Hospital Financial Risk Assessment Tools Not Limited to ERM

After she took a spill on the soccer field and landed on her noggin, Milton Silva-Craig took his daughter to the hospital emergency department to have her injury assessed. The patient registration representative confirmed his demographic information and verified his insurance. Then the woman instructed him that the hospital normally takes $150 at intake. Many patients would likely reach for a credit card, however, more patients are starting to ask, "Can you explain what that’s for?"

That’s what Silva-Craig did, but he’s no layperson. Silva-Craig is the executive vice president of credit and information management consulting firm TransUnion Healthcare, a wholly owned subsidiary of credit and information management company TransUnion, and so he viewed the situation with an eye on payment approach and risk. What he found was that when he pushed back with a few questions, the payment collection process sort of dissolved. It went something like this:

• Yes, the woman had verified his insurance.
• Yes, she had verified his co-pay amount.
• No, she couldn’t tell him if he had met his deductible amount.
• No, she couldn’t tell him if he had co-insurance.
• No, she couldn’t tell him about his credit rating or likelihood to pay.

Moreover, had this been a more complex medical scenario, he adds, she likely wouldn’t have been able to give him an estimate on the cost of treatment either.

It turns out the $150 the front office was asking for was an average patient payment amount, which the hospital arrived at in order to obtain at least some of the patient portion of a bill at the point of service.

Kudos to the hospital for at least making some attempt to collect payment at the point of service, however, as consumers become more responsible for the cost of their care, this approach isn’t going to fly. Hospitals and health systems must give their staff the tools to answer questions like the ones Silva-Craig posed.