Patient Payment Ripples Give Way to Seismic Waves

In recent years, healthcare organizations have started adapting patient payment processes to address higher patient financial responsibilities and consumer payment behaviors. Where these changes are creating waves, we may soon see some of seismic proportions due to existing and emerging price transparency laws*.

Healthcare leaders agree price transparency is helpful for patients, but not all have implemented changes. The time has come for them to realize incorporating price transparency is becoming less of a nice-to-have and more of an imperative. The following slides provide more details on this growing trend and steps to price transparency implementation to help collect more from patients with less cost and stress. 

*Becker’s Hospital CFO, 5 ways executives should prepare for pricing transparency from KPMG, July, 2016

Only Two States Made the Grade in Healthcare Price Transparency…

Recently, a nonprofit health system research and consulting organization graded all 50 states on how well they’re doing regarding healthcare price transparency, including factors such as pricing information availability and how it’s disclosed to patients. With 43 states earning an “F” and only two receiving an “A,” it’s clear many healthcare organizations have a lot of work to do*!

*Altarum, Price Transparency & Physician Quality Report Card 2017, November 2017

…But Many States Are Trying to Make the Grade

Many government leaders aren’t satisfied with their scores, so they are making changes. For example, in Florida:

• One new law protects patients from surprise bills by exempting them from paying balance bills from out-of-network providers*.
• A second recently introduced Florida law requires hospitals and ambulatory surgical centers to group services and procedures via bundles on their websites, so patients can price shop. Organizations are also required to give patients cost estimates upon their request**.
• This issue is even receiving national attention, with new federal actions such as the 2018 ACA Benefit and Payment Parameter Rule, the End Surprise Billing Act and the Patient Freedom Act all aiming to protect patients from surprise out-of-network bills.***.

*Modern Healthcare, Florida governor signs law shielding patients from surprise medical bills, April 2016
**The Florida Senate, 2016 Bill Summaries: Transparency in Health Care
***Brookings.edu, Receive a surprise medical bill? Here are three federal actions that may address surprise bills, August 2018

The Good News about Implementing Price Transparency

If your list of strategic priorities already seems exhaustive, here’s good news about price transparency:

• It can be seemlessly integrated into existing healthcare revenue cycle management (RCM) improvement initiatives
• It correlates with best practices in patient payment processes
• Patient estimation technology tools are available to streamline staff time and automate processes
• Best of all, it facilitates more prompt patient payments—and increases patient payment revenue

Step 1: Evaluate When You Present Pricing Information to Patients

Patients benefit from having pricing information as early as possible—and so does your revenue cycle. Patients who receive cost estimates earlier are more likely to pay earlier. Some ideas:

• Use pre-service communication (appointment reminder calls or emails) to provide any pricing information—even a generic statement such as “We expect at least a partial payment at time of service.”
• At time of service, leverage revenue cycle technology to generate estimates so staff can be certain they’re presenting accurate information—and so they can give patients undivided attention while reviewing costs and payment options.

Step 2: Evaluate How You Present Pricing Information to Patients

Many front office or patient access staff didn’t think they’d be requesting patient payments when they were hired… and talking about costs can seem daunting! That’s why it’s important to make sure your front-line team knows exactly how to present pricing information and ask for payments. Some ideas:

• Ask staff to write their most frequent and/or challenging questions and scenarios so you can provide focused training.
• Use role-playing so staff can get comfortable presenting pricing information according to leadership’s preference.

Step 3: Evaluate How You Confirm Patient Understanding of Pricing Information

Price transparency is far more effective when patients feel they can ask several questions to fully understand costs and payment options. Make sure your team knows it’s OK to spend time answering questions.

• Leverage technology to automate workflow, so your team can devote more time to patient discussions.

• Your front-line staff can have very helpful insights, so create a forum for their feedback: Do they have suggestions for ensuring patients better understand cost or payment information? What is or isn’t working well? 

Leverage Resources to Improve Your Patient Payment Strategy

Best practice processes, technology and insights from fellow healthcare leaders can help you prepare for the significant changes brought about by price transparency regulation. Many resources exist to help—a great start is to find out if your state has enacted price transparency and disclosure regulations in this list compiled by the National Conference of State Legislatures. You can also download this free white paper developed by MGMA and Navicure, New Collections Workflows Raise Challenges for Physicians & Staff.