From cost to care: Offer payment plans to every patient, not the ones who look like they need them

Gordon's argument for offering payment options universally has less to do with revenue than with what a practice assumes when it looks at a patient.

Staff guess, she said, and the guess usually runs one direction. A patient who arrives well dressed and put together is assumed to be able to cover the copay, so nobody raises the subject. But "there isn't a certain look that people are going to present with when they're having financial distress," and for many patients the topic carries enough shame that they will never raise it themselves. Ask, she said, and more people say yes than a front desk would predict. Put brochures about payment options in the waiting room and, in her experience, they disappear.

Her recommendation is to offer the same options to every patient as a matter of policy, with financial hardship handled as a separate track under whatever criteria the practice has set. What she wants to avoid is a patient going without care because the conversation felt humiliating to start.

The education compounds, she added. Patients who understand what they bought tend to choose better-fitting coverage next time, and she hears a version of the same regret constantly: if I had known I was going to pay all this out of pocket, I would have picked a different plan. Over time, she said, that produces a community better able to pay its bills, which strengthens the practice's own financial position.

Why the estimate should come before the appointment

Jacobs made the case for moving the conversation earlier. A patient who walks in knowing there will be an out-of-pocket cost but not what it is stops absorbing anything else. They are nodding along through the diagnosis while doing arithmetic. Give them an estimate beforehand, she said, and they follow through, decide faster and feel empowered doing it.

Mehta does it in the room, sometimes before the patient has gone out to speak with staff. Because her practice sits outside the network but her referrals do not, she walks through the whole structure: the surgery center, anesthesia and nursing are in network, postoperative physical therapy is in network, and her professional fee, which she put at a few thousand dollars, covers 90 days of postoperative care.

She also keeps cash prices for common procedures at the surgery centers she works with, so she knows what a carpal tunnel release runs at each one, and she said she works with an imaging center charging $450 for an MRI at the time of the discussion. That figure matters to a patient carrying a high deductible who has been quoted a hospital rate. She then follows up by email so the pricing is in writing and the patient can think it over on their own.

Part of that groundwork happens outside the practice. Mehta said she wants to know what the physical therapists and imaging centers in her area are willing to do for her patients, because a patient budgeting for surgery is also budgeting for the 10 weeks of rehabilitation that follow.

On who owns the conversation, Lafko's answer was that it depends on size. Health systems and larger groups have whole financial departments. Everywhere else, the entire team has to be able to speak to it: the scheduler on the phone, the clinician adding a service, whoever happens to be standing there when the patient asks.

Jacobs was blunt about the failure modes. "I don't know" and "that's not my job" should never come out of a team member's mouth, she said, because the answer can always be found. A technician can say they will step out and get it. Physicians, she argued, should carry at least a roundabout number and hand the specifics to a financial counselor or patient concierge, so that the patient hears a range from the person recommending the care rather than a shrug.

Meet the panelists

Pamela Mehta, M.D., is a board-certified orthopedic surgeon in California's Bay Area who has practiced for more than 15 years and owned her practice for about 10 of them. Resilience Orthopedics is completely out of network, so every cost discussion in her practice happens out loud and up front, before anyone is treated. She also co-founded Learn at Pinnacle, which delivers education to women in medicine.

Shawntea "Taya" Gordon, MBA, FACMPE, is CEO of Atlas & Perpetua Healthcare Consulting. She has co-authored two revenue cycle books for MGMA and sits on the association's Government Affairs Council, which means she moves between the granular work of repairing a practice's collections and the policy fights that reshape them.

Carrie Jacobs, COE, is Executive Vice President of Operations at Chu Vision Institute in Bloomington, Minnesota, and runs the practice's ambulatory surgery center. She has spent nearly 25 years in practice leadership, in a specialty where insurance-covered and elective self-pay work sit side by side on the same schedule, and serves on the board of the American Society of Ophthalmic Administrators.

Amy Lafko, MSPT, MBA, spent two decades in health care leadership across acute care rehabilitation, home care, urgent care and medical group practices before concluding that most operational problems were people problems underneath. She founded Cairn Consulting Solutions and wrote "People First: A Proven Method for an Exceptional Healthcare Practice."

The discussion was moderated by Jean Moody, CHPC, Vice President of Specialty and Wellness Solutions at Synchrony, which owns CareCredit. Moody has spent nearly 20 years with the company and ran a LASIK ophthalmology practice before that.

This roundtable was recorded in October 2025.