New HFMA guide helps practices discuss costs with patients

An emerging theme over the past four years I've been writing FiercePracticeManagement is the idea of discussing with patients their out-of-pocket costs. This conversation is critically important for two reasons.

For one, healthcare isn't something people can take for granted these days. Insurance deductibles continue to rise and coinsurance comes into play more often. Even copays add up quickly. I know $25 to get in the door makes me think twice before making a sick appointment, let alone a pair of them when my two children share an illness. Financial hardship--sometimes the result of medical bills--is a leading cause of stress in adults. As we've discussed, stress attacks our health. Chronic illness leads to higher medical needs. See where this vicious cycle is going? Nowhere good.

Second, for your practice to have the opportunity to take care of people, you have to stay in business. This means you must collect patient balances. However, you can't let your need to run a profitable business create animosity in the physician-patient relationship. Even in 2013, a lot of patients have a mindset that it's okay to pay every other business they deal with upfront and pay the doctor after they satisfy those other responsibilities. 

With all of these factors in play, the bottom line is that money has to become a part of the conversation between practices and patients. And yes, even doctors need to discuss these matters directly with patients at times, unless and until it becomes more common to employ financial counselors with the expertise to help guide patients through medical-financial decisions.

However, it's a challenge to get this information. In some cases, physicians are aware that a chemotherapy pill, for example, will have the same clinical effect on a patient as intravenous therapy and is covered in full by that patient's plan. But for the myriad of X or Y clinical decisions, physicians having the information to factor in Z (what each choice may cost a particular patient/reimburse the practice) is the exception more than the rule.

Thanks to efforts of groups, such as Costs of Care, there is promise for greater health-price transparency on the way, but it will take time. The dialogue, however, needs to happen sooner rather than later. Not unlike another subject covered in our top stories this week--healthcare social media--the need to act has predated industry guidance about how to do so.

The Healthcare Financial Management Association (HFMA), however, recently initiated a big step in the right direction with the release of its new Patient Financial Communications Best Practices.

The guidelines, released earlier this week at HFMA's annual meeting in Ft. Lauderdale, Fla., were 12 months in the making, according to an announcement. Overseen by former HHS secretaries Michael Leavitt and Donna Shalala, the process involved representatives from the American Hospital Association, America's Health Insurance Plans, the American Academy of Family Physicians and the National Patient Advocate Foundation.

The recommendations cover patient interactions at various settings and points in the care cycle, including at the time of service outside of the ED. The information is detailed and free to access. Nonetheless, it likely can't answer every question a practice has about how to conduct these conversations. Reading it might even raise questions you never considered.

But that's actually a good thing. Discuss this information within your practice and build a strategy for how your organization and its representatives will communicate with patients. It's going to be a long and tricky process that may be uncomfortable to many. But the conversation needs to begin, if it hasn't already, and it has to start now. - Deb (@PracticeMgt)