Improving the Healthcare Patient Payment Experience

Abstract

Healthcare is being re-imagined. Central to this re-imagination are the elements of technology, automation, business processes and the need to comply with an ever-increasing landslide of legislation and reform.

Yet, in this great re-imagining a fundamental element is often overlooked and under-studied: the impact that the patient has upon the entire healthcare delivery process. In a world where patient payments represent an increasingly large portion of a provider’s revenue, and as the healthcare community begins shifting away from a fee-for-service model toward pay-for-performance (and eventually to pay-for-outcomes), the patient has become even more important in this process.

The Healthcare Information and Management Systems Society (HIMSS) has dedicated resources to bringing attention to this important area, placing specific emphasis on how patients impact and are impacted by revenue management processes associated with healthcare delivery. The HIMSS Revenue Cycle Improvement Task Force (RCITF) has been in existence for nearly ten years, and in 2011 delivered an initial white paper on this topic: The Future of Revenue Cycle: Preparing for Near-Term Change; and a follow-up paper in 2012: Next Generation Patient Access. In 2013, the task force released HIMSS G7 Advisory Report: The Healthcare Payment Experience and The Patient Financial Experience: Problem Overview, Clinical Scenarios, and Questionnaire.
This paper summarizes these previous works and aims to bring greater understanding of the importance of the patient’s impact on revenue cycle operations and success. This paper brings to the surface the significance of the role that the patient plays and how important it is to measure patient satisfaction, identify problems early, and improve the bottom-line by improving the patient's experience.

The HIMSS RCITF members include a cross-section of providers, payers, vendors, consultants, associations and governmental contributors whose goal is to improve insight and foster industry-wide collaboration with respect to the patient payment issues.

Read an Excerpt: 

Regulatory and Industry Efforts to Affect Change

In professional circles, the subject of patient payment frequently evokes an uplifted eyebrow and often generates head scratching. Over the past 10 years, organizations such as HIMSS, the Healthcare Financial Management Association (HFMA), Press Ganey, Connance, CMS, McKinsey, the American Health Information Management Association (AHIMA), the American Medical Association (AMA), the American Hospital Association (AHA), and a host of large healthcare systems and vendors have been working together to develop and test indicators to suggest new models to create better patient pay. Governmental regulations are often a driver. As part of Medicare’s move to value-based payment, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) penalty related to patient dissatisfaction was increased from 1% to 1.25% in 2014, and will grow again in 2015. Providers must gain a deeper appreciation of what is involved in the myriad issues surrounding patient satisfaction, including the correlation between patient satisfaction and their financial experience. By making the connection between a patient’s financial experience and their overall satisfaction, providers subject to HCAHPS may experience better scores and improved financial outcomes.

Keywords: 
health business, medical banking, Payment, patient engagement