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The dynamics of expectation in patient collections

Doug Fielding, Vice President of Product Strategy, ZirMed

Doug Fielding, Vice President of Product Strategy, ZirMed

The patterns of patient collections can often seem difficult to predict, largely because there are factors in play – externalities, to borrow the language of economists – that simply don’t exist in other sectors of the American economy.

These externalities are made more complex by overlapping and sometimes competing expectations. Patients’ expectations as healthcare consumers are informed by their more general expectations as consumers – yet patients also have an expectation of privacy, expertise, and transparency that is unlike anything they bring to the table when making other major purchases or shopping for other types of services. Consider the myriad methods of online and mobile payments available – which are only beginning to make their way into healthcare. Or patients’ desire for easy, convenient electronic access to their health records, including financial data – even as all Americans are increasingly aware of (and wary of) the risks related to healthcare data breaches.

The continuing nationwide shift toward high-deductible health plans (HDHPs) heightens these challenges. Whether for the newly insured, those who participate in their employer’s health plan, or long-time self-insured individuals, the balance of financial responsibility for everyday healthcare has swung round and landed squarely on the shoulders of patients, many of whom experience sticker-shock when they receive their billing statement.

To manage this sea-change, keep cash flow strong, and strengthen patient satisfaction, providers must now navigate an unfamiliar financial landscape, one that demands transparency, convenience, and a nuanced understanding of patients’ expectations.

Patient expectations and the consumerization of healthcare

Rising patient financial responsibility is at the core of the overall consumerization of healthcare. Despite recent changes (and regardless of future ones) healthcare will never be “like” other sectors of the American economy.

Providers, therefore, must understand generalized consumer expectations around pricing, billing, and payment – yet also recognize and build processes around the realities that are certain to endure in healthcare.

For example: patients trust their providers.

From a patient-expectation perspective, what this means is that patients inherently (or perhaps unconsciously is a better word) expect their providers to be a single source of truth – especially at the point of care. The questions they expect providers to know the answers to – and that they may be frustrated if providers don’t know the answers to – span the gamut of plan benefit details, associated financial obligation for care provided/appointment type, amount counted toward deductible and overall deductible balance, appropriate referral and associated communication of PHI, and the simplicity and clarity of billing explanation for all care delivered through a single health system or as part of associated episodes of care.

Of course, for providers, accessing this wealth of data can be a time-consuming and manual process – one that most patients have little insight into, meaning it does not materially inform their expectations.

You might be wondering – why does any of this matter?

It matters because aside from the familiar expectation of co-pay, most patients aren’t accustomed to request for payment up front. When providers make this request, patients naturally adopt the expectations they’ve derived from years of experience providing payment after the fact – sometimes long after the fact. In those front-office or pre-appointment conversations when financial obligation and payment are discussed, the experience for patients is much more analogous to sitting at their kitchen table or in front of their laptop paying their monthly bills – they are considering the financial cost for care in the context of their annual or overall budget for healthcare. As consumers, they simultaneously default to the expectations formed around other high-dollar costs – the call they get from their dealership letting them know just how costly that car repair will be, for example, or the monthly payment plan they set up to pay off a credit-card balance.

Providers, therefore, must be equipped to field the questions associated with these patient expectations – hence the long list in the above paragraph related to the single-source-of-truth phenomenon. The more information and transparency healthcare organizations can provide to patients up front, the stronger the positive impact will be on overall patient satisfaction – in part because proactive transparency and communication actually defies the entrenched expectation, formed over decades, that in healthcare you only discover your obligation after-the-fact. That’s how it’s always been – right?

Yes – but it can’t continue to be that way.

All of us – for indeed all of us are patients – need more insight into what we owe, how we can pay, and how we can work out payment plans if a single lump sum isn’t feasible (as is often the case). As patients’ out-of-pocket responsibility rises – and as it makes up a greater and greater share of providers’ overall revenue – processes and technologies that are rooted in a pre-HDHP model will only frustrate providers and patients alike. Patients’ desire for transparency, convenience, and flexibility will only continue to grow – and providers and healthcare IT vendors must rise to meet these elevated expectations.

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