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Recent patient focus group participants shared their opinions on hospital billing statement design.


When you designed your hospital’s billing statement, did you consult with actual patients to find out what they preferred in terms of content and layout? Many hospitals have relied on educated guesses in the development of statements. But an educated guess is still a guess. As patients become increasingly responsible for and involved in paying for their care, it’s essential that providers treat the billing statement as a core patient communications tool that can enhance revenue or detract from it.

Why We Must Know Patients’ Perspectives

The constant change in the healthcare industry is sparking the need to gain deeper knowledge regarding patients’ perspectives on statements and financial communications.

Even before the Affordable Care Act, health care was changing. Market shifts can be acute in how they impact hospital customers—and that should impact the communications, marketing, and other solutions we develop and use to connect with them. This couldn’t be more true for billing and patient statements. As the market has shifted toward consumer-driven health plans with high deductibles and increased patient payment responsibility, overall patient engagement in the financial aspects of care has grown exponentially.

I recently helped develop targeted focus groups to get first-hand feedback about what does and does not work in patient statements. The patient focus groups were structured to reveal actionable insights under the supposition that statements can be revenue enhancers or detractors.

Communication has an impact on hospital revenue. It’s imperative that patients have positive experiences not just in their clinical care but their financial care, as well.

Patient Focus Group: Parameters and Approach

With a goal to gain direct, knowledgeable insights to develop best practices, the focus groups were segmented to bring in health care “heavy users.” To be qualified to participate, patients must meet the following guidelines:

  • Received at least two hospital bills within the last 12 months
  • Bear some responsibility in the payment for care, having directly paid a hospital bill in the last year on behalf of themselves or family members

Across the participant base, a wide range of insurance carriers and many different hospitals were represented. The three groups were separated by age ranges—25 to 44, 45 to 64, and 65 and older—to assess potential age-specific perceptions. The study was blinded so participants had no information about the company conducting the research.

A First Look at Focus Group Findings

Across all three groups, the study revealed a few consistent, core findings.

Patients are not satisfied with the patient billing experience. When asked for words or thoughts to describe their sentiments about statements, patients offered the following comments:

  • Ages 25-44: Disgust, frustration, expensive, lots of paper, confusion
  • Ages 45-64: Frustration, expensive, confusion 
  • Ages 65 and older: Confusion, shockingly high, not enough explanation

The statement is an extension of the hospital experience. Participants’ opinions of hospitals are influenced by their ability to effectively review and understand the content of the statements. Some participants from all groups stated that they trust their insurance providers to offer what they believe is the most reliable information regarding their care encounters. As educated consumers, patients expressed distrust of hospitals that send unclear bills. Patients also expressed concerns about discrepancies between statements and explanation-of-benefit documents.

Patients want clearly conveyed details. The focus groups helped to redefine the term “simplicity” in association with billing statements. While some providers might have interpreted this word to mean a reduction of detail, participants resoundingly stated that, for them, it means clarity of details. Many participants across all groups stated that they rely on phone calls to the hospital to attempt to clarify their charges. They expressed the need for itemization and stated that they wait to receive all the information they need before paying, supporting the supposition that statements play a role in enhancing or detracting from revenue.

Well-designed statement summaries can be effective tools. Participants chose the following summary statement as one of their favorites.

AccessSample Patient Statement
After reviewing various strategically designed statements, participants responded with their initial thoughts. These comments were dramatically different from the input offered in response to their overall perception of hospital billing.

  • Ages 25-44: Doesn’t feel as cold, less likely to call, calming. 
  • Ages 45-64: Less confusion, easier to read, less time spent, more confidence. 
  • Ages 65 years and up: Efficient, user-friendly, not really hiding anything.

Better clarity of information may equate to reduced call volumes or abbreviated, more concise calls, according to feedback from the groups.

What’s Next? Taking Action on the Insights

Providers need to adopt a strategy of clarity for their billing statements. Patients in the focus groups responded positively to summary pages designed with intention, drawing recipients’ eyes to key information such as amounts owed, due dates, and payment options. However, patients expressed the need for clear details to follow the summary as a means of confirming validity of charges.

A full compilation and analysis of the focus groups is currently underway. In addition to offering deep insights into the patient sentiments, the final report on the participants’ comments will delve into details regarding the specific statement features identified as most effective. The groups provided practical perspectives about overall statement design, use of color and bold fonts, placement of call-outs, and order of content.

In advance of the final report, the fundamental take-away from the focus groups is that providers should look at the billing process as an extension of their care and their brands. Best practices can lessen the burden on patients, increase satisfaction, and incentivize payments.

Laura Aylward is manager of market intelligence, Emdeon, Nashville, Tenn., and a member of HFMA's Tennessee Chapter.

Publication Date: Wednesday, September 18, 2013