When Beth Friedman, a longtime, self-employed health IT publicist and former health information management professional, went to Northside Hospital-Forsyth in Cumming, Georgia, for a colonoscopy two years ago, she had a high-deductible health insurance plan. Six months later, she needed an outpatient procedure at the same hospital.
Friedman knew she would owe a significant amount of money, but perhaps surprisingly, the hospital seemed to be prepared to tackle her situation. The bill she received after the procedure listed a number to call to discuss payment plans and other options. Friedman called and worked out a payment schedule.
“They never, ever sent me a statement again,” said Friedman, president of Agency Ten22, a healthcare public relations firm based in suburban Atlanta.
A growing number of hospitals are understanding that patients want answers and advice about financial options, not surprise and confrontation once the bills arrive. That’s according to Rick Gundling, Washington-based senior vice president for healthcare financial practices at the Healthcare Financial Management Association. More hospitals would benefit with a similar change in attitude.
“Patient financial experience plays a big part in the overall patient experience, including the clinical experience,” Gundling said. “It helps your patients and the community. It keeps people from having large medical debts if there are other resources available.”
That is exactly what Friedman experienced the next time she encountered Northside Hospital-Forsyth.
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On Aug. 1, 2015, Friedman’s live-in boyfriend had a stroke and went to the emergency department of Northside. A brain surgery meant two months of hospitalization, including three weeks in intensive care. Later, he went to acute rehabilitation for two more months.
He was uninsured and fired a few weeks after the stroke, but he was not headed to bankruptcy like so many other uninsured Americans.
“On Day 3 in the ICU, the financial counselors came up and talked to me,” Friedman recalled. “They talked to me about charity care, Georgia Medicaid and getting on the exchange.”
When someone loses a job — like Friedman’s boyfriend — that person does not have to wait for the annual open enrollment period to buy insurance on a public health insurance exchange under the Affordable Care Act. The ACA has also created a program called Hospital Presumptive Eligibility, which allows hospitals to grant temporary Medicaid coverage to patients likely to qualify for Medicaid based on income.
Friedman ended up enrolling her partner in Medicaid and working with the hospital on charity care to reduce out-of-pocket expenses. Later, she got him a plan on the exchange because the rehab center demanded private insurance.
From hospitals’ perspectives, even if they have to write off many of the charges or accept low payments from Medicaid, something is better than nothing. This strategy avoids the need to chase bad debts and helps protect the hospital’s reputation in the community.
“It’s all fostered so much goodwill, with me anyway,” Friedman said. “Why cause friction for a patient who you know has no money?”
Offering a payment plan instead is much kinder, she said, noting that some of the counselors even filled out most of the disability paperwork for Friedman’s boyfriend.
“It was such a humbling experience, having been in healthcare for 30 years,” Friedman said. “I think more hospitals are seeing the need for this.”
The Healthcare Financial Management Association didn’t have statistics about hospitals offering financial counseling, but the Westchester, Illinois-based organization does encourage healthcare providers to have open communication with patients on financial matters, Gundling said.
HFMA actually has published a list of best practices for patient financial communications, as well as this video explaining the importance of good financial communications with patients:
https://youtu.be/hH436krPYSo
“Financial discussions go better if there are no surprises,” Jon Neikirk, executive director of revenue cycle at Froedtert & the Medical College of Wisconsin Health Network in Milwaukee, said in the video.
That’s why HFMA encourages hospitals, health systems and medical practices to have financial conversations as early as possible to make patients aware of their options and explain some of the terminology.
If it’s during open enrollment, get the patient on an insurance exchange, HFMA recommends; the 2017 period for private ACA plans runs from Nov. 1, 2016 to Jan. 31, 2017. There is no date limitation on applying for Medicaid or the Children’s Health Insurance Program.
Gundling said worker’s compensation insurance may cover healthcare expenses for people injured on the job. State and local governments might have access to pools of grants for charity care, and large health systems might even have government employees on site to help people apply for these resources. Sometimes, private health plans are the place to start to try to determine patient out-of-pocket responsibilities.
“These are the kinds of conversations [hospitals] should be having,” he said.
In other words, patient engagement isn’t just about interacting with patients about their health and well-being. Financial well-being counts as well.
Stanford Health Care, Palo Alto, California, is another health system that is being proactive in helping patients afford their care — and has been for some time.
Financial Counselor Coordinator Phyllis Garza has been involved in financial counseling for seven years and an employee at Stanford Health Care for 20 years.
“The FC team has been here as long as I have been at Stanford,” Garza said, adding that the team fields daily phone calls from people nationwide and overseas as well. Questions include what insurance Stanford Health Care takes, what patient out-of-pocket responsibility will be and whether the organization has a financial assistance program.
Counselors are present at the main hospital on the Stanford campus, as well as at some clinics and specialty centers, including the Stanford Cancer Center. Sometimes patients are uninsured, while others have insurance and call ahead just to find out how much they owe.
“We try to help patients understand their plan and how their benefits apply at Stanford,” Garza said.
With uninsured patients, Stanford tries to provide a cost estimate up front and help them apply for financial assistance. The application is available on the Stanford Health Care website, and Garza said many people do take advantage of that option.
Uninsured often get discounts or are provided with other options, including help with applying for Medi-Cal, California’s Medicaid program. Those with insurance might have questions about whether Stanford or their physicians are considered in-network or not, she explained.
For those with questions about Medicare benefits, Stanford refers them to the state of California’s Health Insurance Counseling and Advocacy Program. A third-party vendor helps patients apply for Medi-Cal, though Stanford is not in the Medi-Cal network in all California counties, Garza said.
Nor is Stanford an authorized agent for ACA signups, but the financial counseling department can and does refer patients to online public exchanges and agents to obtain individual Obamacare coverage.
Of course, not everyone can plan ahead, so Stanford has counselors assigned to the emergency department to screen patients after they register. Services are meant to be supportive, not confrontational.
“We try to give them courage and hope,” Garza said.
The majority of uninsured patients do get approved for some coverage if they are California residents. Out-of-staters often can qualify for some form of charity care, according to Garza.
The financial counseling department is considered part of the care team, though it does not help with billing after the fact. Instead Garza’s department does assist with a “soft transfer” to the billing department when patients receive invoices.
“We all try to be one team for the patient,” Garza said.
Photo: Veronica Combs/MedCity News
