HFMA: Hospitals must be more proactive with patients on bills

Hospital finance leaders and staff must be willing to engage patients early and often if they want a good chance of collecting all of their outstanding balances after a medical procedure, according to the leader of the Healthcare Financial Management Association's (HFMA) patient-friendly billing project.

"Every day that goes by, that dollar is less collectible," said Terry Rappuhn, who leads the HFMA initiative. She spoke at HFMA's annual national institute on Monday with Mark Rukavina, a principal of Community Health Advisors.

Rappuhn noted that when a patient is prepped for surgery, they receive all sorts of information from their providers, but often little or no information about costs are and when they will have to pay. That often leads to confusion and difficulty when it comes to collecting the entire sum owed. Moreover, the trend toward cost-shifting to patients has made patients more anxious about bills.

"We want to turn the table of how we deal with patients upside down," Rappuhn said. She noted that most hospitals currently bill patients retrospectively as opposed to discussing options with them in advance of care.

That appears to be borne out by a Transunion Healthcare survey that was released at the HFMA conference on Monday. It concluded that 62 percent of patients are either sometimes or always surprised by their out-of-pocket costs, while only one-quarter are given pre-treatment cost estimates from their providers.

Rappuhn and Rukavina cited scenarios involving two different patients. One, a 45-year-old with a middle-class income, believes he is only responsible for his $2,500 deductible and not his $6,300 maximum out-of-pocket costs for a hip replacement surgery. He is shocked when he gets a much larger than expected bill, as opposed to knowing what his costs will be in advance and negotiating a payment plan that will pay off the sum in eight months and includes a 10 percent discount.

The other patient, an impoverished 62-year-old woman without insurance, is admitted via the emergency room. In the old scenario, she is left with a form to fill out that might get her enrolled in Medicaid. In the new scenario, hospital workers help her apply for presumptive Medicaid coverage and then later charity care, leaving her with a $500 balance.

Aside from encouraging hospital finance departments to be more proactive in communicating with patients, Rapuhn and Rukavina also suggested they comb over their bad debt to ensure they are providing enough charity care to their communities, and tailor their Medicaid presumptive eligibility guidelines to help out patients. And, if they should offer discounts, provide them with each payment received on a rolling basis.

To learn more:
- read the Transunion Healthcare survey