Financial Leadership

Patient financial responsibility for COVID-19 treatment: Let’s get it right

April 27, 2020 3:40 pm

  • Media coverage of patient financial responsibility issues during the COVID-19 pandemic should recognize the daunting reality facing hospitals and the lengths to which many are going to meet the challenge.
  • Hospitals should reevaluate their business practices out of sensitivity to consumers, including by expanding financial assistance and pausing out-of-pocket billing in some instances.
  • The public discourse should focus on ways to handle the ongoing crisis, not on hot-button political arguments.

If you’ve been reading the news online lately (and who hasn’t?), you’ve probably seen an abundance of news stories lauding physicians, nurses and others on the front lines for their extraordinary dedication and skill. This favorable coverage is well-deserved. Kudos to the media for its coverage of our clinical heroes.

When it comes to patient financial responsibility for COVID-19 treatment, though, I believe some journalists are predisposed to find the billing entities guilty until proven innocent. This is not the time for anecdotal news coverage of exorbitant COVID-19 charges that paints all hospitals and health systems with a broad brush.

The reality hospitals are facing

The reality is that many hospitals are incurring huge financial losses as a result of the pandemic. Some have already been forced to take emergency measures such as furloughing and laying off employees. The cancellation of elective procedures to prepare for an expected surge in COVID-19 patients, often weeks in advance, is just one reason for the anticipated losses. I have heard countless stories of 40% or 50% revenue reductions due to making space for a surge that in most communities has not occurred. The thought that these revenues will be made up in a short-term bounce-back is absurd.

In addition, the cost of supplies, emergency capital and other preparations for the anticipated surge is massive. Journalists should seek to understand that the pandemic will stretch hospital and health system finances to their limit, and in some cases beyond it.

Instead of looking for hospitals that are getting the financial side of this pandemic wrong, why not look for those that are getting it right? And those stories are numerous and heroic. In an environment saturated with bad news, people welcome a dose of good news. During a crisis like this, we all need to row in the same direction.

Hospitals should reexamine business policies and practices

That said, journalists are not the only ones who should reevaluate their approach to what they do under these extraordinary circumstances. Hospital and health system finance leaders also must adapt their business policies and practices.

Consumers are understandably worried about what they will be expected to pay for COVID-19 care. Millions have already lost their jobs and their employer-sponsored health insurance coverage; millions more could meet that fate in the weeks ahead. We really do not know the extent or length of the economic slowdown, which directly affects insurance coverage. This is the time for hospitals and health systems to reevaluate their financial assistance policies and consider extending assistance to those who don’t currently qualify for it.

Hospitals also should consider pausing billing to consumers for their out-of-pocket payments for COVID-19 care in situations where health insurance coverage is undetermined or ambiguous. Imagine what it’s like to be on the receiving end of those bills. If bills are issued at a time when coverage decisions are still evolving, regulations are still being redrawn and providers are still trying to understand the new world order (let alone update their automated systems in accordance with it), trouble is likely to follow. That trouble could take the form of calls from dissatisfied patients, unfavorable media coverage, social media backlash or all the above.

Holding bills a bit longer and increasing scrutiny of billing practices may be appropriate. I certainly understand the need for cash flow when revenues are cut almost in half, but it’s one way provider organizations can respond to the financial fallout consumers are experiencing.

Focus now on what matters

One thing I know for sure: Responding to the crisis at hand is the order of the day — not debating “Medicare for All” or the failings of employer-sponsored health insurance. We would do well to avoid getting embroiled in heated, counterproductive social media exchanges about such issues.

What we can and should do, as healthcare leaders attuned to the needs of our communities, is increase our focus on consumer-friendly billing and payment policies and practices. During this unprecedented public health crisis, government officials, the media, community leaders and the public understand the true meaning of our mission and community benefit.

Now, more than ever, we are all healthcare consumers. And we are all in this together.


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