Orthopedic providers are responsible for some of the highest-cost outpatient procedures in the healthcare market today, from total knee replacements and spine surgery to ancillary services, including imaging and physical therapy.
Until recently, those high costs didn’t matter so much to insured patients who only had to fork over a fraction of the total price for various procedures.
But that’s slowly starting to change, as patients are increasingly expected to pay for more of their healthcare. In fact, today patients are now the third-largest payer, behind Medicare. As noted by a TransUnion Healthcare analysis, patients experienced an 11 percent rise in average out-of-pocket costs during 2017, up from $1,630 in the fourth quarter 2016 to $1,813 in the fourth quarter 2017. And the medical specialties with the highest average out-of-pocket estimates included orthopedics ($1,663), followed by plastic surgery and neurology.
For orthopedic surgeons and rehabilitative professionals in outpatient settings — who have enjoyed a steady flow of business as patients opt for procedures outside of traditional hospital settings —this is a problem. When patients are asked to pay larger portions of their medical costs, but can’t afford to, doctors will have to employ new strategies to avoid bad debt on services rendered and to ensure patient volumes do not materially decline due to an inability to afford the service.
That’s why it’s more important than ever, right now, for orthopedic practices and other rehabilitative professionals to adopt much more proactive approach to collecting patient payments. We can no longer send a bill for $500, or more, and expect a patient to pay it immediately, without hesitation.
Here are four proactive strategies orthopedic practices can use to encourage prompt patient payments:
1. Be completely transparent about costs
The increase in patient cost-sharing is driven by a higher utilization of high-deductible health plans in addition to higher copays. So, if your patient, who is already paying more up front, sees a high post-surgical bill without any advance warning, he or she may feel angry or confused. Understandably, it’s not easy to change patient expectations, especially for older patients who have experienced a lifetime of fee-for-service care models and expect blanket payer coverage.
However, those practices that are transparent, and offer complete visibility into EOBs, payment expectations, and so forth, have a better chance of reducing the number of disgruntled patients who don’t want to pay their bills after their appointment. Having the most current cost estimates from a cost-estimator solution, prior to or at the point of care, should be standard practice.
2. Verify eligibility…and verify again
In addition to being transparent about pricing, practices should also be more proactive in verifying eligibility when a patient makes an appointment, and again at check-in, before a patient sets foot into the exam room. Eligibility denials are one of the leading types of denials, yet they are easily avoidable. Always make sure to confirm coordination of benefits while verifying eligibility and coverage benefits. While you’re checking eligibility, go ahead and confirm the patient’s demographic information and collect an email address and cell phone number for automated appointment reminders and e-statements.
3. Encourage Prepayment
A growing number of healthcare organizations are requesting payment of unmet deductibles or out-of-pocket expenses in advance of the patient’s appointment. But the more a patient has to shell out in advance, the trickier this kind of request can get. Offering a payment plan or financing options for more expensive procedures can help ease the burden. Another up-front strategy that’s working for some organizations is to offer a discount — say, 10 percent to 15 percent off the out-of-pocket total — for paying in full, up front if your managed care contracts allow discounts. While every organization is different, practices that regularly employed this tactic have noted that patients appreciate the discount. Also, the more money we can collect up front, the less work we have to do on the back end. Remember statement costs, human capital costs for follow up on aged patient balances and high collection agency fees can really increase the provider’s costs to collect.
4. Leverage Automated Technology
So much of the revenue cycle is still reliant on back-end collection processes — like mailing statements or calling patients with reminders to pay up. However, time and again, these efforts yield low success rates. While leveraging automation on the back end doesn’t sound proactive, it is much more effective than making manual phone calls. By replacing manual calls with an auto-dialer your practice can reach more patients. Even if 10 percent of those patients contacted pay their bills, it will save additional collection headaches down the line. In addition to auto-dialers, mobile engagement with text and email to facilitating the collection of outstanding patient liability is also gaining popularity.
By approaching medical payments proactively, healthcare providers are protecting themselves from the misery of back-end collections. Even more important? Providers who are proactive show their patients that they are not afraid to approach difficult conversations about costs — and that they care, not only about patients’ physical health, but their financial well-being too.