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3 Strategies to Deliver Better Patient-Centered Financial Experiences

  • October 30, 2018
  • Published in Billing

There’s a growing trend affecting patients in the U.S. today: delaying or avoiding care because of concerns about costs. High out-of-pocket costs are restraining access to care for many. Even when patients have access and decide to get care, the costs and the financial experience result in even more stress.

Today’s healthcare consumers are also increasingly demanding efficient and smooth experiences as they take a greater financial responsibility for their care. In a study by global brand and marketing consultancy Prophet, only 23 percent of healthcare providers measure their consumer relationship. 

Reimbursement policies are placing patients at the center of value-based purchasing and bundled payment models. Hence, a significant percentage of your facility’s A/R is in the hands of patients. With increasing patient financial responsibility, it is essential to give patients a better financial experience.  

Here are 3 strategies to give better financial experiences for your patients:

Using Payment Integration

Payment integration allows your center to be where your patients are in terms of their preferred method to make payments. When your payment system is integrated with your other systems, you have opportunities to collect at every patient interaction point.

With payment integration, patients can have access to their accounts online so they can see what their insurance has covered, verify recurring payments, check their payment status, and make payments anytime and anywhere. You can enable patients to make payments through any payment channel (online, mobile, over the phone, bank’s bill pay site, etc.) with all payments posting to your existing system in real-time.

Providers that use automated payment systems that can post patient payments directly to the patient accounting system report collection increases and AR reductions.

Train Staff

A highly engaged staff likely boosts patient experience, translating into better performance. According to a study by Deloitte Center for Health Solutions, patient experience scores pertaining to interactions with nurses have the strongest association with hospital financial outcomes. ASC staff needs to be able to empathize with patients and be trained to use tools and technologies that improve the patient experience.  

The study also found that staff engagement measures such as quality of staff, staff communication and responsiveness, and appointment ease, among others, were the most important drivers of patient experience.

Find the Right Partner

Financial services are not a core competency for healthcare providers. But by partnering with companies with core expertise in revenue cycle management and financial services that streamline the end-to-end payment process, providers can solve their most pressing financial problems as well as improve the patient experience. 

Your center needs to partner with healthcare-exclusive vendors rather than a one-size-fits-all agency. Choose healthcare specific vendors that take time to educate patients and help patients understand their financial responsibility in the friendliest possible way. The right partner can raise your facility’s standards for ensuring patient satisfaction and improving collections with implementation of technology, automation, and optimization of revenue cycle processes.

New Propensity to Pay Technologies Can Reduce Payment Defaults from Self-pay

With revenue coming from self-pay increasingly becoming a large portion of the total revenue for healthcare providers, there’s an even greater need for innovative ways to approach the patient collection process. 

According to the National Association of Healthcare Access Management (NAHAM), self-pay is the third largest payer just behind Medicare and Medicaid. Patients now represent about 30 percent of healthcare revenue. 

Self-pay comes at a high price, especially for facilities looking to clamp down on cost and increase revenue. The cost of collection for self-pay is estimated to be three times that of commercial insurance. Moreover, a significant portion of self-pay balances go uncollected by providers and are eventually treated as bad debt.

Since this problem is connected to the growing financial responsibility of patients (many are unable to offset their medical bills without getting credit), it cannot be avoided. Surgery centers will still have to extend credit facilities to patients unable to settle their medical bills at the point of service.  

However, leveraging new technology has helped minimize the risk of default from patients while also simplifying the collection process for both patients and providers.

Recently, behavioral based propensity-to-pay models have been developed to overcome the limitation of accurately predicting the medical indebtedness of patients. The previous practice was to rely on credit scores to predict the probability of default by patients. Credit scores are however not well suited for this task as they focus more broadly on consumer debt.

This new technology relies on data from multiple sources to accurately predict patient’s likelihood of default. Based on their credit ranking, patients are then offered payment plans tailored to suit their ability to pay. 

Providers therefore have greater assurance of a lesser risk of default on the credit advanced to patients. This in turn results in win-win situation for both parties as their interests are aligned.

By being able to ascertain a patient’s ability to pay before surgery is conducted, an ASC can prevent default by engaging patients on the available payment options. Moreover, the time and effort spent unproductively on tracking collections from patients who are unlikely to pay will be significantly eliminated.

A facility can therefore re-prioritize by channeling more resources to patients with a higher probability of repaying their debts. This should in turn increase the facility’s revenue level while also improving their patient satisfaction ratings.

The increase in patient responsibility for medical expenses is changing the way self-pay is being approached by ambulatory surgery centers. At the core of this shift are innovative technology solutions that improve the collection process through computer-based algorithms.

Needless to say, centers will still have to engage with patients on a personal level to get information that software codes just cannot reveal.

What ASC’s Need to Know About Bundled Payments in a Value-Based Setting

 

Low cost and high-quality service delivery are the hallmarks of outpatient care in today’s value-based setting. Patients are out searching for providers that offer the best care at the lowest possible cost while payers are also driving care in-network due to the high financial burden of out-of-network arrangements.

To remain competitive, surgery centers must come up with strategies to increase reimbursements that will also be beneficial to patients and payers. One game-changing strategy that ASC’s can use is bundled payments. Unlike the traditional fee-for-service model, bundled payments are well suited for care delivered in today’s value-based environment.   

Bundled payments provide greater incentive for patients to approach ASC’s for surgeries and for payers to move more patients to surgery centers. Patients can avoid having to bear extra financial burden in the form of co-pays, deductibles, and high out-of-pocket payments connected to typical fee-for-service payment arrangements. Payers also get to enjoy significant cost reductions from bundled payments compared to the fee-for-service model.

Surgery centers will experience an increase in case volumes as more companies move into the bundled payments markets, especially if insurance companies decide to adopt it as an alternative payment strategy. 

However, bundled payment arrangements are yet to gain significant traction in the ASC space. The trend is poised to become mainstream as an alternative reimbursement strategy. Alternative payment models, which include those bundled, currently account for 30 percent of industry-wide payments made by Medicare.

Bundled payments could be retrospective or prospective. For prospective bundles, the provider is paid a fixed amount upfront by the insurer for all services to be rendered to the patient. The provider is therefore responsible for any additional cost incurred during administering treatment.  

But the most widely-adopted model used by hospitals is retrospective bundled payment. This operates in a similar fashion to the fee-for-service payment in that payers reimburse providers for the claims raised for the services offered to patients under their program. The payment made by the payers is then compared to the agreed bundled target price and any discrepancy is adjusted for. Providers will be reimbursed for payments made below the target price while payments made by payers above the target price will be retrieved.

ASC’s are better positioned to offer bundled payment arrangements than hospitals. This is because they can provide procedures offered at hospitals at high prices for a much lower rate. Also, it is easier for them to monitor their costs unlike hospitals who deal with a larger number of patients; complicating the task of tracking their cost. 

How ASC’s Can Protect Patients from Surprise Medical Bills

  • July 25, 2018
  • Published in Billing

Exorbitant medical bills have become a new reality for patients. Even when patients receive care in an environment characterized by low co-pays and deductibles, they find it difficult to adjust to high medical bills where out-of-network payments are becoming increasingly normal. 

It is now common for patients to receive additional bills from out-of-network providers, even after settling their co-pays and deductibles. These additional charges come as a surprise as they believe their insurance companies should have settled what they owe to providers.

With surprise medical bills now attracting attention nationally, ASC’s want to develop strategies to protect their patients from them.

Growing Popularity of Surprise Medical Bills

Surprise medical bills arise because patients receive care from providers outside their networks, either in an emergency or for a procedure not offered by their in-network providers. Since these providers have no prior contracts with their insurance companies, they typically send additional bills to patients. In other words, patients are being balance billed. 

Patients are however becoming increasingly aware of surprise bills and are not being quiet about it. This is evidenced in the growing media coverage on the subject which has created public awareness to protect other unsuspecting patients.

There is an increasing need for ASC’s to operate with patients within their network. This comes because of pressures from insurance companies who are also compelling their patients to receive care from providers that they have prior relationships with, to avoid high out-of-network payments.  

The Complexity of Surprise Medical Bills  

Despite these reactions, surprise medical billing has become more complicated and this calls for a proactive response from surgery centers to protect their patients. 

Initially, surprise medical bills would only arise when emergency treatments from providers took place outside of the patient’s carrier network. This is no longer the case as patients today can still receive surprise bills even when their care comes from providers within their network. 

This is because an ASC can be in-network while some of its medical staff are out-of-network. Providers can decide whether they want to be in or out-of-network.  Take for instance an anesthesiologist who decides to stay out-of-network to receive higher payments than he would if he operated within the patient’s network.  

These type of providers are referred to as “invisible providers”. They include anesthesia, pathology, and lab professionals. Patients typically pay less attention to the involvement of these professionals in their surgical care because they are more likely to build relationships with their surgeons or physical therapists when having surgery.

Even though ASC’s are making effort to ensure that these “invisible providers” are brought in-network, some remain out-of-network. This can pose a challenge for a surgery center as patients often hold surgeons and facility owners responsible for any surprise medical bills they might receive.

ASC’s must therefore be proactive to ensure that most of their ancillary professionals are brought in-network. Services rendered by those that can’t be brought in-network should be clearly communicated to patients.

Understanding the Legal Rules

Because of the public clamoring for protection against surprise medical bills, five states including California and New York have passed laws aimed at protecting patients. This trend is poised to increase in scope as two other states, Pennsylvania and New Jersey, are also on the verge of passing laws against surprise bills.

These laws have important features that ASC’s need to pay attention to. Laws can restrict what providers are permitted to charge patients for an out-of-network service. They can also require that patients be fully aware and give consent to receiving care from an out-of-network provider. In the event of disputes between providers and patients, the laws also make provision for the resolution of such disputes.

Providers operating in these states should ensure they understand these laws to avoid lawsuits. Even providers that do not have facilities in these states ought to take steps to ensure that patients are protected from surprise bills. Since ASC’s are known for providing high-quality low- cost treatment, a facility can easily lose patronage from patients if surprise billing is normal and not occasional.

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