Imagine a shoulder injury sends you to the hospital. The good news is that there is no permanent damage. The bad news is that on your road to recovery your mailbox starts filling up with medical bills. You get one from your primary provider of care. That is followed in short order by bills from the imaging facility that provided the MRI, the radiologist who read the MRI, the surgeon, the anesthesiologist, the hospital, the rehab clinic and on and on. Those bills are accompanied by explanations of benefits (EOBs) that may or may not align with bills that may or may not be itemized in ways that are decipherable to the layperson.
Organizing and interpreting this mountain of paperwork seems impossible—and you haven’t even started wrapping your mind around how you will resolve these debts. Are there payment plans available? Financial options? Discounts? Has your provider already referred your account to a collections agency?
When you were injured, there were dozens of caring professionals dedicated to getting you back to your old self. Now, as you look upon a kitchen table covered by fine-print liabilities, it’s easy to wonder whom—if anyone—is advocating on your behalf.
The Unsustainability of Medical Billing
This scenario has repeated itself millions of times over for a number of years. The side effects modern healthcare billing has on patients is that grave. Medical debt, even among the insured, is the leading cause of personal bankruptcies in the United States—more than student loans, home mortgages and divorce. In fact, more than half of Americans believe that getting an unaffordable medical bill is as bad as getting diagnosed with a serious illness!
A veritable cottage industry of websites and apps have sprung up to help patients gain a toehold in the complex and often-opaque world of medical billing, but these solutions, at best, only help you better organize an unsustainable problem, not carve a viable and confident pathway to resolution.
VisitPay asked several healthcare billing professionals to imagine what a patient friendly bill might look like. While their professional expertise informed their visions for a better bill, many of them spoke from their own experiences as patients.
“As a patient, as a mother, I think something that’s really critical is not just seeing my own liability but being able to have perspective into the broader liability of my family,” said Gena Bezdek, Senior Director of Client Engagement at AVIA. “It’s being able to understand what I might owe, getting updates on how that’s evolving. If that estimate or bill is changing. And to have a sense of, if I do have a financing plan, how I might integrate that with other liabilities that I have or other plans that I have.”
Medical bills are way too confusing and frustrating for the average patient. Bills are static snapshots of highly fluid processes that tell an incomplete story and often create more questions than they answer, such as whether insurance payments, adjustments, and co-pays are accurately captured.
Additionally, consumers don’t want one-off bills for single doctor or hospital visits. Rather, it’s far more convenient to present consumers with a statement of all charges for a month. Ideally, consumers would have the option of unifying all family members under one account to manage any number of people – parents, children, grandparents, and other family members.
“I think the most important thing on a patient friendly bill is that the patient knows what services that they received and that it’s very obvious what they owe and what their options are to pay and where they can pay,” said Lorrie Jost-Bailey, Director for Cash and Customer Service for BJC Health Systems.
Billing clarity is more than an industry shift, but a cultural one as well, noted David Salsberry, Chief Revenue Officer at Texas Health Resources. “I think the patient responsibility level has increased so dramatically that people just don’t know what to do, and they are looking to us to help with that,” he said. “We have to provide the resources and the knowledge and the education that patients can use to make informed decisions from a financial standpoint.”
Most of the people we spoke to recognized that a better bill needs to accompany better patient education regarding financial obligations.
“One thing that has stood out for me is the notion of educating the patient or the consumer earlier on in their experience or in their journey and finding ways to proactively bring financing options to them out of the gate,” said Bezdek. “I think that there’s an incredible opportunity—not only on the patient bill front—but also on the broader consumer experience front. There’s an opportunity to integrate our communication and our engagement with patients in a very different way. It’s not thinking about this singularly—as the patient bill or revenue cycle engagement vs clinical engagement, but an overall more cohesive experience.”
Healthcare in the patient-as-payer era has reached an inflection point as health system margins grow tighter and patients become more frustrated with both rising bills and their provider’s inability to help them sustainably manage those obligations.
In a digital world, it’s easy to forget that there is a complex person behind every bill. “We need to figure out better ways to communicate with our patients early on in their visit so that they’re more aware of what their balance may be,” said Jost-Bailey. “And we need to come at it in a comprehensive way—that we care about you as an individual.”
Jenny Renee, Director of PFS Patient Contact Center at Inova Health System, said, “I want to give patients the ability to choose how they’d like to ‘connect’ with Inova, by offering them multiple ways to pay that also takes into consideration their financial ability. I want our patients to know Inova cares by providing them with an experience that is compassionate, convenient and financially flexible.”
The patient-as-payer era represents a significant risk to all hospitals and health systems. But it also offers opportunities to those who approach this challenge with empathy, transparency and the desire to help patients manage their bills for good.
Patients require an individualized approach that makes them feel heard and empowered. To meet the needs of patients, healthcare stakeholders must work together to help consumers take control of their healthcare payments—leveraging technology, engagement, and education. By adopting new payment strategies that prioritize billing transparency and robust, consumer-friendly payment options, health systems can help shape this new healthcare consumer.
The consumer is the new focal point of healthcare finance—and engaging them requires a different approach. As health systems consider the nuances of the patient financial experience, a great place to start is the VisitPay eBook—The Rise of the Healthcare Consumer.
This publication takes a deep dive into consumerism’s impact on healthcare and proven methods for improving the consumer experience. Download the eBook here.