Cost estimates, scripts, and cost distress screenings are top ways providers can have cost-of-care conversations that boost collections and outcomes.
Patients are paying more and more for their healthcare services, making effective cost-of-care conversations a skill that providers need to successfully treat patients.
Health plans with deductibles are becoming commonplace. A new analysis from the Kaiser Family Foundation shows that about 85 percent of covered workers had a plan with a deductible in 2018 compared to 59 percent ten years prior.
With the rise in deductibles, patients are spending significantly more on out-of-pocket healthcare costs compared to the recent past. The average deductible has risen by over 150 percent from 2009 to 2018, KFF reports.
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Patients and their providers are now finding healthcare affordability to be a major challenge. Nearly three-quarters of providers in an Instamed survey reported an increase in patient financial responsibility, and total hospital revenue attributable to patients has increased by 88 percent from 2012 to 2017, TransUnion recently reported.
Providers are now relying more on their patients for revenue capture. But their workflows do not align with the new trend in healthcare. For example, only 35 percent of patients in a recent Connance survey said their providers contacted them prior to treatment to discuss patient financial responsibility.
Having effective cost-of-care conversations with patients is a new necessity for providers. Being able to discuss patient financial responsibility is not only key to improving patient collections but also keeping patients healthy. One in four patients a recent West Health Institute/NORC at the University of Chicago national poll said they have skipped recommended medical tests or treatment due to cost.
Providers and their staff can start having effective cost-of-care conversations by integrating the discussions into the provider workflow, calculating out-of-pocket cost estimates, creating scripts, and screening patients for cost distress.
Integrate cost-of-care conversations into daily workflows
Carving out the time and resources needed for routine patient financial responsibility talks is the first step to having effective cost-of-care conversations that can boost the bottom line and patient outcomes.
Unfortunately, providers generally do not have a system for conducting cost-of-care conversations.
A new study of two Kaiser Permanente regions found that clinical and non-clinical staff wanted to address patient financial responsibility concerns and questions but they oftentimes had to find “creative workarounds to existing workflows.”
The workarounds included “cheat sheets” near workstations and informal relationships with staff in other departments. The staff also reported that they had to access data sources they might not normally use (e.g., patient insurance contracts) and perform tasks beyond the scope of their job.
Identifying or hiring an employee who is responsible for having cost-of-care conversations would help integrate the discussions into clinic workflows, staff members at Kaiser Permanente advised.
Staff members also suggested that provider organizations give employees real-time access to data on costs, such as patient insurance benefits or fee schedules for specific services, so staff members can find out-of-pocket cost estimates at the point of care.
They also recommended that organizations implement EHR-based documentation systems that would help to identify and document patient financial needs, questions, and follow-up.
Provide out-of-pocket cost estimates
A lack of data on out-of-pocket costs is a major barrier to effective cost-of-care conversations. Providers and their staff generally have access to chargemaster prices, but patients rarely pay hospital charges after insurance.
Furthermore, manual insurance verification processes and front-end revenue cycle management systems that cannot verify insurance in real-time and crosscheck the information with payer contracts can impede timely cost-of-care conversations.
Technology can help providers find accurate, personalized cost estimates, said Sean Lundy, CMPE, of the Hand & Wrist Center of Houston.
“It is critical for providers to use accurate estimates when collecting the patient responsibility, as inaccuracies can generate added follow-up expenses, such as refunds and bills, which may turn profitable procedures into losses,” he explained. “Since obtaining current allowable amounts directly from payers can be challenging, to say the least, providers should use software tools that assess historical data and estimate allowable expenses for specific payers and procedures.”
Providers can also implement front-end revenue cycle management systems that not only electronically verify insurance but also use payer contract data to calculate personalized out-of-pocket costs for patients.
Script cost-of-care conversations
Once providers and staff have access to cost estimates, they must communicate the information to patients in a sensitive manner.
“You have to have that awkward conversation,” Jill Barton, the vice president of revenue cycle at Montefiore St. Luke’s Cornwall Hospital, recently told RevCycleIntelligence.com. “We don’t want long term arrangements. We are not a financing institution. We are a hospital. So, we’ve created a script for the team.”
Barton trained members of the hospital’s new pre-access center on how to identify verbal cues from patients to tailor cost-of care conversations.
“We ask if it would help to set up a payment plan and identify what the patient can afford,” she explained. “Depending on the answer, we’ve trained and scripted our staff to respond and collect the information we need to make that payment happen. And our staff can escalate the patient up if he says it’s too high of a dollar amount or he says there is no way he can pay the amount.”
The scripts have helped the small New York hospital collect over $1 million a year in patient payments, and hospital leaders expect to collect $2 million by the end of 2018.
“You need to invest in the front-end by improving the quality of training and your staff’s ability to communicate and help people understand their health insurance,” Barton said. “We increased the level of education for our front-end staff so they can not only answer medical-related questions but also read the patient and understand their anxiety about the financial process as well.”
“Technology is definitely a very key component. But people are just as important,” she emphasized.
Screen patients for cost distress
A patient’s financial situation is one of the top social determinants of health that can easily deteriorate patient outcomes if left unacknowledged by providers. While research shows one in three patients experience distress overpaying for healthcare services, many patients and providers fail to discuss cost of care.
Given the prevalence of cost distress and its potential negative impact on patient outcomes, the American College of Physicians (ACP) advises providers to screen patients for cost distress to ensure they are having effective cost-of-care conversations.
The national organization of internists suggests that providers ask their patients a series of questions and if the patient says yes to any of the questions, then the provider should engage in a cost-of-care conversation immediately. The questions include:
- Do you feel financially stressed due to your current healthcare needs?
- Are you worried about how your healthcare bills will be paid?
- Are you concerned about your current financial situation due to your healthcare needs?
- Would you like to discuss your cost of healthcare with your provider at today’s visit?
Providers should screen every patient for cost distress and be prepared to have an in-depth discussion about cost of care that is framed around getting the best care at the lowest possible cost, ACP adds. The organization also stresses that providers should always have a follow-up plan with patients who are experiencing cost distress.
Having cost of care conversations with patients may not be at the top of physician priority lists. But as patient financial responsibility continues to grow, treating a patient’s clinical and financial needs will be key to improving patient outcomes while keeping the bottom line healthy.
Date: May 24, 2019