The patient financial experience is very important—but it’s not the end game for consumerism.
We at HFMA are focused on improving the patient financial experience for several reasons. The financial experience affects patient satisfaction with a medical encounter and can even impact willingness to seek care. Additionally, a negative experience reduces propensity to pay, while a consumer-centric revenue cycle improves ability to collect. Our MAP Award for High Performance in Revenue Cycle winners and our Patient Financial Communcations Best Practices Adopters tell us that when patients know up front what to expect, they are more willing to come to a resolution sooner and stick to the agreement, whatever it is. Finally, answering a reasonable request from consumers is simply the right thing to do.
Our industry must do a lot of catch-up work to shift from a B2B model to a consumer-centric orientation. Most is on the basics: ensuring consumers know ahead of time how much they’re expected to pay, helping them avoid surprise upcharges, and informing them of payment policies, options, and potential discounts. (See how basic that sounds without healthcare jargon? That translates to price transparency, avoiding surprise out-of-network bills, and improving patient financial communication, respectively.) Let’s assume we master the basics and we also offer mobile payment. What then? Will those steps make us masters of consumerism?
Not quite. We will have completed the prerequisites for delivering on the true promise of consumerism: helping patients make better decisions and choose high-value health care. That’s the end game. I know that sounds like jargon, too. Examples may help.
Helping patients choose high-value health care means providing information about the out-of-pocket costs and expected health outcomes of different treatment options, such as back surgery for a herniated disc versus nonsurgical treatments. (Over the long run, both approaches are about equally effective at reducing pain and other symptoms.)
It also means patients can easily access relevant information that allows them to compare the same service (e.g., knee replacement) performed at different hospitals, or in the case of imaging or lab work, at hospitals versus freestanding facilities.
All of this must be delivered in a way that consumers can understand—something that’s particularly challenging for health care.
Going down this road, there will be pressure on higher-cost providers to reduce their costs, justify them, or exit some service lines. Those are not easy options. Maybe that’s part of the reason that providers have been slow to embrace transparency.
What’s the alternative to embracing transparency? The market—and/or regulatory bodies—will make the choices for providers. Health plans will increasingly choose to contract with best-value providers. Consumers will choose lower cost, nonhospital facilities for imaging and lab work, and best-value providers for elective procedures. Price transparency regulation will increase. It may be slow, uncomfortable, and painful, but eventually the market forces (i.e., what are our society is willing to pay for health care) will win out, be it through pure competitive market forces, price-setting by the federal government, or some combination.
Delivering high-value health care is an imperative in an environment where health spending continues to increase at an unsustainable rate. The future of consumerism is value transparency.
Access resources for improving the patient financial experience: hfma.org/dollars
Follow Joe Fifer on Twitter: @HFMAFifer
