Richard L. Clarke, DHA, FHFMA
President and CEO, HFMA
What do price transparency, pay for performance, discount policies for the uninsured, community benefit accounting, and tax exemption have in common (other than they all seem to result in more cost or lower payment)?
These concepts, and the concerns they generate, converge in the notion that healthcare organizations (especially not-for-profit hospitals) are community trusts.
I don’t mean trust in the legal sense, but in the sense that these organizations serve as trusted community assets—among the most important assets that any community has. Being a community trust means that the actions of the organization’s management team must be based on what is best for the community within the organization’s financial and structural capacity—not so easy when media and regulatory attention seems designed to penalize good work rather than help create solutions.
So what should we do to earn and fulfill this trust? First, we must embrace consumerism. We must adopt a philosophy of actively engaging consumers in their health and medical decisions. As healthcare leaders, we must set the tone for the organization that members of the community are our primary stakeholders—our primary customers. Our focus should be serving their needs and helping them achieve improved health status. In internal meetings, external communications, and actions, we must demonstrate that the community we serve is our focus—not physicians, payers, or employers.
Second, we must live that philosophy by improving internal systems and by working with others to remove barriers to engaging consumers. A key concept of earning and fulfilling community trust is price transparency. Trust cannot be generated or maintained with our stakeholders if they believe we’re trying to confuse or cheat them with unintelligible pricing information. And the pricing information that is most meaningful to patients is tailored to their condition, insurance coverage, discount eligibility, and past payment history. A wealth of resources for this effort is currently available, including the summer 2006 PATIENT FRIENDLY BILLING® report Consumerism in Health Care (www.patientfriendlybilling.org).
Third, those of us who are not-for-profit healthcare providers must fulfill our charitable mission by identifying and communicating how we meet the needs of all members of the community—not just those with the ability to pay. And we must be accountable to the community for our actions. Discount policies for the uninsured converge with consumerism. Such policies reflect the idea that within its financial capability, an organization has an obligation to engage consumers, regardless of their ability to pay. Collaboration is important here as well. Working with community groups, employers, and payers to develop local solutions to obtain insurance coverage and/or provide services to this portion of the community is a key. The February 2005 Patient Friendly Billing report contains a wealth of information on how to achieve effective discount and collection policies as well as approaches to collaboration.
To truly be a trusted community asset requires courage in leadership. It requires us to move beyond rhetoric, to remove barriers, and shine a light on hidden agendas. And it requires us to evaluate all our professional activities on the most important criterion of all: how they help our communities.
