November 25, 2014 •Brian Watson
It’s no secret that smart patient financial communication has a significant impact on financial performance.
Clean, easy-to-understand statements and letters speed self-pay payment. And effective communication reduces collection costs – resolving issues that might otherwise lead to patient service calls or additional statements that tie-up resources and slow receivables.
But while financial benefits are the primary reason why providers invest additional time and money to achieve better patient statement quality, don’t underestimate the effect it has on patient satisfaction metrics
Mastering Patient Statement Satisfaction
Statement processing has a very narrow purpose: to collect self-pay revenue from patients as quickly and efficiently as possible. But the truth is that limited objective affects more than just revenue cycle operations.
A generic, poorly designed statement first harms financial performance. When patients are confused about their financial obligations, payment is delayed and the cost to collect increases.
Who do I owe – the hospital, my surgeon, or both? Why did I receive multiple bills – from multiple sources – for just one encounter? How much of my bill is covered by my insurance? What’s the total amount I owe out of pocket?
Those questions lead to a higher volume of billing-related service calls and more statements, as patients wait for a really scary-looking bill, like final notice or past due, before concluding insurance won’t be making any more adjustments – or they won’t be offered better payment terms
But the effects of bad billing don’t exist in a financial operations vacuum.
When a patient has to take time out of her day calling customer service to resolve a billing issue, it is very likely to inform her opinion of your organization and the treatment experience you offer. In that way, patient billing also extends to relatively unrelated areas like customer satisfaction, brand equity, and even patient loyalty and preference
The greater the hassle – say a patient waiting on-hold for 20 minutes to speak to a call center representative or being sent to a collection agency for recovery – the greater the potential damage to your reputation and bottom line.
Most importantly, these relationships aren’t just figures on a spreadsheet that affect profit and loss.
They involve real people; patients that, in many cases, your providers have spent years treating and with whom a highly-personal relationship has developed.
The Hidden Costs of Poorly Performing Statements
According to a recent study, only 21% of patients were fully satisfied with their billing experience, with a third reporting they had to contact the hospital directly to resolve a billing question. And reported levels of satisfaction with a patient’s treatment process drop by 10% from the time a patient is discharged from the hospital.
Providers typically have little to no contact with patients during that period, aside from billing activities, suggesting a clear link between business office activities (like statement print and mail and balance payment) and a patient’s overall impression of their encounter.
Not surprisingly, patients that were highly satisfied with the billing process were five times more likely to recommend a hospital to a friend. Similarly, almost 70% of respondents to a 2013 TransUnion study who gave the highest rating to their quality of care also gave high marks to their billing and payment experiences, compared to only 24% who rated their care poorly
And satisfaction with the billing process is set to assume a new level of importance for healthcare organizations.
Under new ACA guidelines, nearly $1 billion in Medicare reimbursements are now tied to how providers score on the CMS’ Hospital Consumer Assessment of Healthcare Providers and System survey. The survey is designed to gather patient feedback on a wide range of experience metrics: doctor and nurse communication, responsiveness of hospital staff, cleanliness and quietness of the facility, and discharge information – as well as patients’ overall rating of the hospital.
With increased transparency and higher out-of-pocket costs fueling an emerging healthcare consumerism movement, it’s no longer enough to offer a health experience that’s merely solid. Because the billing process is generally the last chance you get to make any kind of impression – good or bad – a transaction that leaves patients with a bad taste is especially troublesome from a patient loyalty perspective.
And confusing, complex, inaccurate billing is a major source of patient frustration and dissatisfaction.
Given all that’s at stake – patient loyalty and preference, brand equity, Medicare reimbursement rates – patient satisfaction with the billing process has assumed an all-new level of importance. Now more than ever, it’s essential that providers work to ensure the billing and payment process is as simple, fast, and hassle-free as possible.
Making Dollars and Cents of Satisfaction-Driven Statements
That's not to say that there isn't a tangible, real-dollar benefit to statements that are easy to understand and take action upon. In addition to the big-picture financial gains that go hand-in-hand with collecting more revenue faster, satisfaction-driven statements help reduce service costs that can be a major drain on organizational resources.
Customer service overhead is a significant source of collection costs for many providers, reducing cash flow and weakening profitability levels.
That’s not surprising, since billing issues are among the most common reasons people contact customer service. For example, a third of patients surveyed in a recent study admitted that they have had to contact patient services in the past to resolve a billing question.
And even financially savvy patients often struggle with billing details - why was a payment divided and allocated to two separate sources? When is it okay to make a partial payment on an outstanding balance? What in the world does a “Physician Visit Level 2” mean?
Large call loads can quickly create productivity bottlenecks that increase collection costs and threaten patient satisfaction. Equally problematic is the effect overburdened patient financial staff and resources can have on patient satisfaction metrics. Limited staff tasked with fielding a large volume of calls often leads to high on-hold times and call abandonment.
For example, the average of the longest on-hold times across all business sizes and industries in a recent call center benchmarking analysis was 7 minutes and 19 seconds - a figure that is likely to contribute to high call abandonment. As a result, many satisfactory relationships are put into jeopardy: 89% of consumers have stopped doing business with a company after experiencing poor customer service.
In light of service costs that can slice into profitability and test patient/provider relationships, smart patient communication increasingly emphasizes customer service tools in much the same way that payment channels are prioritized. Because while even the best designed bills can’t entirely prevent statement questions, incidents shouldn’t have to escalate to costly, difficult support calls that threaten patient satisfaction with the treatment process.
Designing a Statement For Satisfaction
Service-oriented statements anticipate and proactively respond to patient issues in two important ways.
The first is by leveraging internal patient service data to isolate the patient billing and payment issues most often handled by customer service.
A hospital in rural Indiana can expect to face different billing pain points than a dialysis clinic in Palo Alto. Tailoring on-statement service tools to best fit the needs of individual patients - not all patients - helps troubleshoot problems before they become service calls.
Common applications include:
• An on-statement Frequently Asked Questions tailored to a specific subset of patients. For example, patients that have a high balance due and low propensity-to-pay profile might receive a custom FAQ that centers on financial aid options – applying for charity care assistance, internal assistance programs, or how a specialized payment plan works.
• Custom billing instructions for patients based upon their financial profile, encounter type, and position in the revenue cycle. A common example is escalating warnings for patients that have a past-due account or that will face collection activities if a bill continues to go unpaid.
The second is by empowering patients with the information and tools to solve issues on their own schedule. For example, many providers only offer call center hours during the day, when patients are often busy at their own jobs. That condenses call load into a small window and can lead to long wait times and call abandonment that harm satisfaction and loyalty.
Presenting a variety of self-service support options on a statement - online help, an automated in-bound IVR phone line that’s available 24-hours a day, secure communication via a payment portal - in addition to a traditional call center help patients receive quick, simple answers to their billing issues. Not to mention reduces phone support and related collection costs for providers.
Service-oriented statements should provide:
• Links to online patient financial resources. Cost and scope limit the amount of space you can realistically devote to billing instructions and frequently asked questions on a statement that is mailed to patients. But healthcare transactions can be very complex. Give patients the option to continue the conversation online with clearly marked on-statement links to public-facing billing and payment resources through your corporate website.
• Additional tools available behind a secure patient portal, including account statement/payment history or value-added applications – such as an interface that links with insurers’ websites to pull daily claims information. That approach offers a holistic snapshot of deductible status, out-of-pocket spending, and total annual healthcare costs, so patients know exactly how much they’ve spent on healthcare – and where – as well as how much they have left available.
• A variety of traditional and self-service support channels, including general online help and resources, in-bound IVR, and secure communication via your payment portal.
