Costly Decisions: How Rising Healthcare Costs Affect Patients and Providers

By David Shelton, President & CEO, PatientMatters
Twitter: @PatMatters

The cost of healthcare in America is on everyone’s minds. People at all income levels, insured or not, worry about treatment and medication costs, which are expected to climb an average of 5.5 percent per year through 2027. Many are so concerned, they’re making decisions that could negatively affect their health and wellbeing.

Statistics tell the story
The significance of the healthcare cost burden on American adults came to light in a 2019 Gallup survey. Twenty-six percent of respondents said they put off medical treatment, 19 percent delayed buying medication and an alarming 41 percent skipped going to the emergency room because of the expense. Nearly one-quarter cut back on household spending and 12 percent borrowed money to pay for healthcare. Almost half of those surveyed fear a major health event could leave them bankrupt.

Patients deferring or foregoing care can have far-reaching impacts, not only on people’s health, but on provider revenue and financial performance. The Gallup study found that in the last year, 65 million Americans decided not to seek treatment for a health issue because of what it might cost—a potentially significant amount of unrealized revenue for providers. Patients’ fear of the unknown is justified. Less than 20 percent say they know ahead of time what outpatient surgery or emergency room care will cost, and awareness isn’t much better for more routine care. Only about a third of patients say their doctors talk to them about how much procedures or medications will cost, understandably increasing fear and anxiety.

A three-pronged approach
To reverse patients’ negative perceptions of the financial side of healthcare and regain their trust, providers must focus on three fundamentals: 1) cost transparency, 2) multiple ways for patients to pay and 3) improved patient experience.

Cost transparency, which ensures there are no surprises for patients from the first appointment to the final bill, should be providers’ first priority, given the current environment. It starts with accurate and complete bill estimates showing what the patient’s insurer will cover and how much the patient will owe. A good bill estimation tool can also improve providers’ financial results by generating insights to help them collect all earned income, avoid denials and identify sources of drops in revenue.

Offering multiple payment options similar to what people are accustomed to in other parts of their lives is the next step to alleviating patients’ financial concerns. The best processes and technologies give provider staff members immediate access to patients’ credit scores, payment history, income and other financial data to determine ability and willingness to pay. Giving patients the option to pay with cash or credit cards or set up personalized payment plans based on financial status can increase collections, reduce write-offs and improve provider profitability. Customizable scripts can help staff members walk patients through each phase of the financial process to ensure they understand and agree to comply with payment arrangements before services are rendered.

Patient experience has been defined as, “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Certainly, today’s patient experience must account for actual interactions and care as well as what patients perceive, understand and remember about costs. To improve the financial experience and thus the overall experience, providers must offer easy-to-grasp cost information, seamless payment solutions and a customer-oriented approach that eases patients’ apprehensions. Doing so can positively impact providers’ bottom lines. A Deloitte analysis of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores showed hospitals with “excellent” HCAHPS patient experience ratings averaged a net margin of 4.7 percent, compared to 1.8 percent for hospitals with “low” ratings.

If projections are correct, healthcare costs are not going down anytime soon. In the meantime, providers should adopt technologies, workflows and staff training to deliver new levels of patient-friendly information, personalization and service. By easing the financial stresses associated with healthcare, all parties can focus on what matters most: patient health.