The key to happy and healthy patients? Honest talk about finances.
Physicians may be focused on how patients are treated in their practices and the quality of care they receive, but they often overlook one of the biggest factors in engagement that also affects outcomes: patient finances. Steven Merahn, MD, FAAP, chief medical officer, Essen Health Ventures, and Jan Oldenburg, consumer health information strategist, Participatory Health Consulting, spoke about the importance of not overlooking money issues to increase patient satisfaction at the virtual MGMA 2020 conference.
“Patients see payment and billing as part of the total clinical experience even though doctors don’t,” says Oldenburg. Patients are seeing rising out-of-pocket costs and a push toward more health care consumerism, and patient expectations from doctors is changing.
Patient surveys show that only 12 percent said they had received information about out-of-pocket costs, while 67 percent said they have not discussed or do not plan to discuss their final bill with the hospital or provider.
Merahn says there are a lot of barriers to financial discussions: varying levels of financial and health literacy, unclear of complex information, social barriers or stigmas. “Despite the potential discomfort, it is critical to discuss the financial aspects of care,” Merahn says. “As a clinician, it’s not about them paying, but about committing to their care.”
Patients may be putting off care because of high deductibles or other financial reasons that doctors may misinterpret as them not wanting the treatments. “Helping people understand what care is recommended, and what can I pay for, when put together, changes things dramatically,” says Oldenburg. “Health care is implicated in 70 percent of bankruptcies, and it’s true that financial stress can have an impact on how someone recovers from an illness.”
Surveys show that patient behavior is influenced by money matters: 43 percent of patients said they changed their behavior regarding medical visits or procedures because of costs while 24 percent delayed prescriptions or never had them filled for the same reason.
Patients don’t always understand what they are paying for, so doctors need to help. “We haven’t done a good job of giving them tools to help them understand where costs from and what they can do to change them,” says Oldenburg. “We haven’t given consumers a way of figuring out whether this is a Gucci price because of the quality, or if it’s just a Gucci price for a knockoff product.”
Costs can also play a role in patients switching doctors, usually after a visit that generated an unexpectedly high bill. Of the patients surveyed, 65 percent said they would consider switching providers if they received a surprisingly high bill. “This is why you should make it easy to have a financial conversation way upstream of the bill,” says Oldenburg.
Merahn says that the foundation of a successful medical practice is the willingness to share the worries of another human being, and that includes their financial worries. He says practices need to embrace all the digital payment options and provide flexibility for patients to pay. “There are ways to pay that are convenient for them, not us,” he says. “Are there ways you can make things more efficient and more convenient for the people you are serving? Don’t forget about when actually caring about a patient’s time, that is a dimension of showing the organization is caring about them as a whole person; it’s not just getting money, but showing you care about their issues, including their time and convenience.”
Part of that convenience is translating goals into the real world. “An HbA1c level is our measure, not theirs,” says Oldenburg. “Their goal may be to dance at their daughter’s wedding. If we framed our goals in their terms, we will be more successful.”
A lack of money is also a social issue. “The financial education piece may not seem relevant, but as we are looking more at social determinants, it is a major one,” says Merahn. “Taking on some responsibility to help them with the basic science of financing is important. You aren’t balancing their checkbook, but helping them understand how it works both for and against them, and how to make educated decisions. And asking finance to set up a payment plan is not the same as providing assistance.”
He says that finances have to be considered part of the patient’s social history. “Get out of the idea you are prying into their personal lives. Part of medicine is professional intimacy; you understand their body and lives in many ways. In today’s society, it’s important to understand the circumstances of their life.”
Without looking at costs, a doctor is doing a disservice to the patient. “It doesn’t do anyone any good to charge forward and recommend an option they won’t act on because of cost, and if we don’t know that, then shame on us,” says Oldenburg.