The new reality of patient-as-payer

In theory, health care consumerism is a straight-forward idea: Shifting costs to consumers, typically in the form of high-deductible health plans (HDHPs), gives them an incentive to make informed decisions about the health care services they purchase.

In practice, consumerism represents a significant challenge to providers' bottom lines. A recent report reveals that for 74% of providers, patient collections take over a month. Further, 66% of providers said patient receivables are a primary revenue concern.

Part of the problem is many providers' patient collection processes do not align with consumer preferences. For example, 88% of providers reported relying on manual and paper-based transactions for patient collections, but 46% of consumers prefer electronic communication for medical bills, while 65% prefer to pay medical bills via online portals or mobile apps.

This has left many patients in the dark about how much they owe and the available payment options. Many providers, including durable medical equipment (DME) providers, have been left without the tools and resources necessary to communicate sensitive financial issues, explain benefits coverage, or provide accurate and timely estimates.

As the nation continues to grapple with the COVID-19 pandemic, telehealth has become a critical means of delivering access to care for patients. For DME providers, it is more important than ever to ensure that the health systems and physicians' offices they work with have a seamless means of ordering DME for patients within the telehealth workflow.

Defining patient access

Patient access is a mix of technology, process efficiencies and strategies to engender patient accountability, and it is based on three pillars of the revenue cycle process: enhancing the patient experience, increasing yield and containing cost.

Properly implemented, patient access processes allow providers to drive measurable and meaningful business improvements with tools that improve accuracy and increase revenue. Patient access has three goals: Help patients understand what they owe, make it easy to pay and set expectations.

To achieve these goals, a provider must invest in its patient access department and technology to provide the following:

Fast and accurate estimates of each patient's financial responsibility

Forecasts of each patient's propensity to pay

Multiple payment options and patient-assistance plans

Functions of a patient access program

Patients who know in advance how much they will pay are likely to be more satisfied. It is common sense to avoid surprising patients with higher bills than they were expecting. For an effective patient access program, providers must implement the following steps.

Conduct pre-appointment checks. Before receiving services, patients should know the provider's payment options and assistance plans. They should know what insurance will cover and what their total financial obligation will be for the appointment. Pre-appointment checks, whether in person or through telehealth, should be part of every provider's workflow.

Ensure billing is clear and concise. Patients often struggle to understand what they owe due to bills from multiple hospitals, physicians, and labs for the same episode of care. Often DME providers are one of the last services patients need in an episode of care, which makes clear and concise billing even more critical. Statements should be designed so patients can easily understand the language and format.

By using technology and building more flexibility into collections, providers can reduce their reliance on paper statements and reduce administrative costs. To interact effectively with patients, real-time adjudication and point-of-service collections with effective follow-up strategies are imperative.

Make it easy to pay. Patients have different expectations, practices and preferences regarding how they pay health care bills. DME providers have learned that a small technology investment can bring more flexibility to the collections process. For example, most DME practices already include options to pay by credit card, but relatively few organizations offer an online payment option.

The biggest opportunity to collect from patients is at the point of service, so providers should make it standard practice to collect payments while patients are onsite. To this end, leading DME platforms feature workflows that enhance providers' telehealth strategies by ensuring that ordered products are delivered to patients remotely. These solutions make it easy for providers to identify a patient's need for a product, create an order, discuss the costs upfront, then ship the product to the patient and bill appropriately.

Engaging patients as consumers

Even with greater transparency, encouraging patients to keep current with payments is an important task for providers. Accomplishing this will require consistent communication with patients. Many organizations underestimate how important it is to engage patients from the beginning and maintain positive relationships. By proactively addressing financial information and payment options, providers can improve patient engagement and satisfaction.

Steve Ingel is the executive vice president of DJO Healthcare Solutions, a leading provider of high-quality medical devices and technologies.

Lillian Phelps is the senior director of product management for Availity, the nation's largest health information network.