Back in the day, the notion of healthcare providers discussing the cost of treatment with insured patients was relatively unheard of. After all—aside from a nominal patient copay—insurance usually footed the bill. That’s not the case today. As Fair Health President Robin Gelburd writes in this Physicians Practice article, the insurance industry has evolved to place greater financial responsibility on patients—hello, high-deductible health plans (HDHPs). As a result, patients want to know the cost of the services they’re receiving before they get blindsided by a bill. And can you blame them? So, it only makes sense that healthcare cost transparency should be a given across the board.
Unfortunately, though, there is “a critical disconnect in our healthcare system today: Although patients are being asked to shoulder a greater portion of their healthcare costs, they do not have ready access to the price information that enables them to plan for those expenses and exercise truly informed decision-making,” Gelburd writes. So what do they do? Well, according to Gelburd, they turn to their healthcare providers for guidance. That’s where you come in.
It’s imperative that patients understand the cost of care—before they receive therapy services in your practice.
This holds true even if—actually, especially if—you’re concerned that the cost of your services may scare away your patients. As WebPT’s Nancy Ham advises in this webinar: “Bite the bullet. While it may be scary to tell your patients—especially those with high deductible plans—upfront what they’re financially responsible for regarding their treatment, there really shouldn’t be any surprises when it comes to healthcare costs.” She goes on to say that patients deserve healthcare cost transparency—“because they deserve to make an informed decision about what they believe is best for them. No matter how much you may want to make that decision for them, it’s not yours to make.”
Figuring out the cost.
But what constitutes cost? In this post, WebPT’s Courtney Lefferts quotes the Healthcare Financial Management Association (HFMA) as saying, “To the patient, cost is the amount payable out of pocket for healthcare services, which may include deductibles, copayments, coinsurance, amounts payable by the patient for services that are not included in the patient’s benefit design, and amounts ‘balance billed’ by out-of-network providers.” In order to be transparent about the cost of your services, you first must know what the cost will be to your patients—and that requires insurance verification and cost estimation before that patient’s visit. As I wrote here, “While cost estimation does require some legwork, the benefits—which include improving upfront collection, boosting patient satisfaction, and minimizing days in accounts receivable—are worth it.” Once you’ve figured out the cost, don’t wait to share that information with your patient until after you’ve already provided services—or worse, after he or she leaves. Instead, have the conversation upfront.
Cost estimation only goes so far if your patients don’t understand the definition of a copay, a coinsurance, or a deductible—and how each term relates to them. Download your free copy of the PT Patient's Guide to Understanding Insurance today. Then, provide this valuable resource directly to your patients.
Otherwise, you may face problems down the road.
In her post, Leffert also mentions this survey, which found that 95% of the 407 patients polled said it’s important that they know the total cost of a healthcare procedure upfront. Not only that, but 96% of patients want to understand the payment options that are available to them before they decide to move forward with treatment. As Bethany Black—the author of this Advisory Board article—warns, inaccurate estimates “can decrease volumes and patient satisfaction.” In the same article, patient access expert Cassie Wolfe says there’s a lot at stake for practices that can’t or won’t provide accurate cost estimates to their patients upfront: “In the past, a lot of organizations were afraid that sharing financial obligation information before the point-of-service would scare patients away. Today, if you can't provide this information upfront, you run the risk of losing patients to competitors who can provide accurate price estimates.” As WebPT President Heidi Jannenga mentioned in the above-cited webinar, practices that withhold cost details until after services are rendered should be prepared to deal with angry patients: “There’s a good chance that you’re going to end up with an unhappy patient who either won’t pay or won’t see you again,” Jannenga said. “He or she may even take out some frustration on your billing department or, worse, on social media, telling other potential patients that he or she felt ripped off or taken advantage of.”
Plus, cost transparency has some benefits of its own.
As Jannenga and Ham discussed during the webinar—and Gelburd reiterates in her article—practices that value cost transparency can experience some added benefits. For starters, conversations regarding the cost of your services can also open the door for a more robust discussion about the value of your services. As long as the value of your services really is commensurate with what you’re charging, then—with the right data—you can communicate that value in such a way as to allay your patients’ concerns and ultimately leave them feeling more confident in your services than they would have otherwise felt. This can, in turn, improve patient engagement, which can lead to better outcomes—creating, in Ham’s words, “a wonderful cycle.”
According to Gelburd, “while developing and maintaining engaged patient relationships begins with offering high quality, evidence-based treatment, enduring patient relationships can also be bolstered by helping patients understand what their care will cost, including how their insurance coverage and reimbursement fit into treatment plan options.” She recommends providers who wish to “engage patients on the financial aspects of their care” adopt several best practices, including providing patients with educational resources that help them to understand critical insurance concepts such as cost-sharing, various methods for reimbursement determination, and out-of-network costs.”
Speaking of which, if you missed the link above, you can download your free copy of the PT Patient's Guide to Understanding Insurance here. In it, you’ll find all sorts of incredibly valuable information to pass along to your patients—to help them better understand their insurance coverage and thus, make the most of your services, regardless of the cost. For more general patient-facing insurance resources, check out these articles from Fair Health.