to discuss the affordability of care options with patients.

The patient experience: A key consideration for revenue cycle managers

There's no question that people perceive billing as part of the overall patient experience. Revenue cycle managers play a central role in developing tools and strategies that answer patients' top question: How much do I owe? When patients get a surprise charge or confusing bill at the end of an episode of care, it affects how they feel about healthcare facilities or doctors.

"If everyone in a health system isn't aware that revenue cycle management has to be improved as part of the patient experience measures, the organization won't succeed as much as it could," said Ms. Oldenburg.

Sometimes patients don't follow up with referrals because they don't know what a visit will cost. Mr. Morris suggested, "The best time to have a conversation about payment is during the pre-encounter stage when you can review financial policies and cost estimates. The earlier you can have this conversation, the higher the likelihood of collecting from the patient."

For consumers, convenience is huge. "We must develop healthcare payment strategies that are as convenient for patients as paying for services in other parts of their lives," said Ms. Oldenburg.

Healthcare credit cards, like CareCredit, are one solution. In a recent survey, nearly half of CareCredit card holders (42 percent) indicated they couldn't have received treatment without this payment alternative.[4]

A Promising Approach

A positive patient financial experience is a strategic imperative for hospitals, and patient-centric financial solutions can improve outcomes for both patients and providers.

Delivering value-based care requires a sound partnership between providers and patients. Providers are incented to close gaps in care, while patients are often reluctant to pursue necessary care because they have no way to gauge its cost. Incorporating the patient experience into revenue cycle management is a promising approach for addressing this challenge.

As Ms. Welle-Powell observed, "We need clinical, financial and operational integration to avoid surprise bills, engage patients in their care and ensure providers aren't burned out by unhappy patients."

 

[1] Kaiser Family Foundation, 2019 Employer Health Benefits Survey, Published: Sep 25, 2019

[2] Gallup, Health Costs Top Financial Problem for U.S. Families, Jeffrey M. Jones, May 30, 2019

[3] CareCredit, Path to Purchase Research, 2018

[4] CareCredit, Cardholder Engagement Study Q2 2018

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