“I don’t think it will be a deterrent to seeking health care,” she says. “But I think it sets up an adversarial relationship between the patients and the provider.”
BUY-IN FROM PATIENTS
The first steps toward introducing such business practices include assessing the need for improved collections—is getting paid even a problem for you?—and determining what types of fees or policies you can legitimately implement. Many insurers—most notably, but not exclusively, those that are government-funded—prohibit health care providers from collecting money from patients outside the terms of the contract.
Furthermore, as credit card companies seek to reduce risk for fraud, your merchant accounts may take issue with holding a patient’s credit card information and charging it “remotely,” as opposed to swiping the card at the time of service.
But most important, if you decide to introduce these policies, is getting buy-in (no pun intended) from patients. The #1 concern will be the safety of their information: how it will be stored and how it will be used. (Your billing software vendor or merchant account may have solutions for you.)
“People often don’t want to leave their credit card [with you]—although good grief, Amazon has everybody’s credit card!” says Phillips with a laugh. “But you want to make sure you have a signed agreement on hand giving you permission to do this, and then a way to communicate with patients that you have carried this out and charged their card.”
Patients also appreciate knowing that you will work with them. Payment plans may be a suitable option for patients who have difficulty paying an entire bill; even $10 a month, as Lenell says, is a sign of “good faith. We just want to know that you don’t think our services are worth zero.”
The collections methods of the past—threatening letters and phone calls—did little to engender goodwill among patients who were made to feel like criminals over $5. “What we’ve said is ‘Tell us how you would like us to work with you, so that you can be a good patient and we can be good providers, and everybody is getting what they wanted out of the service,’” Lenell says. “[But] if patients want the ‘luxury’ of that comfortable place where you go in and everybody knows your name and you feel welcomed and cared for, they have to pay their bills.”
In larger practices, it may be easy to separate the financial from the clinical realm—the health care provider can direct patients to the office manager—but in smaller offices, the clinician/owner is where the buck stops. Elwell, for one, does not discourage patients from discussing the financial aspects of their care with her.
“If we’re really going to be partners in health care,” she says, “then that’s a significant part of it: the ability to pay for it. It’s a fact of life; to push it off or ignore it doesn’t work.”
Allowing patients to set up payment plans, ordering tests judiciously to reduce out-of-pocket costs, and directing patients to low-cost care options whenever possible are some of the ways clinicians can help patients reduce financial burdens—and perhaps ensure timelier payment for themselves.
“I don’t want to sound like a Pollyanna,” says Elwell, “but I really find that when you take good care of people and try to work with them and the resources they have, it usually works out in the end.”