Ask ASC staff what topic they enjoy speaking about with patients least and you can expect many — if not most —will say financial responsibility.
As out-of-pocket costs for patients has increased (quite significantly in a short period of time, as the data shows), so has the difficulty for patients to pay for their care. Further complicating matters is a lack of understanding among many patients about why costs have increased and why insurance does not cover as much of their care as it used to. Financial responsibility is a subject that can elicit feelings of anxiety, fear, and even anger for patients.
If ASCs want to collect what patients owe for care — which is necessary to remain solvent and comply with insurance contract rules—staff must be prepared to effectively discuss the sensitive subject of financial responsibility. Here are three tips to follow to help make these conversations easier and more successful.
1. Show compassion. One can never predict how someone will react to learning how much they owe for their care. Most patients lack a good sense of how much they will be expected to pay prior to speaking with an ASC representative. There's a high probability that the amount they think they will need to cover will be lower — perhaps much lower — than what they actually will owe. Finally, the figure could elicit very different responses from patients. Some may have no problem spending $1,000 or more for their care. Others may view a bill of $200 as life-changing.
It is for these reasons that business office staff should try to show compassion and remain calm when speaking about financial responsibility. One's tone of voice can greatly affect — positively or negatively — an entire discussion. Speaking bluntly about financial responsibility to patients concerned about money can cause their stress levels to rise and put them on the defensive or even offensive. A failure to show compassion to those in a financial bind could make collecting more difficult and may even lead to a case cancellation. On the other hand, a compassionate tone can ease patient stress and help a discussion about what patients owe and how they will pay for their care to proceed more smoothly.
2. Do not assume anything … and be prepared for everything. When discussing financial responsibility with patients, it is imperative that ASC staff do not make assumptions about patients. This includes the following:
• preferred language;
• level of health literacy;
• cultural differences;
• ability to pay; and
• understanding of how insurance works, including co-pays and deductibles.
Unless staff members have been provided information about any of these points, they must be prepared to ask patients a wide range of open-ended questions that can help paint a more complete picture about patients and what will be required to secure their payment.
If a patient's preferred language is something other than English (as is the case for millions of people in the United States), an ASC must find an individual — whether in-house or through a language translation service — to guide non-English speaking patients through the payment process and answer questions.
If patients possess a low level of health literacy, staff must be prepared to converse using very simple language, preferably supplemented by pictures to help with understanding of more technical information.
Cultural factors can influence everything from accepted roles of men and women (e.g., some patients may not feel comfortable discussing finances with one gender or the other)to body language and whether touching is permitted (e.g., don't assume that patients want the comfort of a hand on top of their own hand).
As noted earlier, the ability to pay will vary from patient to patient. It's vital to determine whether a patient is likely to struggle to meet their financial obligation before proceeding with discussions about payment. It's also critical to offer solutions to help with making payments (which is discussed further below).
Then there's the matter of health insurance. A 2016 survey found that only 4% of Americans were able to correctly define the four terms that determine how much they would personally need to pay for medical services received under their health insurance plans: deductibles, copays, coinsurance, and out-of-pocket maximums. ASC staff must have the training and resources available to address questions from patients about their specific insurance(s) and what it covers as well as questions about why insurance coverage has changed significantly.
3. Come with solutions. If the amount patients owe make them feel overwhelmed, that figure may feel even more overwhelming if patients are expected to cover the full amount with a single payment. That's why it's imperative to offer solutions that can help address budgetary concerns, are easy to understand, and will allow patients to receive their surgical care as scheduled.
One such option that checks all these boxes and more are healthcare installment loans (learn more about them here). Inform patients that such payment solutions are available early in your discussion about financial responsibility. This will help alleviate stress associated with seeing and/or hearing a figure that as a single number may appear quite high, but when broken down into smaller payments may seem well worth the expense if it will allow them to receive treatment that can greatly improve their quality of life.
Randy Bishop (rbishop@surgicalfunds.com) is a partner with Surgical Funds, which facilitates patient financing solutions to supplement out-of-pocket expenses for ASC procedures.