This past month, HBI hosted its 2020 Fall Member Retreat, a virtual summit on The Patient Journey: Synchronizing a Singular Experience. While HBI has in the past enjoyed holding these sessions live in cities such as Nashville, Boston, Chicago, or San Diego, we had to put the safety of our staff, members, and attendees first. As a result, HBI was able to offer more content, a total of 16 CPE credits, and at no added travel cost for attendees.
Naturally, the topics discussed by speakers and during frequent question and answer sessions gravitated toward the current COVID-19 pandemic—how the patient journey has been affected, altered, and even improved as a result of the challenges faced and overcome.
One of the most pervasive themes explored was how to offer financial flexibility to patients as they experience varying levels of unemployment, hour/income reduction, or other secondary impacts of the pandemic. The following shares recommendations and insights as they were expressed throughout the event, which featured 21 different health system leaders and industry experts.
Continue being transparent with patient expectations and options
While many organizations stopped upfront collection attempts early on or at certain points during the pandemic according to HBI data and case studies, speakers widely emphasized that early financial discussions only grew more important.
This required training pre-service and patient access staff to pick up on more cues or factors that would benefit from a financial counseling connection. More than one leader noted they needed to ensure this occurred as early as scheduling, especially when patients expressed financial concern, lack of insurance, or had a history of bad debt.
One organization relocated financial counseling staff to its specialist offices. This ensured that a one-on-one financial discussion could be scheduled as part of surgery and other consults, with the objective of covering the estimate, defining insurance benefits, screening for funding sources, initiating payment arrangements, and even identifying further needs, such as for transportation, all before a single service occurred.
“While the actual dollars our financial advocates collected reduced, the amount that patients paid at the time they arrived for those services increased substantially. Connecting with the patient earlier engaged them, made them aware of what to bring with them at check-in, and they were committed to a plan that we developed with them, not for them,” said a registration and admissions leader from a Michigan provider.
More than one speaker noted that their organizations were working toward the ability to hold such meetings virtually. Otherwise, focus was applied to automating estimation, payments, or patient financial information, as well as emphasizing financial and payment options through signage and on websites.
Tailor payment plans to each patient
Participating organizations applied the same proactive mindset concerning payment plans. The aforementioned Michigan provider set a goal to have 90% of its payment plans (administered through a vendor) signed by the patient prior to the service date.
Additional insights and emphasis included:
- Approaching all payment plan arrangements or modifications on a case-by-case basis and applying special consideration by request.
- Ensuring interest-free options remain available.
- Giving more than the typical 12- or 24-month maximum repayment period for certain balance amounts and circumstances—up to five or six years of repayment.
- Granting patients payment deferral for one to two months based on their payment history or temporary job/income loss.
- Ensuring financial service partners are operating from the same philosophy and can offer patients accessible methods of payment plan modification.
- Providing the ability for patients to add new, separate, or outstanding balances into a singular or existing payment plan.
Consider temporary adjustment to financial assistance policy
Aside from making special addendums to the organizational financial assistance policy to waive cost-sharing for COVID-19 care and testing for all patients, participants shared that greater flexibility was permitted to the documentation accepted. Given the rapidly changing nature of events, requirements for providing tax returns or even monthly pay stubs may not have been sufficient to show real-time financial circumstances.
This is again why upfront financial discussions became so integral: staff needed to be able to reconcile estimated out-of-pocket responsibilities to each patient’s actual working capability, the state of their employer, and unemployment filing. In some cases, organizations may offer temporary assistance for situations like intermittent job loss or delayed unemployment benefits.
Additionally, more than one health system noted moving toward an online financial assistance application process. While participants said that patient discounts were not altered, they did emphasize their availability during financial discussions.
Cease credit reporting and legal action
Hospitals and health systems, as well as the collection agencies they partner with, have also instituted tactics such as allowing for an up to 90-day hold on all collection activity for patients saying they have been impacted by the pandemic. This also includes ceasing, waiving, or suspending interest accrual, credit reporting, bank garnishments, lawsuits, and liens. In some cases, existing garnishments may have been released and in general, organizations looked to be open to canceling or amending payment arrangements per expressed need. These organizations want to show their patients and communities that communication will result in flexibility and assistance to help sustain loyalty and secure payment once financial circumstances improve.
It may be important to note that the White House issued an Executive Order on September 24 called “An America-First Healthcare Plan.” Among a variety of directives and timelines, it seeks to eliminate surprise bills. It calls for reporting of how often hospitals pursue legal action such as garnishment or liens, which could create pressure to limit these actions long term.
Other innovative ideas
Although not a practice in place at a particular hospital or health system, the president of a clearinghouse and denial prevention solution shared an idea that builds off automatically deducted monthly payments. This entails obtaining permission from the patient to charge up to a certain dollar amount to their preferred account or credit card. She has found that the majority of patients are willing to do this if there is an agreed-upon dollar amount or range and after insurance has paid and the bill is finalized.
One leader at a Wisconsin health system also mentioned that it is in the process of integrating its propensity-to-pay algorithm into payment reminders. While all options remain on the table for any patients that may be eligible, different arrangements can be emphasized based on whether there is a high or low propensity-to-pay.
Another crucial aspect of being able to meet patients where they are financially—especially now—is ensuring staff have been adequately informed of changes, properly educated on how to explain them, and that they are also trained in the arts of compassion, empathy, understanding, and patience. Furthermore, verbatim scripts no longer work. Front-line staff need to be empowered to alter their approach to each patient and unique circumstance for the foreseeable future.
Check back with HBI for additional insight into how these same organizations continue to approach staff education, engagement, and empowerment during these unprecedented times.
HBI events are no cost to our members. To learn more about HBI membership, fill out the form below!