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Practice Academy Winter 2023: Patients are struggling to anticipate and pay for care —how can we bridge that gap?

Medical Economics JournalMedical Economics February 2024
Volume 101
Issue 2

How to bridge the payment gap: ©Syda Productions -

How to bridge the payment gap: ©Syda Productions -


Physicians in the American health care system offer incredible care to patients, with treatments ranging from flu vaccines to organ transplants — but it’s not free. Prices have increased over time and since the COVID-19 pandemic, inflation has pushed up costs of seemingly everything across the economy. A growing number of studies show that high prices lead to patients avoiding medical care or carrying debt because of it.

One survey found that 72% of consumers were unable or unwilling to pay health care bills immediately. In another survey, 67% of respondents agreed that “inflation has made it harder to pay medical bills.”

People without health insurance are less likely to seek health care. But even with health insurance, 43% of working-age adults said it was very difficult or somewhat difficult to afford health care costs, according to the Commonwealth Fund Health Care Affordability Survey, a new initiative that was launched in 2023. Physicians who want to get paid can find ways to help their patients achieve physical health without breaking their fiscal health.


  • Understand patients’ perceptions of care costs over a lifetime versus actual costs.
  • Address financial challenges via informed discussions with patients.
  • Prepare solutions aimed at addressing financial barriers to care.

Meet the panelist

Claude Royster, vice president and general manager (wellness)
at Synchrony

To watch this session on demand, click here.

Helping patients’ health without causing financial collapse

CareCredit, a Synchrony solution, commissioned its own summer 2022 study of 3,200 people, aged 18 to 79 years, about their out-of-pocket health care expenses and how they manage them. “Part of this is for us to understand what the needs are,” said Claude Royster, vice president and general manager at Synchrony. “What are the perceptions of these patients as they think about their health care costs? Not only the current health care costs but [also] the younger generations [and] their future health care costs. How are you saving for those? What are they thinking when they have to decide any type of elective care or emergency situations? How are they going to handle those expenses over time?”

Synchrony has a dual mission to increase awareness among consumers and health care providers about the cost of care over a lifetime, Royster said.

Patients estimated their annual out-of-pocket costs add up to $1,310. Including health insurance premiums, that number jumps to $5,266. Over a lifetime, insured patients could spend up to $320,000 on health care. The total tops $700,000 for Americans who buy their own health insurance without employer or government subsidies, or those who have a chronic illness such as diabetes, heart disease or cancer.

“When you think about the medical costs that the average patient has to think about, it can be very similar to a mortgage,” Royster said.

The poll also found consumers’ top five worries about health care costs:

  • Unexpected or catastrophic events
  • Ever-increasing out-of-pocket costs
  • Affordability or being
    able to pay
  • Coverage
  • Debt or bankruptcy

Although patients can vocalize their worries, 59% of physicians and other health care providers rate their patients’ financial literacy as poor. “Patients often struggle to plan for their health care expenses,” Royster said. “Despite good provider investments in this area, patient literacy still lags.”

Physicians have options for closing the gap between patient perception of cost and the reality of paying their medical bills, Royster said. Education is a strategy, and practice revenue cycle managers may be a resource to assist patients in finding ways to pay for care.

Physicians themselves are not necessarily satisfied with their current patient payment solutions; the poll found a 42% satisfaction rate, which means 58% are looking for other options. “A second strategy is [to] provide customers with flexible payment options,” Royster said.

There also is a disconnect between payment solutions that physicians offer and ones that patients want. Physicians want options to accelerate payments and reduce days outstanding, whereas patients’ top priorities are flexible payment options and frictionless experiences. However, fewer than 10% of doctors are making flexible payment options a top priority when selecting a payment solution, Royster explained.

If a procedure has a $2,000 out-of-pocket cost, most patients don’t have savings to cover that. But a program that grants patients flexibility to pay over time will ease the burden of worrying about affordability, he said.

Timeliness is part of the third strategy for health care practices. A full 84% of providers calculate preservice cost estimates, usually focused on co-pay amounts. But providers still lag in estimating and collecting total patient liability before care is delivered, Royster explained.

There are additional strategies that can help patients pay and practices thrive. Royster suggested physicians and business managers look for solutions beyond increasing cash on hand. Minimizing accounts receivable will reduce administrative burdens. Patients may respond to self-serve resources, such as integrating payment options into electronic medical records in patient portals. Some options could be subject to patients’ credit approval, but those could include equal payment/no interest plans, credit cards or installment loans.

In his presentation, Royster conducted an impromptu poll of the audience that showed 30% were satisfied with their payment collections, but 70% said there is an opportunity to do more and collect earlier. Exact solutions will depend on the practice or health system, according to Royster. “The truth of the matter is [that] there really is no right or wrong here … depending on your practice or your health system,” he said.

Solutions & takeaways

  • CareCredit said physicians should consider steps under three strategies built on education, flexible payment options and partnerships.
  • Educate consumers on costs and train customer service staff to assist patients in finding resources they need to navigate financial options ahead of, during and after their care.
  • Invest in a suite of services to offer patients alternatives.
  • Give patients more flexibility and payment options.
  • Improve the ability for patients to access and pay bills electronically, including text to pay and card-on-file options.
  • Integrate preservice estimates earlier into general patient communications to ensure more payments are received on the front end.
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Jennifer N. Lee, MD, FAAFP
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