HealthiPASS Insights

Why Current Revenue Cycle Tools are Insufficient to Address Patient as a Payer

Posted by Rajesh Voddiraju on Mar 10, 2018 11:48:10 AM

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Tools to Address Patient as Payer.pngOne of the most important aspects of a successful healthcare organization is effective revenue cycle management. Although in the past, patient accounts were managed primarily by bulky paper files, the 2009 HITECH ACT now mandates they are stored electronically.  Electronic health record systems can make the work of billing and payment more efficient, but many are not set up to fit the new dynamic in health care-- addressing the patient as a payer. Therefore, these revenue cycle systems can still fall short in making sure patients are both empowered and informed about the cost of care, limiting their ability to become smarter healthcare consumers. 

In an informal survey conducted by the website, forty percent of physicians said that there were issues with time, resources, and billing cycles in healthcare organizations, and more than eighty-five percent thought a significant amount of money was left uncollected.  While most medical practices use some form of automated patient revenue cycle solution, these systems often lack the pricing transparency and convenient payment options healthcare consumers so desperately need.

Now more than ever, patients are taking on more financial responsibility for their health care. In fact, revenue collected directly from patients has increased from 5-10% to 30-35% in the last ten years.  This shift to patient-as-payer can be attributed in large part to increasing healthcare costs and the rapid expansion of high-deductible health plans (HDHPs). Since patients are spending more of their own money on healthcare, they are by necessity more conscientious of healthcare costs. However, there is a disconnect that exists in many medical practices today in terms of giving the patient adequate tools to manage their own healthcare costs and payments.

The role of the patient in medical practices is drastically changing and those who cannot provide the resources and tools to address the patient as a payer, rather than just a person who receives care, will fall behind. 

So, what are the issues that fuel this disconnect, and how can it be fixed?

A large part of the blame must be attributed to outdated patient revenue cycle management systems that are in place in many medical practices today. Many of these systems are not equipped with adequate functionality to effectively address patients as payers. Many practices are aware of this problem. In fact, in a 2017 survey done by Black Book, 74% of  respondents said their organization is “putting population health, analytics, physician practice acquisitions and recruitment, and patient engagement on the back burner to reprioritize RCM[revenue cycle management] through Q4 2017.”

 For a medical practice that may not be aware of potential risks in their current RCM system, the following are reasons why many of the current revenue cycle tools that we see in place today are insufficient in addressing patient as a payer:

  • Limited staff to handle patient payment process
    Successfully addressing the patient as a payer involves thoroughly communicating with the patient before, during, and after their visit. If an organization does not have a sufficient number of staff to handle patient communication, and they do not have a system in place to automate the payment process, the organization could see a significant loss in both operating income and patient retention.
  • Insufficient tools to estimate cost of care
    A lack of the proper tools to address the rise of “healthcare consumerism” (where patients want and expect more cost transparency from their health care organizations) is a growing and vexing problem. Much like anything else an average consumer pays for, they want to know what it will cost beforehand.

    Estimates give consumers more trust in the product or service they are buying, and it allows them to get their finances in order before the bill is due, increasing the chance that they will pay in full. Without the right tools and technology to provide cost of care estimates, a lack of communication and a looming sense of distrust will exist between the patient and the healthcare organization.
  • Lack of payment options
    Another aspect that the patient as a payer expects is the ability to set up a payment plan. With so much to pay for these days, including your own health, patients are constantly on the lookout for flexible payment options that allow them to balance their financial obligations on an organized schedule. Organizations that do not have systems in place to accommodate payment plans will not be able to keep up with the evolving dynamic of the patient revenue cycle.

Patients are taking on more financial responsibility and therefore expect more transparency, clarity, and payment options from the medical practices providing them with care. This means they want a transparent, secure, and automated system that allows for a free flow of communication between the patient and the practice. The ability to put these systems in place allows for greater patient satisfaction and operating income efficiency.

HealthIPASS has the solution you need to successfully adjust to the changing patient dynamic by providing cost transparency that today’s patients expect, thus building invaluable loyalty and trust between you and your patients. Without the proper systems in place to address the patient as a payer, your organization will lack the ability to keep up in a changing healthcare landscape.

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Topics: Revenue Cycle Management, The HealthiPASS Solution