Doctor, how much will that cost me?’
Executive Summary
Patient access departments are moving the financial counseling process to the point of scheduling and helping providers to address patients’ concerns about the cost of care.
• Financial counselors can inform patients of out-of-pocket costs in providers’ offices.
• Providers might be able to offer a less costly alternative.
• Patients obtain assistance in a single phone call prior to the scheduled service.
Patient access employees at Virginia Mason Medical Center in Seattle moved "from a reactive to a proactive process" for having financial conversations with patients, according to Amber Reeff, director of patient access systems.
"This is a major initiative for our revenue cycle," Reeff reports. "Our patients are becoming much more savvy, and their out-of-pocket expenses are much higher due to the Affordable Care Act."
Increasingly, providers are fielding questions about cost from their patients, many of whom purchased high-deductible plans on the Health Insurance Exchange Marketplace. Monique Gatterson, supervisor of patient financial services, says, "Patients want that concrete information. They want to know, If I go and have this procedure, I am not going to go into debt.’"
It typically isn’t possible for providers to tell patients what their out-of-pocket cost will be, says Reeff. This cost depends on many factors, including the hospital’s contracted rate, the patient’s benefit structure, and discounts given to self-pay patients.
Patient access put together a "cheat sheet" for providers, listing out-of-pocket costs of a colonoscopy for various insurance plans. "The feedback that we got from providers was that they were worried that by disclosing this information, that the patient may put it off or refuse to have the test," says Gatterson. "This puts the provider in a bind."
Financial counselors and providers formed a partnership. "Our providers do need to feel comfortable with having a basic financial conversation with the patient," says Gatterson. "But they reach out to the financial counselors to have a more extensive financial conversation."
The financial counselors give patients options to pay their out-of-pocket responsibility. "This helps ease the fear of Can I afford to move forward?’" says Gatterson.
The clinical care team contacts financial counselors for assistance when patients have concerns over cost.
"We are in the process of embedding the financial counselors into the clinic flow," reports Reeff.
When questioned about payer requirements and high deductibles, "providers feel a little helpless," Reeff says. Once the financial counselor becomes involved, the provider might be able to come up with a less costly treatment plan that does not compromise quality of care, such as prescribing a generic drug instead of a name-brand.
"We are moving those conversations to the very beginning," says Reeff. "When the doctor comes up with a treatment plan, it includes the financial piece." (See related story, below, on other changes the department made to its financial counseling processes.)
