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No Time to Call Patients Pre-Visit? They'll Call You Eventually Anyhow.

Analysis  |  By Alexandra Wilson Pecci  
   October 22, 2018

Surprise medical bills prompt more patient calls to the business office, a new survey shows.

It can be a challenge to find the resources to make pre-arrival calls to patients who are going to be hit with large balances after their treatment, but failing to do so might make more work for the business office in the long run.

A new survey from Connance, a Waystar company, shows that among patients whose bills were higher than they expected, 63% have called or will call the business office.

Compare that to patients whose balance is what they expected it to be: 70% of them say they won't call the business office.

And while consumers say they wish they'd been given a heads up about their impending bill, just 35% of consumers with payment responsibility say the business office had called with an estimate prior to treatment.

"When they're surprised it causes them to engage badly," says Steve Levin, former CEO of Connance and current executive vice president of strategic alliances at Waystar.

"This means they call into the business office, this means that they don’t pay bills, this means that they hold off on the follow-up care. You get this vicious, higher-cost cycle," he says.

In other words, if you don’t get in touch with patients upfront, they'll not only call you eventually anyhow, but it could set off a ripple effect of other negative—and expensive—behavior.

In July of this year, Connance surveyed 500 U.S. consumers who were at least 27 years old and have been to a hospital within the past 12 months. It's been conducting the survey annually since 2010.

There are five main takeaways from the findings.

1. Things are getting better: "We are finding that over time there's a long-term trend of improving the patients' financial experience," Levin says. He points out that in the first survey in 2010, only 20% of the patients gave the billing experience a score of 5 on a scale of 1-5.

Today that number is up to 40% of patients, which should give revenue cycle leaders "a great sense of confidence and pride."

"That is a systematic, sustained demonstration of progress," Levin says, thanks to investments in technology and tools that aim to give patients a less burdensome billing experience. 

2. Loyalty is tied to experience: Levin says that they have seen over time a relationship between the billing experience and patient satisfaction and loyalty.

"A good billing experience is tied to future utilization of a facility," he says. "Even if the clinical experience is exceptional, you find that a bad billing experience, before or after that clinical event, can really kind of put a damper on that repeat user." 

He's careful to note that a single bad billing experience will not "swamp" a great clinical one, but the cumulative effect is worth noting. 

"As these dissatisfiers build up, these patients will move over time somewhere else," he says.

3. Patients are open to new approaches: When it comes to improving the financial relationship, patients are increasingly open to different relationship approaches, like portals, pre-arrival engagement, and payment plans, Levin says.

However, the survey shows that patients want self-service technology and one-on-one communication instead of email, text, or mailed communications.

How they want to engage also varies by age. For instance, younger respondents prefer to pay their bill through portals or by credit cards over the phone, the survey shows

4. Large balances remain surprising: Levin says that although the trend toward large patient balances isn't news to people in the hospital industry, it is news to patients, and "financial surprise is a major dissatisfier."

"From a patient perspective they remain surprised," he says. "If we can change the surprise quotient, that can really change the relationship."

5. There's an education opportunity:  According to the survey, 53% of respondents believe the insurance company is the most capable and believable entity for their estimated balance.

In addition, one in four patients don’t know what an Explanation of Benefits is, and younger respondents will often ask a friend or healthcare expert to review their bill, giving hospitals and health systems a chance to seize these education opportunities.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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