The cost of care is often an important consideration for both patients and providers today. Even before the coronavirus pandemic began affecting many individuals and institutions financially, a number of widespread, inter-related trends already were contributing to an increased focus on cost. Many patients were having to pay more out of pocket due to increasing premiums and deductibles, according to information from the Kaiser Family Foundation. And InstaMed reports that many providers say they have to collect a greater portion of the costs of care directly from their patients, rather than from traditional third-party payers. 
A Gallup Poll published in December 2019 found that 33% of Americans surveyed said they or a family member had postponed needed medical care in the past year due to cost. When patients move forward with care, providers may have to devote substantial time and effort to billing and collections. One recent study found that 77% of providers surveyed said it takes more than a month to collect any patient payment, and 67% cited patient receivables as their top revenue cycle concern, according to the InstaMed report.
More recently, 32% of consumers surveyed said they were adjusting their healthcare spending, and a separate study found that 44% of surveyed patients had cancelled or postponed healthcare appointments due to the pandemic. These decisions directly affect healthcare organizations and providers that may still be working toward full reopening or adapting to new processes (and incurring associated expenses) to protect and reassure staff and patients.
Essential conversations, sensitive subject
The importance of sharing information on out-of-pocket costs and having clear, honest discussions about payment expectations and options seems obvious. Despite this reality, many healthcare professionals may still hesitate to broach the subject with patients, and they may feel uncomfortable or uncertain when engaging in financial conversations. Patients may share this reluctance to talk about money as well.
A recent CareCredit study found that most patients surveyed (63% to 83%) said they are not looking for information on healthcare costs and payments at various points (from learning they need care to receiving a bill for balance due). This suggests that many healthcare consumers may still expect insurance to cover all or most of their healthcare costs, which could mean they are not budgeting for a significant out-of-pocket obligation.
Given the situation, providers may see themselves as delivering unwelcome news about how much or how soon patients may need to pay. However, even when patients find the details of their financial obligations surprising or challenging, being aware of these details as soon as possible can make it easier to plan ahead and make informed decisions. When providers share information in a clear and proactive way, it can help patients avoid incurring unexpected costs, which can help improve patient satisfaction and retention, as well as payment collection.
It is generally better for patients and providers alike to overcome any feelings of discomfort and address this essential topic through open, honest dialogue.
Making financial conversations comfortable
Delivering a more patient-centric financial experience rarely happens overnight. It helps to begin with some deliberate planning at a leadership level, followed by thoughtful roll out to staff and ongoing reinforcement over time. A good place to start is by considering where challenges and gaps may currently exist. Are there certain questions that multiple patients have at the same point or in similar scenarios? Are there specific issues that are causing difficulty or inconsistency for staff members, affecting patient satisfaction or impacting business metrics like revenue and retention? If so, these may be areas where new policies or practices could help.
The next step is to document and share any relevant decisions with everyone who may be involved or affected (e.g., leadership, staff, patients). This communication is key to ensuring that everyone is on the same page and able to proceed in a clear, consistent way. In-person conversations also are helpful, especially in cases where individuals may have questions or concerns. Even positive change can sometimes be uncomfortable, so it is important to help reassure people that the change is necessary and intended to be positive, and that the organization will help enable the transition by providing training, tools and other forms of support.
To that end, staff members may benefit from the option to have some open, candid (though focused and positive) discussions in a group setting. It is wise to offer some opportunities for practice, such as small group activities or pairing off to role-play patient conversations. Periodic reinforcement is beneficial, whether this involves occasional meetings to share ideas, experiences and advice, or refresher training and practice sessions.
Ultimately, patients often want and need information on cost and payments, so team members should have the confidence that having financial conversations with patients can be a positive and helpful experience. Especially when providers focus on staying positive, offering options and working with patients to decide on the best way forward, financial conversations can be a win-win.
To learn more and access additional insights and resources, visit carecredit.com/hfma.
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 Kaiser Family Foundation, “Employer Health Benefits 2019 Annual Survey,” Sep. 2019; InstaMed, Trends in Healthcare Payments Ninth Annual Report: 2018, May 2019
 Gallup, Gallup Poll Social Series, December 2019.
 PWC, “The COVID-19 pandemic is influencing consumer health behavior. Are the changes here to stay?,” April 2020; GCI Health and Harris Poll, “The COVID-19 Health Impact Survey: Select Findings for Communicators,” May 2020
 CareCredit, Understanding the Medical Journey research, conducted by Chadwick Martin Bailey, Q2 2019.