Billing, even more so than other areas of healthcare, has experienced a steady stream of seismic changes over the past two decades. Payors, providers, patients and regulators have been forced to adapt, again and again, to tremendous alterations to their expectations, participation and operating processes relative to medical billing.
As part of our “Countdown to HIMSS’16” series, we spoke with Ric Sinclair, Vice President of Product at ZirMed (HIMSS’16 booth #6647), an industry leader in the fields of revenue cycle management and billing since 1999. He not only made the argument that healthcare providers can effectively collect on their billings while increasing their patient’s satisfaction, but that they must effectively collect on their billings while increasing their patient’s satisfaction.
Free: How do you see payment expectations from outside industries such as retail and hospitality impact a patient’s set of payment expectations in healthcare?
Sinclair: If you think about it, healthcare is the only industry where 90 percent of a provider’s revenue is collected after the time of care. If you just think about that and consider how consumers are used to paying their bills before goods or services are rendered. It can create a little bit of a catastrophe when a consumer has already received services and there is no transparency in terms of pricing and 30, 60, 90 days later the consumer receives a bill that says he or she is liable for what many times can be thousands of dollars of procedures.
It may be a cliché, but to get past this issue, it is simply a matter of common sense and following retail best practices. When people say the phrase “consumerization of healthcare,” all that means is healthcare is starting to become more sensical, or more logical, and we are starting to treat patients like consumers where they expect a bill to be easy to understand what they are going to owe before services are rendered and then they expect a logical way to pay their bill from a mobile device with easy payment plans.
It should be as easy to pay your healthcare bill as it is your DirectTV bill. That’s just common sense. We are trying to apply a lot of different approaches and thinking in terms of what should a software company do in healthcare, when we think about best ways to collect the bill, we are looking closely at corporate leaders like DirectTV, American Express that are getting it right.
Free: Some would say that it is not an fair comparison to make regarding the payment expectations within the industries you mentioned and healthcare. Do you feel the current and prevailing expectations of patients are reasonable when it comes to how they desire to be billed?
Sinclair: No matter how complex the process is, I don’t think that that’s an excuse for not providing great customer support, and, ultimately, a seamless experience for your end user, or in the case of healthcare, the patient. Regardless of how complex that process may be, we should be able to give them that awesome experience.
When you think about our utilities payments or the fluctuations of prices of futures commodities, I don’t necessarily care that it’s a very complicated formula that decides how much my utility bill may be. Most of the time, I don’t really care about my usage, my neighbor’s usage and what current and future prices are. I just want to know what I owe and I want to be given an easy ability to pay my bill.
So, I hear you. There is certainly an under appreciation for the complexities and the nuances of a healthcare provider being reimbursed. That’s what we at ZirMed are all about. Getting providers paid. But, we take things a step further because we understand that we need to supply our provider partners with the ability to treat their patients the right way throughout.
Free: Unlike most customers of DirectTV and American Express, in healthcare there is a very intimate element of billing that is attached to one’s health. A very pleasant visit with my doctor can turn ugly due to a bad billing experience or a physician’s visit where a patient learns dire information about his or her health can avoid additional stress and anxiety if the billing process is handled well.
Sinclair: No one enjoys being a patient, right? Being a patient means either there’s an episode of care where you are sick, or that maybe you were injured, or there’s recurring care for recurring treatment, and you’re point is spot on. We need even better than normal consumer service because not only is there a financial amount of money that our customers owe, but then there is also some other burden that’s going on in their life for themselves, or for someone that they are a guarantor for that’s equally as important. So, being sensitive to those things and doing that in-flight and concurrently is the way a provider can truly provide a world-class experience for a patient.
Free: How do you suggest providers execute their billing processes effectively as they also try to increase their patients’ satisfaction during the process?
Sinclair: There are two things to consider: services that are known before they are rendered and services that are not known until they are given.
Services that are known are out-patient procedures that are scheduled before hand like radiology, primary care, etc. Before a patient comes in for those services, you need to make sure there is no pre-authorization necessary. You need to walk through a patient eligibility process where you make sure you specifically understand the benefits available to that patient, and then you need to take all of that data and put that data into a process. There are a lot of software tools out there that will predict what a patient is going to owe after a remit comes back and it is received from the payor. Then there is a way to triage that information and get in touch with a patient prior to them coming in.
In terms of the services that we don’t know are going to be rendered, that process becomes a little more complex and a little more nuanced. This is a big issue for large inpatient IDNs [integrated delivery networks] or an urgent care organization where you don’t know what is actually going to happen until a physician closes his or her charges. Instead of getting in touch with a patient before they come in, you need to be able to close charges and to have conversations with a patient before they discharge and before they leave. The data created will provide the patient the needed information as to what they owe before they leave a facility.
But, just like when we have services that are known before they are rendered, we have to offer patients the ability to easily pay their bill. Virtually any payment option that’s out there should be considered so patients have the ability to set up an easy to use payment plan with mobile tools and mobile reminders, etc. Those extra steps are common sense measures, but they are often overlooked.
Free: What are some of the tools available to providers to help quickly and efficiently to connect with their patients and give them the information they need?
Sinclair: Not too long ago, we launched a patient estimation tool. It’s a piece of software that can create an estimate of what a patient will owe in less than a minute. So that is not only collecting a patient’s information, verifying their eligibility information in real-time online and taking all of that information and putting it into a set of algorithms. It then creates an estimate of what the patient is going to owe. We put that into a modern interface that is clean and easy to understand for a patient. Providers can send that estimate electronically to a patient or the conversation can be had with the patient in person.
As far as connecting physicians with their patients, one thing that is important that I would encourage anyone to do whether or not they are a provider, healthcare administrator, healthcare IT administrator, is simply make sure that you are future-proofing your technology. What I mean by that is don’t get lost in a particular app or a particular operating system. Just make sure that whatever you are investing in is mobile enabled, mobile adaptable and device agnostic. Patients should be able to get information from any device that they may have available to them. That, again should be common sense. That’s the way we build software at ZirMed.
Free: How do you see billing evolving over the next 5, 7, 10 years? In particular, what sort of changes will patients experience?
Sinclair: On the provider side, there’s a tidal wave that’s coming where many healthcare providers are starting to move into risk sharing arrangements with payers. Providers are going to be held accountable for the care that they provide to patients and incentivized for providing true high-quality care as we move away from pay-for-service to pay-for-value. That has myriad ramifications for providers and for patients, but I don’t think it changes the crux.
The underlying problem still is this, regardless of your payment model now or in the future, patients will want transparency for what they owe and providers are going to be held accountable for ensuring the right processes are in place to engage with patients the right way.
So, certainly people are moving to downside risk arrangements, risk sharing and models that are really cool and that provide them with tools to help them with revenue forecasting, contract modeling and contract management for the future. But the underlying issue of communicating with patients in clear, concise ways and providing clear transparency into their bills, that’s just common sense. I don’t think that changes, ever.