America’s watchdog on competition, the FTC, says that “Competition in health care markets benefits consumers because it helps contain costs, improve quality, and encourage innovation.” (https://www. ftc.gov/tips-advice/competition-guidance/industry-guidance/ health-care) As providers seek to contain costs, we have seen decentralization of care popping up around us. For example, the number of stand-alone emergency departments, in a 2016 study, had increased 76% from 2008 to 2015, mostly in states that do not have “determination of need” regulations that aim to protect local health care providers from competition. For some patients, the free standing emergency department can be a precursor to hospital admission when surgery, observation or more long term or targeted care is required. (https://catalyst. nejm.org/how-the-freestanding-emergency-department-boomcan- help-patients/)
This increased competition in the provision of medical services can squeeze the already stretched resources of provider billing departments, pushing CFOs to seek help earlier in the billing and collection process. Increased competition is driving a higher level of focus on patient experience, not only by care providers but also as it relates to billing and collection. While the facility the patient chooses may be in part guided by the network of providers under contract with the patient’s insurance plan or plans, another strong consideration can be patient satisfaction with or confidence in the billing processes of a provider.
With the push to convert to electronic health records, modernization of revenue management systems has taken a back seat, sometimes to the detriment of patient satisfaction, which can be a driver of patient choice when it comes to the decision about where to seek medical care. Another complicating factor is consolidation within the healthcare industry. When account management systems of merging systems can’t talk to each other, patient billing can become a confusing battle of the hospital bill, lab and other secondary services bills and the doctors’ bills that clog the patients’ mailbox. If a freestanding emergency facility visit was part of the patient’s care process, additional complication can result from the fact that some free-standing emergency departments are not permitted to participate in Medicare, Medicaid and TRICARE because they are not outpatient departments of an acute care hospital.
The confusion is voiced by patients every day. Once that hospital bill is paid, they assume that process is now behind them. Then they get a statement from a doctor they have never heard from, providing a balance for who knows what service? And it is 90 days after the service date and they are just now receiving a bill? Is this legitimate? And a call to the hospital doesn’t provide any information because the hospital doesn’t employ the doctor directly? We could ask these questions all day, and perhaps have spoken with patients who have asked us exactly those questions. Until all billings for all services provided during a hospital encounter are provided in a one-stop-shopping type of portal or billing statement, these problems will continue.
Another consideration is the audience. Geriatric patients want a paper bill. Millennial patients want to access their bills online, see their explanation of benefits side by side with their bill and want to pay electronically. Some patients will not pay anything that doesn’t carry their signature. The transition to all electronic billing has its own set of challenges. Today’s millennials are tomorrow’s geriatrics, but for the time being, the ability to provide account information that meet the needs and desires of a broad range of patients can be key to getting paid. Billers and early out providers who can close this gap may be able to provide higher levels of patient satisfaction for their clients, proving their value.
Staffing back office programs is a universal concern. Clients who ask the collection agency to take on their internal back office programs may be doing so because they cannot maintain competent and adequate staff to do it, especially if they lack technical support to add efficiency to their processes. Taking on such an endeavor requires the application of technology for efficiency to improve the extended business office experience. Be ready to work with the client to implement process changes. Moving manual processes from one location to another will not solve the problem— you may be experiencing the same staffing challenges that face your clients. Demonstrating ways that you have created efficiencies within your own operation can bring some comfort and optimism that you are the key to patient satisfaction and more success in the competitive world of healthcare.
I would like to thank Tina Hanson, Executive Vice President/ Chief Strategy Officer, State Collection Service, Inc., Madison, Wisconsin, and Penny Mount, Director, Active A/R Solutions, Wakefield and Associates, Inc., Fort Morgan, Colorado, for their contributions to this article.