Providing cost estimates to patients to improve patient experience

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: Does your organization provide cost estimates to patients for non-routine services? The majority (68%) indicated “yes,” their organization provides cost estimates for non-routine services to patients, while 27% responded “no” and the remaining 5% were unsure.

Respondents who answered “yes” were then asked when cost estimates were provided to patients. More than nine in ten (91%) said their organization provides cost estimates before service is provided, while only 2% said after service is provided. The remaining 7% answered “other” and responses included:
 

• "When requested for by a patient"
• "At the time of scheduling the service"
• "Cost estimates are provided to self-pay patients only”

This poll was conducted on April 16, 2019, with 1,219 applicable responses.

In an age of value and patient experience components for reimbursement, transparency is becoming more important than ever for effective medical practice management.  According to Ginny Shipp, a professional services counselor at Waystar: “Individual consumers are affecting healthcare revenue at a growing rate due to rising insurance deductibles and higher out-of-pocket medical expenses - the current reality is: the average individual deductible is $4,300 while the average family deductible is approximately $8,300.” Ginny goes on to explain that “out-of-pocket costs for patients have increased 230% in the previous 10 years, with 81% of self-pay net revenues going unrecovered and end up defaulting at a rate of 30% or more.”

To understand how we can adapt to this changing environment, Craig Wiberg, senior editor at MGMA, spoke with Sheila Augustine, director, patient financial services, and Wendy Hanson, support manager at Nebraska Medicine. According to Augustine and Hanson, there has been an increasing trend in employer-provided, high-deductible health insurance plans. This trend has led to high medical costs, creating a financial barrier to patients seeking healthcare and financial hardship for medical practices. “Patients more and more are covered by high-deductible insurance plans, this directly drives up days in A/R (after the insurance process); as a consequence, this increases time burden and cost on the practice,” says Hanson. Augustine and Hanson suggest the following solutions:
 

• Utilize EHR assistance to clarify contracted/non-contracted services
• Verify patients’ insurance prior to service
• Educate patients on their financial responsibility and help them navigate potentially narrow networks with a team of specialized financial counselors
• Provide patients with cost estimates prior to service
• Utilize online cost estimator tools for services

A key takeaway is that lack of transparency leads to poor patient experience and directly affects practice operations and financial management. Focusing administrative bandwidth on payment for service will continue to be important for patient experience and for the financial success of practices.

MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: http://www.mgma.com/stat

Sources

• “Utilizing patient financing to drive patient experience” (MGMA Podcast)

Stefan v. Jarmusz
Project Analyst
MGMA Buisness Intelligence