The Patient is Always Right
As patients take on a greater share of their healthcare costs, they become a seismic influence that revenue cycle professionals can no longer ignore. Patients have more choices than they did in the past, and healthcare leaders must begin to think of them as customers with options regarding where they go for care. And as the old saying goes, the customer is always right.
Social media is redefining both human connections and consumer behavior. Facebook status updates, restaurant reviews on Yelp, and 140-character rants on Twitter are the norm in daily life. Social media is where consumers of health care are now venting about their care and its cost—information prospective patients will see and pay attention to.
Fifty years ago, a patient with health insurance had all their health care paid for. The patient would not have any financial responsibility. How things have changed and are continuing to change is mindboggling.
While the conversations surrounding the Affordable Care Act and American Health Care Act continue in Washington, it is apparent that the complexity of both the law and proposed legislation confuses elected officials and citizens alike. What is more apparent to everyone is that employers are paying the price for governmental decreases in payment, with private health plans raising their premiums. Attempts to address the cost shift—such as health savings accounts, and bundled payments—serve only as temporary solutions. Patient premiums and deductibles are skyrocketing, producing a great financial toll.
It’s well known that most patients don’t begin to understand their healthcare benefits until they need to use them. And hospital bills and financial statements only that add to the confusion. Additional bills from other providers such as physicians, consulting physicians, radiologists, anesthesiologists, and others further add to the perplexity.
An educated patient can look up charges, compare charges among hospitals, review physician and hospital satisfaction data, and share that information on social media. To be competitive, healthcare organizations need to treat the patient like a consumer. The patient demands the same type of healthcare financial experience he or she gets in the retail environment.
Patients want bills they can understand. Healthcare organizations should work with health plans to provide an explanation of benefits any patient can understand.
When patients walk into facilities other than the emergency department, they should know what will happen, how much their out-of-pocket costs will be, and how much the insurance will pay. Health plans and providers should form a team approach to inform each patient of his or her financial responsibilities—even if services are fully covered.
The marquee of this concept at Yale New Haven Health (YNHH) is the Patient Financial Advocate (PFA). YNHH embeds PFAs in the clinical departments to help patients and their families navigate the healthcare financial experience. In the hospital’s transplant center, the program has shown such great success that in 20 years, not one transplant case has been written off as bad debt. YNHH is now expanding this concept to other service lines. The hospital also has created a patient advisory panel to collect patient feedback on the billing process.
Increasing costs and the connectedness of people in the age of the Internet has strengthened the position of patients, who are investing significant sums in their health care. Healthcare organizations are well advised to pay attention to the voice of their customers.
David Wurcel, MBA, CHFP, CPAM, is vice president, corporate business services, Yale New Haven Health, New Haven, Conn.