Four Ways to Turn Outpatient Frustration into Loyalty

As hospitals and health systems face ongoing financial pressures, so, too, do their patients. According to a recent Kaiser Family Foundation poll, “About half of US adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months.” The average annual deductible for a single worker with job-based coverage tops $1,500.

The Biden administration announced plans to remove medical debt from credit reports. One non-profit New York health system, Rochester Regional Health, decided to stop suing patients for unpaid bills, shifting efforts to settle bills before collections started—instead of chasing people who didn’t pay, a “costly process that often yields meager returns.” Although such a dramatic step isn’t feasible for many hospitals, it’s important to recognize the financial climate that your patients are navigating—and the steps hospitals, health systems, and other providers are taking to mitigate financial stress.

The thing is, you don’t have to start big. When considering the financial lens through which your patients experience your hospital, starting with complex, multi-day acute encounters can seem like a big hill to climb. Instead, consider your outpatient and ancillary experience. Encounters are less complex clinically and financially. But their smaller financial impact belies their value. These outpatient and ancillary encounters can:

• Support early diagnosis and preventive care
• Reduce readmissions and severity of acute events
• Provide a valuable touchpoint for patient education
• Build affinity and loyalty for your hospital or health system

To realize the full value of these services, however, hospitals must mitigate points of friction in the outpatient financial experience—and with more and more encounters transitioning to these settings, optimizing that experience carries increasing weight. Here are four sources of frustration for patients and some ways you can reverse that frustration to build trust and affinity.

Issue #1: Sticker Shock Prior to Care or Service

The Scenario: The patient receives an unexpectedly high estimate of their financial responsibility for a pending procedure.

The Risk: The patient decides to seek care elsewhere, postpone it, or forgo it entirely—especially if they receive that estimate prior to presenting to the point of care. The hospital misses out on an opportunity to bill for an encounter and demonstrate its value; the patient could suffer a suboptimal health outcome.

The Solution: Because of their increasing share of the financial burden for care, patients closely scrutinize their healthcare costs, starting with the patient responsibility estimate. The first step in preventing sticker shock is ensuring the estimate is as accurate as possible, accounting for relevant payor-specific pricing, test or procedure information, and real-time eligibility. Capturing the correct patient demographics is also critical.

Even with an extremely accurate estimate, however, that amount can seem high to a cost-conscious patient. Proactively and clearly communicating the availability of payment plans and financial assistance, whether in person, electronically, over the phone, or in a letter, helps alleviate that stress.

Issue #2: Inaccuracy-Driven Sticker Shock After Care

The Scenario: The patient receives a high billing statement that doesn’t correctly reflect their financial responsibility.

The Risk: For smaller clinical events, like routine lab work, some patients may simply pay an inaccurate bill, but the downstream discovery of that inaccuracy will undermine confidence in accuracy for more financially complex encounters.

The Solution: Start with prevention. Obtaining accurate patient information helps prevent denials related to missing patient demographics. Also, verifying coverage before delivering care, ideally with a real-time benefit eligibility check that validates the patient’s insurance is active, identifies secondary insurance, and works at the plan level to confirm co-pays, co-insurance, and deductible.

You can also reduce errors and friction after the patient encounter but prior to billing. For denials, evaluate claims with a “Patient Responsibility (PR)” denial code—often a claim will be denied, and the entire charge will be shifted to the patient’s responsibility with that code. Reviewing other remark codes on the Explanation of Benefits (EOB) can reveal the underlying reason for the denial before billing the patient.

As a broader strategy, monitor payor denial patterns and implement processes to ensure you’re meeting payor requirements. Also, implement an appeals strategy reinforced by an automated appeals process. Automating components of the appeal process ensures efficiency, reduces manual and cumbersome responsibilities, and allows more time to focus on more complex denials.

Issue #3: Financial Complexity

The Scenario: At the point of discharge, a patient needs to ensure case management and coordination for their home health needs. The process is complex and fluid, leading the payor to issue a denial because the timeframe for equipment drop-off lapsed beyond their policy.

The Risk: The patient does not understand whom to contact; the situation requires connection and coordination among multiple entities. This negatively impacts trust in the healthcare system, potentially influencing future treatment.

The Solution: For complex situations such as these, take a holistic yet patient-centric view of the process—and work toward optimizing RCM workflow to reduce friction, errors, and denials among multiple provider types. Be mindful of provider-/payer-specific-type edits (e.g., same/similar, BlueCard program, frequency/date spanning) to further reduce the chance of denials. Also, establish and monitor DME denials, reimbursement, and payment benchmarks. Lastly, dedicate the time and staff resources to provide patient education and care coordination at discharge.

Issue #4: Getting Lost in the Shuffle

The Scenario: A paper bill for routine simple bloodwork is lost or unrecognized among the clutter the patient receives in the mail.

The Risk: The bill goes unpaid and is either written off or sent to collections, which can further frustrate the patient.

The Solution: Flexibility is key here. Give patients the option to choose statement and notification preferences, including paperless statements and email or text reminders. Providing multiple channels, such as interactive voice response (IVR) systems and online portals, to access statements, pay, manage payment plans, and resolve issues also helps. To prevent the issue in the first place, many providers encourage pre-payment or payment at the point of care and send courtesy letters before the actual statement.

Bringing It All Together

When it comes to alleviating friction in the outpatient experience, there are some common underlying themes. It starts with understanding your patients’ mindset—their stresses, concerns, and needs, all of which are amplified when facing a serious clinical condition. Put yourself in their shoes. Survey your patients and keep an eye on economic issues in your community. Ask your friends and loved ones where they see stress and frustration in their own healthcare billing experiences.

With those things in mind, you can architect a strategy and framework that informs your financial engagement strategy by meeting patients where they are and meeting financial needs and concerns before they arise. That not only heightens patient trust and satisfaction but also accelerates cash flow.

You can evaluate and improve your outpatient financial experience in two additional dimensions. They are:

Staff Allocation

Consider delegating and placing your knowledgeable staff at the points of greatest patient need—and financial value. Assigning knowledgeable, veteran team members to complex claims alleviates patient friction behind the scenes by connecting the dots between payors and providers before the patient sees the bill. Additionally, ensuring staff are trained and available to educate and care for patients at the point of need—or even prior to it—deepens affinity. If you shift your team to meet these needs, there’s still other work that needs to be done if you want to maintain peak financial performance, especially if you’re facing staffing constraints. In that case, consider reinforcing your team.

Technology

Your RCM solution isn’t a panacea, but it is a crucial component in building and maintaining patient trust. Workflow automation enables your team to work more efficiently by eliminating redundant, low-value tasks. Embedded AI can alleviate patient friction at registration, scheduling, admission, and beyond. Providing multiple engagement channels empowers consumer choice and boosts satisfaction. And financial reporting allows leadership to benchmark and evaluate performance, align it with overall organization metrics, and identify opportunities for growth and performance.

Ultimately, the patient’s bill itself represents a patient touchpoint in their healthcare journey, one that can either undermine confidence in your hospital or health system—or reinforce it. Taking steps to optimize the experience before, during, and after the patient receives it pays dividends.

For a deeper look at the outpatient financial experience, view our on-demand webinar, Outpatient Excellence: Unify Patient Trust and RCM Performance, conducted in partnership with HFMA.