Are Doctors Talking About Patient Financial Responsibility?

Most patients–or their parents–worry about the cost of care.

In an ideal world, finances wouldn’t be a problem, and physicians would be free to provide the best care possible without regard for cost-per-service charges, preventive care, testing and supply costs, or insurance payouts. Unfortunately, we live in a reality where patient responsibility is a key concern as well as a potential challenge for many patients and their families.

Despite that, the costs associated with healthcare—even those directly affecting patient responsibility—remain largely a mystery to the majority of consumers.

According to one article, a 2016 Public Agenda survey revealed that only 28 percent of adult patients have discussed their financial responsibilities and healthcare pricing with their provider’s staff or physicians. Similarly, only 20 percent of patients even tried to compare provider prices before committing to a practice, a statistic that is closely linked to the 63 percent of survey respondents who indicated that there was not enough information available about the costs associated with various healthcare services.

In short, many patients don’t know that costs vary between providers and often don’t understand how those costs will affect their own wallets. This lack of transparency has become a major topic of discussion in recent years and has been identified as an issue needing swift resolution in order to improve the quality of care and encourage more competitive pricing within the industry.

Even so, change is slow.

What many practices don’t realize is that open communication and transparency would actually benefit both care and financing outcomes. By addressing patient responsibility up front and setting clear expectations, as well as communicating openly about pricing information, physicians can help reduce patient anxiety regarding healthcare costs, improve the likelihood of regular patient visits, and prevent past due accounts that might otherwise result from unanticipated charges.

Create a patient responsibility guide and share it with your patients.

Most patients are not completely clear about how the payment process works with their physicians. It’s important to create a plan for managing patient responsibility, one that covers both insured and non-insured patients. This plan would include basic expectations for scheduling appointments, deadlines for co-pay/payment expectations, the availability or unavailability of payment plans, and the limitations of the your practice with regard to discussing insurance coverage.

Make patients aware of their role in coordinating benefits.

As a recent Physicians Practice article pointed out, the patient is the owner of his/her insurance plan and may be the only one who can make calls about certain information. Make sure your patients are aware of their rights and capabilities in this regard. Many may be oblivious to their role in managing their own coverage and coordinating benefits.

Verify insurance coverage and discuss co-pays, deductibles, and non-covered expenses up front.

Before seeing any physicians, your patients should be made aware of the co-pays, deductibles, and standard procedures for managing costs that could result from denied claims. The more clearly you communicate these expectations up front, the more readily your patients will comply with their financial responsibilities.

Set a clear pricing schedule for most basic services.

More and more often, practices are beginning to set clear pricing schedules for their most common services. This can be posted in the office, included in the patient responsibility literature, or posted online for your patients’ convenience. With all the upheaval regarding insurance these days and the presence of urgent care facilities that tend towards low fee-per-service pricing and high cost transparency, general practices will gain more from a direct and open approach than ever before.

The day-to-day operations of a practice can easily cause staff and physicians to lose sight of the fact that most patients want to pay their bills and desire, above all else, to obtain the best healthcare possible for the best pricing available. Practices can help ensure patient responsibility is met consistently by anticipating challenges, communicating openly about pricing, and setting clear expectations from the beginning.

Patients should also feel that they can discuss their financial responsibilities with both practice staff and physicians in a way that will allow them to manage costs and important practical considerations. In the real world, sometimes a payment arrangement is necessary or a cheaper, generic prescription would be better for the patient’s budget. The most successful physicians are flexible with these small realities and are able to advise, counsel, and treat patients in a manner that is feasible for each patient’s specific needs.

In this way, rising healthcare costs are a concern for practices as much as the patients they treat. By keeping your patients in mind and doing your best to help them understand their responsibilities and options, your practice can ensure not only more effective care outcomes, but also more satisfied patients who believe your practice truly has their best interests at heart.

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