Industry Voices—The Rx for improved patient billing experiences

Helping patients understand their financial responsibility and pay for services continues to be driven by an outdated and unnecessarily complex experience. Last year, three in 10 Americans had an unpaid healthcare bill go to collections.

As more of the financial burden falls to patients with rising costs and an increase in high-deductible health plans, consumers are frustrated and confused, reinforcing that something must change.

In a rare act of bipartisan alignment, lawmakers seem to agree that the current situation is untenable. We’ve seen action from recent legislation to protect patients from surprise bills associated with out-of-network care. That’s a great first step, but only addresses part of the problem.

Many patients still face issues when receiving in-network care or even care from within the same health system. They encounter high costs and hard-to-understand bills that require fast payment—a reality that is unrealistic for many. While some of these issues are very complex and involve contracting between parties, a lot of the problems associated with billing and communicating patient financial responsibility are related to revenue cycle management and technology.

It’s happening across the nation, including at some of the top health systems in our country, according to a recent study of 20 of the top 100 U.S. health systems conducted by The Health Management Academy (The Academy). 

RELATED: Hospitals, doctors raise alarm over surprise billing legislation advanced by Senate lawmakers

The Academy study highlighted several hurdles, including a lack of consumer-friendly resources, struggles to consolidate bills, inconsistent RCM technology use, and limited tracking of patient-centric metrics when measuring the success of billing and RCM.

Healthcare poses unique complexities but at a time when other industries have made it extremely easy for consumers to conduct nearly any transaction from their phone, why are we still struggling to figure out patient billing? 

So, what can health system executives do? Below are three recommendations:

Treat patients like people, not transactions

Healthcare is not like the retail or credit card industry. It’s deeply personal and typically even more costly. Yet we often treat patients the same way credit cards treat consumers.

Take payment plans for instance. Approximately 82% of the top health systems offer low- or no-interest payment plans to consumers based on factors like credit scores. But only 41% are offering self-select payment plans, which allow patients to personalize their terms. Payment personalization is a huge opportunity for health systems. They already have access to tremendous troves of data that could help craft more flexible plans. 

RELATED: Industry Voices—AI and blockchain can bring revenue cycle management into the 21st century

Health systems also must do a better job helping patients understand expected costs before an appointment or service. While new regulations are pushing for greater use of chargemasters, they’re definitely not the main answer, because they often don’t accurately predict actual costs.

Instead, tools like out-of-pocket cost estimators are a great way to help patients be more informed. The Academy study found that 56% of the top health systems are using them, which is good, but it’s time for that other 35% to step up. If we truly want healthcare to be more consumer-driven and be a better all-around experience, the industry should start with more personalization and transparency.

Consolidate bills from within the same health system

Many complex companies that may bill for a multitude of different services have figured out how to offer consumers consolidated bills, yet healthcare has largely been left in the stone ages.

Currently, more than one-third of the top health systems don’t offer patients a consolidated bill. Of those that do, it largely doesn’t include affiliated providers. Anyone who has had an emergency room visit that turned into a hospital stay dreads the post-discharge billing tsunami and, to be honest, it’s kind of ironic.

RELATED: Moody's: Surprise billing solutions will hurt hospitals

Healthcare has some of the most sophisticated technology inside of the hospital, but invoicing leaves much to be desired. There have been tremendous strides in RCM in recent years, and yet many health systems still aren’t using an end-to-end solution. Instead, they're relying on fragmented, piecemeal approaches.  

The ability to view anything associated with a patient’s episode of care in one place will not only reduce frustration for patients, but it will also drive more revenue for health systems.  

Prioritize patient-centric metrics when evaluating RCM processes

From retail to travel to financial services, we are now in an experience-driven economy where a premium is put on providing a top-notch experience. And you can take it to the bank: Healthcare’s reckoning is not far behind.

However, the Academy study found that many health systems appear to prioritize tracking financial metrics over the patient experience metrics. Every health system in the Academy report (100%) indicated they were tracking net collection ratios and claims denial rates. But patient-centric metrics, such as patient satisfaction, time to bill, self-serve and bill readability lagged.

RELATED: Experts on Capitol Hill: Solution to surprise billing should fall to hospitals, insurers—not patients

If health systems are mainly focusing on RCM metrics that focus inward, then as an industry, we’re only compounding the problem of the impersonal billing experience in healthcare. Health systems must prioritize their patients’ experience because when you consider the long-term ramifications, those that are optimizing the patient experience from end-to-end should expect to improve the financial metrics as well. 

The bottom line is that a seamless financial experience needs to become the norm. Financial interactions are the first and last touch-points for patients—if we can't deliver on a more consumer-centric approach, patient satisfaction and revenue outcomes will continue to be compromised.

With the right technology and leadership alignment, we have an opportunity to prioritize the consumer across the entire patient journey, not just clinical care.

Florian Otto, MD, Ph.D., is the co-founder and CEO of Cedar