Shawn Stack: The value of revisiting policies and processes for financial assistance

The charity care processes adopted by healthcare providers have attracted criticism in media stories focusing on the high cost of care. On a recent episode of HFMA’s “Voices in Healthcare Finance” podcast, HFMA Policy Director Shawn Stack discussed the value of revisiting financial assistance policies and processes. Below is an excerpt from the interview.

Erika Grotto: Charity care has come under scrutiny in the media, with the prevailing narrative being that hospitals do not provide enough of it. Why do you think that narrative exists?

Shawn Stack: I think, first of all, no one can define what “enough of it” is. I know that hospitals are offering charity care and financial assistance and reliable payment plans to anyone who qualifies for them, when the patient agrees to have that conversation with the provider. I think many times .… [the struggle] is really getting that patient to the table where they trust the provider or the hospital enough to have those financial assistance discussions or those qualifying conversations for charity care. It’s a trust relationship there that the hospital really has to build with the patient.

Grotto: The cover story for the May issue of hfm is about a health system that designed a process to catch more patients who qualify for charity care. How would you recommend hospitals and health systems start conversations with patients to ensure that those who qualify for any type of assistance receive that assistance?

Stack: What you’re talking about is a presumptive charity eligibility process, which actually is growing in popularity across the healthcare market with hospitals and providers. A lot of that goes hand in hand with the technology that’s now offered to be able to prequalify these patients very early on by credit checks, by income verifications that folks can now obtain through TransUnion and different mechanisms. That is helping hospitals a great deal.

You’re right. Hospitals never want to send a patient to collections who can qualify for charity. It’s just making that connection with that patient. And honestly, the farther upstream a hospital does that, the more captivated audience they have to screen them for charity eligibility and not only get that patient in for that service that they need but also make sure that that patient feels comfortable coming back for the follow-up care they need. …. So it’s not just that one service. Many of these services have follow-up care that patients need to seek. That’s what a hospital is focusing on, making sure that full continuum of care is provided at that hospital.

And to give you an indication on how nuanced some of this outreach is, Erika, I just spoke to a business partner that works very closely with HFMA and is doing a health equity study with us right now. They had designed a program …. to screen patients in person for charity care and financial assistance at the hospitals. And what they’re training many times encompasses is casual dress [and speaking in terms that are easily understood …. [by the patient].

What this business partner found out …. they have an entire texting outreach program for charity care, so if the patient comes into a hospital and they go home, the hospital might send a text message out and say: “Hey, please fill out this online screening application. You may be eligible for charity care.”

What they found was .… when you send texts to a patient, if you present that text content in an informal setting, patients ignore it because they think it’s a scam. So they had to roll that back and send out a more formal digital communication to the patient so they could trust it.

So we are learning, through this [partner’s] outreach on what works for different populations — for different patients that we serve in different communities. But that’s something hospitals are really working toward.

Grotto: That’s a really interesting finding.

Stack: It was fascinating to me.

Grotto: One thing that comes up in some of the stories we read on this topic is that patients are avoiding needed care because of the cost. And with mechanisms like good-faith estimates and transparency tools, we’re better able to know that cost sometimes but not all the time. So I wonder how often patients are putting off care not because it will cost a lot but because they think it will cost a lot. What do you think about this?

Stack: It really creates a large impact on delayed care and care that patients don’t seek because of fear. Really, the word there is fear.

If I had a 20-year-old car and I was told consistently by the media that if I go to a new car dealership, or a used car dealership, I’m going to be fully taken advantage of and I’m going to be bankrupt if I try to get another car and don’t get my 20-year-old car fixed, I’m probably going to limp along as long as I can on that 20-year-old car until it breaks down.

Well, that’s the same thing with healthcare. If you’re constantly told that if you go in for maintenance or you go in for preventative care or some procedure that is not necessarily life-threatening right now but could be life-threatening …. if you don’t get that care, it is eventually going to become more acute or more critical. It’s the same thing, that fear mentality that hospitals don’t want to work with you. That’s not the case.