The media blame game regarding patient financial conversations

Erika Grotto: Hospitals doing the right thing with patient friendly payment, today on HFMA’s Voices in Healthcare Finance podcast. 

Hello, and welcome to the podcast. I’m your host, Erika Grotto. Today, I’m talking with HFMA Chief Content Executive Brad Dennison about patient-friendly payment and its coverage in the media. But first, let’s hear what’s happening in healthcare finance news. Here’s HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack. 

Nick Hut: Hello, everybody. In this segment, we wanted to discuss an intriguing new project that could really simplify some of the administrative work that takes place leading up to a care episode. It’s called the Commons Project, and I know, Shawn, you’ve been watching this unfold with great interest. Can you tell everybody what it’s about?

Shawn Stack: Hey, Nick. Yeah, I’ve been following this and working with the folks on the Commons Project for awhile on this initiative, and Rick Gundling, my boss, has too here at HFMA. And this is really a smart health insurance card initiative. There are over 1,000 different health insurers out there in the U.S. with their each individual ID card format, and you know, that translates to a lot of lift in access at either large physician groups, physician offices or hospitals. The manual entry and challenge with finding all the pertinent information on all these different types of cards where everything’s located in different areas, the tiny print—that just leaves room for typos, copying over invalid information. Registration eligibility errors, as you know are the leading cause of claim denial errors. I think they come in around 22% right now. So this process is really kind of moving that manual process to a QR code initiative process where more and more plans are beginning to have digital cards or have actual health insurance codes with QR codes on them that the hospital can scan, and all that information uploads automatically from that QR code, just like you’re at a restaurant loading a menu. It’s secure, and that includes tamper-proof digital signature. It eliminates all those check-in backlog errors and really kind of expediates the check-in process and makes it more valid and therefore eliminates a lot of those eligibility coverage errors that we’re getting right now.

Hut: Is there a way to leverage this information for broader, even digital health management? I know you and I have been talking about disruption and just ideally allowing people to manage health data and share data from wearables with their doctors a little bit more easily. Is there an application in that regard?

Stack: Yeah, that’s an interesting question, Nick, and actually, this initiative is talking about that right now, kind of peripherally because we’re still trying to get more buy-in. But there’s a lot of buy-in right now into this QR code initiative. CVS, Walgreens, Walmart, Epic, Amazon, Samsung, Google and Apple are now on board along with tons of insurance companies really wanting to push for standardization of these QR codes and this digital information. And I also left out there that there’s two major state Medicaid programs that are going digital and pushing for QR code usage in the next couple of years, and that is Louisiana’s Medicaid, and California has a smart health cards initiative. But you’re right, Nick. We can see this as we’re talking through this, we can see this cascade into a lot of benefits. So saying that, you know, Nick presents and he’s allergic to three different drugs, that information being embedded in that QR code somehow. Or maybe, Nick, your blood type. So we are looking at ways that traditional information can be embedded in these secure QR codes. That would really have some benefits to patient safety as well, if that’s kind of what you’re getting to.

Hut: Yeah, absolutely. So potentially game changing application of technology in terms of both consumer and provider ease of access to information. Real quick, what is HFMA’s role in this project? Consulting, or, how are you working with them on this?

Stack: We’re really teaming up with the Common Project to get education out to our providers, especially our large and small providers, who really have this administrative burden of entering in all this information annually. We’re getting that education out that this initiative is underway so they can chime in. We have Mayo Clinic already on board to sponsor this initiative, to really engage with the Common Project in building this out in a standardized format. So it’s more of an education piece right now, just to make our members aware, our physician groups and our hospitals, aware that this is going on, that this is being pushed. There’s a lot of meetings coming up in May with the California initiative kickoff. There’s a lot of meetings going on around D.C. on this initiative, so really just getting them engaged and getting our members’ feedback on potential issues they can see or potential benefits that they can see beyond the current scope. Just try to develop this process as clean and as uniform as we can.

Hut: Alright. Well, Shawn, thank you for sharing news on this very exciting development, and thanks everybody for listening. We’ll talk to you next time.

Stack: Thanks.

Grotto: The cover story in the March issue of hfm magazine is about one of my favorite topics: patient-friendly payment. Our writer Jeni Williams explored successful revenue cycle practices from organizations like MAP Award-winning Henry County Health Center. Today, I’m talking with HFMA’s Chief Content Executive Brad Dennison about the story and what kinds of stories our members can expect in the future. 

Patient-friendly payment is an age-old topic here. We’ve got resources about it, we’ve talked about it on this podcast before. This cover story really gets into the importance of the patient financial conversation. What makes this story so important right now?

Brad Dennison: I think there’s a patient population out there where their insurance has changed as their jobs have changed. Obviously lots of people job hopped over the past few years. There’s people who don’t have insurance that had it before. There’s people who are underinsured now. So I think that catching these changes in insurance up front and being sure that things are clear from point of service on through the process is just hyper critical at the moment.

Grotto: This article begins with one CFO talking about his health system putting a stop to financial conversations before care was delivered. This was early on in the pandemic. They were afraid that cost would deter patients from getting the care they needed. But an interesting thing happened when they reinstated having those conversations again. Their point-of-service collections went up. So what do you think this tells us about what patients really want when it comes to financial conversations?

Dennison: Well, two things on this with Henry County. First of all, they saw a barrier to service, and they cleared it out. And I think that was an important takeaway from that in what they did. And if you think back, this was a time when people were deferring all sorts of care. It wasn’t just, “I’m sick and not going to the hospital.” People were deferring screenings and today, we have a sicker patient population than we did before because of deferred care. So I applaud Henry County for getting a barrier out of the way to be able to provide service. The other side of this though is when they brought the patient financial conversations back and collections went up, I think it just goes to show that patients want to have that conversation and need to have that conversation up front.

Grotto: One part of the story that I found really compelling, and I know you did too, is the discussion about major media outlets like The New York Times criticizing hospitals for their collections practices, and I think now is a good time to mention, for anybody listening who doesn’t know, you have a long career in media before you started with us, right?

Dennison: Yes. I actually started out as a reporter and rose through the ranks to become an editor. I was an editor at the Chicago Sun-Times. I’ve been a vice-president of news for a couple of different national companies, a senior vice president at Gannett, which used to be called Gatehouse, ran my own media company for five years before I came to HFMA. So yeah, I’ve been around the block.

Grotto: So I mentioned The New York Times specifically, but it’s not just them. It’s industry sources, it’s other major media outlets, and it’s obvious to a healthcare industry person in some of this reporting that there are knowledge gaps and lack of understanding. What are some examples of that when it comes to the topic of collections?

Dennison: Well, I think that they all come from the point of view, when you read even some of the recent New York Times stories, that collections somehow are bad. Collecting money from patients for providing a service is a bad thing. It’s a negative. And that’s just the case. It’s a wrong assumption. It’s not how business works, whether it’s a for-profit hospital or not-for-profit hospital, it is a business and needs to be run like a business. You have to provide a service and collect for it. What other business would we look at and say “How dare they try to collect money for the service or product that they provide.” So a lot of reporters come from the point of view of, certain things are automatically a negative, and I don’t think collections can be viewed as automatically negative. That’s part one. And there’s been scrutiny over discussion with front-line workers of how to collect better and more at the point of service, but what that really means is having a high quality financial conversation with the patient up front at the front desk before they receive service. How many times have you or I been in an urgent care center with our kids and asked for clarification on what our portion would be and didn’t get an answer, didn’t get the right answer. That’s a thing. So I think the assumption being made about criticizing how to better have these conversations up front with the patient, which is essentially what’s happening, is very misguided. Now, you can get into a lot of things later in the collections process, right, so as invoices age and go through that process, there’s a host of people who may not have the ability to pay. You would hope that you smoke out the people up front who don’t have the ability to pay, who qualify for charity care, who are 300-400% below the poverty level, whatever it is, whatever your measures are. But things get very, very complicated along the way in that process, and I know a lot of health systems—maybe every health system—have really worked on these policies and procedures over how they collect over the past few years. So I think like a lot of things that land in media stories, they’re far more complicated than the reporter really understands. Now, I’m not saying they’re not rooted in some reality. There are facts here, but I think they tend not to do a quality 360 walk around this story. There are really good investigative reporters out there, but there are also a lot of investigative reporters who get something in their sites, and it’s like a river with the current running one direction, and to find something that moves in the other direction doesn’t fit the narrative. And I think even in a lot of cases lately, we’re seeing stories being written where there is no attempt to get the other side of this story or to get clarification or to truly understand how something works.

Grotto: And I think it’s something that we’re going to be deliberate about in some of our content.

Dennison: We are going to be more deliberate about it in our content, and that’s for a few reasons. One is that our listening posts with our membership, more and more we’re hearing a fear of the media, a fear of being negatively portrayed, a fear of misuse or twisting of facts and data. And we are, at our hearts, a data-based organization, a numbers-based organization. We’re a frequent flyer in terms of being a source in the media, by the way. When reporters who are very conscientious and want to know how something works in healthcare, healthcare finance, we tend to be the ones that they call to really understand it. Sometimes we’re a quoted source, and sometimes we’re not, but they know we’re independent and that we will tell them the mechanics of how it works without falling on one side or the other. So you know, I think that we have a responsibility to not exonerate folks who end up in articles but to point out how data was used or misused or how incomplete pictures have been drawn, or wrong conclusions, with the right data. So I think we have a place in this, and we’re excited about that. I think it’s a good exercise for us to go through.

Grotto: Patient-friendly payment has long been a favorite topic of mine. I thought this cover story was great. I think it’s something that a lot of members are going to be interested in because no matter how good a job you think you do, you can probably always do better, so Brad Dennison, thank you so much for joining me today.

Dennison: Thanks, Erika.

Grotto: Voices in Healthcare Finance is a production of the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Additional writing and research are done by Nick Hut, Shawn Stack and the HFMA editorial staff. Sound editing is by Linda Chandler. Brad Dennison is chief content executive. Our president and CEO is Joe Fifer. Don’t forget to read the cover story, and more, in the March issue of hfm. You can find it in your mailbox and at hfma.org. 

The media blame game regarding patient-friendly payment

The cover story in the March issue of hfm magazine explores best practices in revenue cycle with regard to patient-friendly payment. Organizations like MAP Award-winning Henry County Health Center share stories of tactics that increased both collections and patient satisfaction. On a recent episode of HFMA’s “Voices in Healthcare Finance” podcast, HFMA Chief Content Executive Brad Dennison discussed the story as well as upcoming related coverage from HFMA.

The stopping and starting of conversations

At the beginning of the pandemic, Henry County Health Center, a 25-bed critical access hospital in Mount Pleasant, Iowa, halted discussions around healthcare costs before care was delivered, with the hope that cost would not deter people from receiving care when they needed it, according to the story. Several months later, Henry County reinstated those conversations and saw collections dramatically increase even from pre-pandemic levels. Dennison said that points to two things.

“First, they saw a barrier to service, and they cleared it out. This was a time when people were deferring all sorts of care … and today, we have a sicker patient population than we did before because of deferred care,” he said. “The other side of this is when they brought the patient financial conversations back and collections went up, I think it just goes to show that patients want to have that conversation.”

Collections as a negative

The hfm story also touched on media coverage of hospital collections practices. Media outlets like The New York Times and others have published stories in the past several months that Dennison says paint the picture that collecting money for healthcare services rendered is a bad thing.

“It’s not how business works, whether it’s a for-profit hospital or a not-for-profit hospital,” he said. “It is a business and needs to be run like a business.”

Several stories (including one Dennison discusses in a recent blog post) criticize hospitals for collections practices but do not fully explain how those practices work or how they’re regulated by federal and state governments.

“I think, like a lot of things that land in media stories, they’re far more complicated than the reporter really understands,” Dennison said. “There are facts here, but I think [reporters] tend not to do a quality 360-degree walk around this story.”

HFMA will continue to scrutinize media content about the healthcare industry in Dennison’s blog and an upcoming podcast.