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Seven Insights about Transparency in the HealthCare Revenue Cycle

A strong trend in healthcare is for patients to assume a greater degree of financial responsibility for the cost of their care. This change has led many people to work to understand more “about the cost of care so they can shop around for services, plan for elective procedures, and budget appropriately.” To support the desire for greater transparency around healthcare costs, many healthcare organizations have begun “to rethink aspects of their revenue cycles, especially regarding pricing and cost estimation.” A recent HFMA Executive Rroundtable sponsored by Change Healthcare, Healthcare Consumerism and Transparency in the Revenue Cycle, offers valuable insights about where healthcare is heading in this regard.

Consumers Are Now Shopping for the Best Healthcare Deal

One participant, Sarah Knodel, System Vice President, Revenue Cycle for Baylor Scott & White Health in Dallas, offers her experience that patients “are shopping around, trying to understand what their out-of-pocket costs are going to be for specific services. Ultimately, they are looking for high-quality care at a reasonable cost.”

Many Prospective Patients Want to Know Their Financial Obligation in Advance

Barbara Tapscott, Vice President of Revenue Management for Geisinger Health System in Scranton, Pa., regularly sees a new situation for patients “where employers and insurance companies are putting more cost responsibility into consumers’ hands, such as through high-deductible health plans.” She adds, “In these markets, patients are seeking estimates for services and engaging in comparative price-shopping.”

Just Like We Are Using Online Reviews for Consumer Products, So Goes Healthcare

We are reminded by Eric Krepfle, Associate Vice President at Change Healthcare in Nashville, Tennessee, that “Today’s patients often come from the ‘Yelp’ generation. More and more, they’re searching for the best price and want recommendations for the services they plan to have.” He tells us that folks want lots of data about the service they may be purchasing, “They pay attention to things like quality scores, waiting room times, scheduling convenience, flexible hours, a self-service portal, and so on.”

Healthcare Organizations Need to Do More Than Just Publish Prices

Tapscott advises, “So, if an organization merely publishes its prices with no context, [it] could be quite damaging. However, if it generates estimates and has a robust education program supporting them, patients and the organization can benefit. If people understand their costs, they are more likely to accept responsibility and pay their bills.”

Giving Patients Estimates Can Be Valuable

Krepfle offers that “Providing estimates can be an effective way to be more open. However, there is a danger in setting a false expectation about costs, particularly with a self-service estimation tool.” As long as there are disclaimers about the nature of an estimate, providing one can “serve as a starting point for further discussion about a patient’s liability.”

Training Can Help Staff Communicate Better About Patients’ Financial Responsibility

Tapscott also shares that for her organization, “We want them to deliver a consistent message to patients. As such, we need to give them the right tools to communicate that message in the most sensitive—yet standardized—way possible. HFMA offers guidance and sets the standard for consistency in communication. “Amy Beal, Manager of Patient Access for Baton Rouge Medical Center in Baton Rouge, Louisiana, adds that her organization uses “some of HFMA’s PFC best practices as a starting point, modifying them when necessary to fit with our front-end processes.” Their goal is to “ensure that everyone in the organization delivers the same financial messages no matter how a patient accesses our facility.”

Measuring Success with Data and Analytics Helps Organizations Constantly Improve

Knodel’s organization keeps close tabs on “how many patients we’re having financial conversations with by service line and department. Our expectation is that we are talking to at least 95 percent of the patients who walk through our doors.” To ensure that patients are getting the highest standards of assistance and communication, she finds that “reviewing summary-level data by facility and department is helpful,” and they “also assess trends at the representative level so we can spot trends and the need for more focused training.”

All quotes are from “HFMA Executive Roundtable: Healthcare Consumerism and Transparency in the Revenue Cycle,” (December 1, 2017), Retrieved at https://www.hfma.org/Content.aspx?id=57035.

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