Deductibles are escalating and give no indication of slowing down. With consumers becoming more financially responsible for their care, the entire patient experience cannot be overlooked.
At Becker's Becker's 2nd Annual CIO/HIT + Revenue Cycle Conference, a panel of revenue cycle management and technology experts shared their experiences in the evolving healthcare payment system and how the consumer will play a larger role in healthcare going forward.
High deductibles have placed more financial responsibility on the patient who in turn will become more conscious of their services' quality, from the procedure room to submitting a payment.
"If I am bearing the brunt of the cost with my high deductible health plan, I intimately care about the services and the price transparency around those services," said Ric Sinclair, VP of product for Zirmed.
Ten years ago, a high deductible totaled around $500, with some patients today paying a steep fine of up to $5,000 or even $10,000, depending on their plan, Michael Orseno, VP of revenue cycle management for Regent Surgical Health, noted.
Although high deductibles may take a toll on patient's finances, they do carry some benefits. With high deductibles come lower monthly premiums. Some patients may take on more risk to drive down their monthly premium costs. The benefits may vary depending on where patients fall in the economic spectrum.
"The general benefit is with more responsibility, patients have more control," said Tom Hui, founder, president and CEO of HST Pathways. "Some patients may be less likely to consume healthcare, and that is a decision they make. There is no perfect answer. Some good comes along with the bad."
However, the patient payment experience is often convoluted and doesn't carry the ease of payment, which is often at the core of several other industries. Mr. Sinclair said the patient experience lacks a sense of normalcy.
"Technology is advancing so that patients can pay bills in five seconds much like catching a Pokémon in this room," he said. "If we are shifting payment responsibility to patients, but not providing a retail-like experience, that's lunacy to me."
Patients are consumers and consumers want ease of transaction. Zirmed conducted an analysis to determine how patients were paying their bills. The company found in 2013 patients paid 5 percent of online bills from their mobile phone. That figure increased a four-fold, hitting 20 percent this year.
"If you fast-forward 36 months, you will likely see between 45 percent and 50 percent of payments from patients' mobile devices," Mr. Sinclair said. "If your organization doesn't offer this, they will either give you a bad patient satisfaction score or they will go elsewhere."
To do well in the pay-for-performance payment system, hospitals need to bring patients into the fold and ensure they fully understand their benefits. Many patients do not understand how to interpret their insurer's explanation of benefits and others are often confused by their bills. When paying their bills, patients do not positively receive surprises, so giving patients the most accurate estimate you can provide at the time is an element of care hospitals cannot afford to overlook.
"If there are any surprises for patients about what they are on the hook for, that is a negative event regardless of how the surgery turned out," Mr. Hui said.
Although it may be an awkward conversation, talking to patients about prices and what will come out of their pockets is crucial as deductibles continue to rise. Technology is making it easier for patients to obtain estimates so they don't walk out of the procedure room surprised at the bill for the services rendered. However, organizations should ensure their processes are strong and are used in conjunction with the technology. Mr. Orseno said patient financial counseling may serve as a vital tool to educate patients about the billing process and their financial responsibility.
"You have to make sure your business operations are sound," Mr. Orseno said. "Collectors should be nice to the folks on the phone, while being firm. It is a hard job to be both firm and compassionate."
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