Health Care Collector - Kluwer Law International

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PAGE10 AUGUST 2010 examples that follow apply to the cost of medication. But the principles are the same whether you are talking about transportation to and from the office, arranging daycare for an elderly parent, or participating in patient education programs. Patients often need to be encouraged to talk about health care costs. And when they do, it’s important to listen to their concerns and help them explore their options. Editor’s Note: As more hospitals are publishing information about the cost of their services, managers or employees working with patients in billing and collections are often called upon to talk to patients about the cost of services—and about their patients’ insurance coverage. Educating patients about billing and services are two big issues for the patient accounting staff. Health Care Collector editors believe that Osborne’s patient education/communication tips are valuable no matter what the topic. Ways to Approach Discussing Health Care Costs with Patients Know the basics of health care costs. Almost every day, there seems to be new information about health care costs. It can be hard to keep up to date. Patients are likely to have an even more difficult time understanding the complexities of cost structures and payment options. It’s important to learn the basics of health care costs and then to teach this information to patients in ways they can understand. One example would be to explain drug formularies. As defined by Medicare Part D, this is “a list of prescription medications that a drug plan will pay for.” Most insurers offer three tiers within a formulary: • Generic (lowest cost); • Preferred (middle cost); and • Nonpreferred or brand name (highest cost) drugs. But just explaining drug formularies is not sufficient. You also need to teach patients that there can be several options within each tier as well as cost differences when purchasing prescriptions at the pharmacy or by mail. In my health plan, for example, a one-month supply of a generic drug costs $5 while a nonpreferred drug costs $40. When patients understand what is available to them when it comes to filling prescriptions, they can discuss cost saving options in the provider’s office and with the pharmacist. Open the Lines of Communication In most purchasing situations, buyers want to talk with sellers about ways to save money. Admittedly, health care transactions are more complex, but the principles remain the same—one party has to pay for services and goods rendered by the other. Shrank says there are a couple of reasons why patients and health care providers seldom have conversations about costs. For one thing, patients rarely initiate conversations about expenses. In part, Shrank says, this may be due to patients feeling embarrassed or ashamed about financial concerns. Time is also a factor. In a brief office visit, patients, like their doctors, are usually more concerned about diagnosing health problems than about talking about how they plan to pay for treatment. Likewise, physicians and other health care providers seldom start discussions about costs. In a recent survey, Shrank found that almost all physicians agree it is important that patients’ out-of-pocket costs be managed. But only about one third of physicians surveyed believe it is their job to do so. Physicians and nurses can help open lines of communication by routinely asking patients if they are taking their prescribed medications. This might be done when taking a patient’s health history or vital signs. If you ask, “Are you taking (x) medications?” and the patient says no, follow up with a question about why. If the answer has to do with money, encourage patients to ask about less costly options. Another example: In the instance of patients who may not have the financial resources to cover costs, but are embarrassed to mention it, financial counselors can bring up the issue. Use Plain Language Many health plans now mail patients letters about the cost of prescription drugs. These letters often include a statement along the lines of “You are currently charged (x) for this medication and there is a generic for (y) that will cost less.” Shrank knows of no research about the effectiveness of these letters and wonders, from a health-literacy perspective, how well this information is being communicated. You can help by offering to review the readability of these letters and advocating for them to be rewritten in plain language. Explore the Use of Technology Find out what tools there are that can help patients understand and get a handle on their health care costs. Once you learn about them, you can then HEALTH CARE COLLECTOR
PAGE11 work with patients to make sure they know how to use them. One important step in this process would be to ask about access to the Internet: • Does the patient have Internet access at home? • Is there someone who can help the patient learn how to use the Internet if the patient doesn’t already know? • Can the patient go to the library to get online? Other tools patients might use include videos they can borrow from the library for exercise or diet instruction rather than pay fees to join a class. Instruction in how to join an email support group can save a patient the expense of transportation to meetings while at the same time providing access to a community of individuals who share the patient’s concerns. Editor’s Note: If your offi ce or hospital has a Web site, advise patients about it. Help them get signed up so they can take advantage by asking questions or making payments online. Consider the Human Costs Everyone agrees that it is expensive being a patient. A recent study looked at patients’ nonmedical costs at three phases of cancer care. These costs included time spent traveling to and from care, waiting for appointments, and receiving consultation from providers. They totaled hundreds to thousands of dollars per year. By talking with your patients about these costs, you can help them find ways to reduce those costs and relieve part of the stress involved in getting good health care. ■ Reader’s Resource William Shrank, MD, MSHS, is an instructor at Harvard Medical School and at the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital in Boston. You can reach him by email at wshrank@partners.org. Source: Article reprinted with permission from the author and On Call Magazine and published by Boston.com/Monster , a division of Boston Globe Media. On Call is available online at http://www. boston.com/jobs/health care/oncall. Collection Tips and News Fine Tune Your Payer Collections Strategy How well do you know your payers? Start by developing a profile of each payer and identifying how each payer’s process works. Then, check it against your employees’ procedures for working with that payer. You may find that your employees use the same procedure from one payer to the next. But one process does not fit all payers. First, assess what your staff currently knows about the payer. What information and phone numbers do they have? To begin, a payer profile should include the names and phone numbers of the key payer contact staff, including: • Customer service; • Customer service supervisor and manager; • Claims department; • Claims department supervisor and manager; • Mailroom supervisor; • Medical review manager; • Medical officer; • Legal counsel; • Compliance officer; • UR manager; • Appeals manager; • Provider rep; and • Provider rep manager. Tip: Find out how much authority each provider rep has to resolve claims issue. If reps have no authority, you can move on to the next level. Source: Judy Veazie, CPAM. HEALTH CARE COLLECTOR AUGUST 2010
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Health Care Collector - Kluwer Law International

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