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This course addresses the HFMA Healthcare Dollars and Sense initiative and its impact on revenue cycle operations.<div><br></div><div>Estimated course completion time: 1 hour</div>
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Course | Basic | Consumerism
This course addresses the principles of price transparency, the role of price estimates in patient financial care and how pricing information is used to prepare and present price estimates.<div><br></div><div>Estimated course completion tim...
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Column | Consumerism

Patient financial responsibility for COVID-19 treatment: let's get it right

Column | Consumerism

Patient financial responsibility for COVID-19 treatment: let's get it right


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 their 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.

Hospital reality during the pandemic

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. Canceling 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 revenue reductions of 40% or 50%% 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 nothing less than incredible. 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 bit of good news. During a crisis like this, we all need to row in the same direction.

Need to adapt business policies, 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 are at risk of losing them in the weeks ahead.  We really do not know the extent or length of the economic slowdown, which plays directly into 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.

Hospitals also should consider pausing billing to consumers for their out-of-pocket payment 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 for COVID-19 treatment 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 the right approach. For revenue cycle professionals who pride themselves on their low discharged-not-final-billed rates, holding onto bills may go against the grain. And 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 due to the crisis at hand.

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.

It’s hard enough to build the plane while we’re flying into record-breaking headwinds; we can’t redesign it now, too.  What we can and should do, as finance leaders attuned to the needs of our communities, is increase our focus on consumer-friendly billing and payment policies and practices. In these moments, 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.

About the Author

Joseph J. Fifer, FHFMA, CPA,

is president and CEO, HFMA, Westchester, IL

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