Patient Consumerism

Why The Healthcare Industry Should Take Note From History

Written by James. N. Giordano

Americans are confused, anxious and frustrated by rising and unpredictable copays, deductibles, and out-of-network expenses. COVID-19 has presented additional financial challenges and barriers to care. The patient financial burden continues to increase and most patients don’t understand why. What they do know is that it’s getting costly and it’s getting personal.

Patients find their specialty and primary care doctors are turning to out-ofnetwork models at a rapid rate. Patients utilizing in-network doctors and facilities are still faced with their insurance plan’s high deductibles, copays and coinsurance. The learning curve is steep and patients are just educating themselves.

NPR and Kaiser Health News “Bill of the Month” article uses actual patient bills to educate their readers on how to be more active in managing their unexpected healthcare costs. Bills selected run the gamut of circumstance and cost to the patient.

What does this mean to the healthcare industry? Unfortunately, when increasing amounts of medical cost fall on the patient, the choice of providing care or pursuing payment weighs on all medical providers. The pursuit of payment is costing an average of 27% of total revenue for physician groups and 21% for hospitals, according to a recent brief by the Center for American Progress.

A patient’s access to care is no longer just limited by geography. Patients are forced to consider the cost of care even for preventative care. The financial afflic- tion associated with a patient’s responsibility for their own care is forcing the healthcare industry at large to rethink the way they attract new patients, keep existing patients and collect on payment. In this economic and socially shifting environment, it is more important than ever that the industry shift their current collection paradigm to a more customer centric model.

Learning from Other Industries

Mortgages expanded the housing industry making homeownership a possibility for those lacking large amounts of capital at the ready. Retail credit cards transformed the way people shop and how shoppers engage with retailers.

In 1920, Americans were introduced to the first mass-produced, “af- fordable” automobile, which left most wondering how they could ever afford to own one by paying upfront. It wasn’t until automobiles were considered a necessity that the idea of buying one on credit truly took off. Enter auto financing, and less than 10 years later, half of the United States population proudly owned one. By 1930, two-thirds of cars were purchased on credit.

Necessity drives consumerism in all industries: transportation, housing, utilities and now, healthcare. How can the healthcare industry learn, adjust and make healthcare more attainable and affordable to patients?

The Rise of the Patient Consumer

The annual value of patients’ outof-pocket medical expenses is estimated at $63.7 billion. Private practice medical doctors and healthcare administrators need to learn from history in order to navigate the financial payment landscape that allows them to offer care to their patients and get paid for their services. There is too much at risk not to conform.

As patients knowingly assume more financial responsibility for their healthcare, they will become more selective about who, where, when and if they will receive their care. The rise of healthcare transparency and surprise billing legislation will give patients new tools to make these decisions that much easier. When patients are armed with the ability to choose where they receive their healthcare based on price, those offering healthcare services will become considerably more proactive in marketing to patients.

The healthcare industry must pivot, analyze and rethink business as usual based on financial circumstance, decision making process and method of communication. Patients aren’t just shopping for their healthcare, they are shopping for medical doctors and facilities that value their business and prove it to them. Patients want the ability to pay their medical bills like any other expense today - without hassle and over time.

Payment Plan’s Role in the Patient Decision Process

Consumers want payment choices and use these options as part of their purchase decision. In a recent survey, 93% of patients responding and willing to use payment plans also wanted providers to be proactive in offering such a plan. In addition, an overwhelming majority of patients (76%) who were offered and used payment plans said they would complete the plan on time. Consumer-centric patients seek non-predatory payment options as a reason to commit to a doctor’s care plan and see through including payment in full.

With $7.5 billion in medical bills going uncollected each year, what is there to lose?

Consumer-centric patients understand that unfortunately, all payment options are not favorable. Early players in the medical payment subsection thrived and continue to market as interest free to patients, but fine print tells a different story. Doctors and facilities should count on patients being aware of these practices, especially with online reviews and social media. In fact, 24.8% of respondents who used payment plans said that incurring additional fees was the reason they had previously avoided payment plans altogether.

Technology Offers Access to More Consumer Patients

Beginning in the early 1990’s payment plans based on credit score allowed patients to pay for health care with a credit card model with interest rates risk of over 25%, retroactive. Consumer patients are increasingly more shrewd to the fine print of the predatory payment plans of the past, and are seeking out payment plans that benefit both the patient AND the healthcare facility.

Evolutionary risk assessment technologies can now assess a consumer’s ability to pay using thousands of social, behavioral and financial indices, not just credit score. By using alternative means to assess risk, non-predatory, truly inter- est and fee free payment plans are now available to patients with credit as low as 400. Remarkably, these advancements can successfully lower the barrier of entry for patients while eliminating the burdensome administrative costs associated with traditional payment plans.

With the help of technology, interest and fee-free payment options do exist. Savvy consumers should beware of predatory impersonators in the form of credit cards and micro-lending “matchmakers.” Only medical practices and healthcare facilities who invest in the consumer-centric patient relationship will be willing to help patients get the care they seek and the means to make it more affordable. These are the practices and institutions that will thrive in the future healthcare market. 1

James N. Giordano is CEO and Founder of Care Cap Plus, the technology driven leader in interest-free financing and payment plans.

1- Bill Of The Month

Julie Appleby - https://khn.org/news/tag/bill-ofthe-month/

2- Excess Administrative Costs Burden the U.s. Health Care System

Emily Gee-Topher Spiro - https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrativecosts-burden-u-s-health-care-system/

3- Auto Financing Changed Industry and Society

Steven Finlay - https://www.wardsauto.com/ideaxchange/auto-financing-changed-industry-and-society

4- History Of the Auto Lending Industry https://lendedu.com/blog/history-of-auto-lending-industry

5-Healthcare Payments https://www.pymnts.com/study/healthcare-payments-study/

7 Ways To Turn Patients Into Your Biggest Fans

So You Can Grow Your Business

Written by Dr. Brent Lacey

Ioften meet a patient for the first time when I’m meeting them on the day of their endoscopic procedure. My nurse practitioner sees a lot of patients ahead of time, so by the time I meet them they have already had some experience interacting with people in our clinic. I almost always get positive comments.

• “Your staff is just so nice!”

• “Everyone here is really professional.”

• “You guys are so efficient!”

• “Are you the doctor from Texas?”

We have worked hard to create an extremely positive customer service experience for our patients. Any time we get a complaint from a patient about an aspect of our clinical service, we take steps to correct it. In a small, rural North Carolina community with one major hospital, reputations spread very quickly, and we have built a reputation for high quality, professional care.

I really enjoy spending time with my patients in clinic. It’s the best opportunity I get to make an impact with patients one-on-one. I realized a long time ago that a patient’s experience with our practice starts long before they ever meet me, and it’s crucial to address all of the aspects of that encounter to ensure that patients have a great experience.

If I serve my patients well, they become my most ardent supporters. I haven’t had to spend a dime on advertising or marketing. My whole practice has grown by word of mouth.

Here are 7 things you can do to create fans that will market your practice for you.

1. Hire the right team, and cultivate the right culture

It all starts with hiring the right people and building a good team culture. As a physician, you are a leader in your business, whether you wish to be or not. We direct the flow of patient care. One of my mentors loves to say, “Your team will get the patients better, and the doctors aim their team.”

Depending on your employment status, you may not have a lot of say when it comes to hiring. However, you CAN influence your team’s culture. Build the culture that you want, set high expectations, and you’ll tend to see that people who aren’t a good fit will just leave.

Work with people who are friendly, hard working, and strong communicators. That will help fix >90% of your clinic’s issues.

You can’t be everywhere at once, and you can’t come up with ideas to fix every problem that arises. What you can do is hire great team members and turn them loose to do their jobs well.

2. Make it easy for patients to get into your clinic.

You are in a referral business. It should be easy for patients to get referrals to you. That should be a low-friction process for the patient. If they have to spend any time figuring out how to get in touch with your office, they’ll go somewhere else.

If you’re getting direct business (e.g., primary care), people are probably find- ing you online or through friends. Is your website easy to navigate? Do you have a clear process on your website to show people how to set up an appointment?

Your referring physicians should also have an easy way to send referrals to you. If they have to spend any time working through a complex administrative system to get to you, they’ll go somewhere else. Make this process easy and clear!

3. Spend more time with your patients

This is easier said than done, especially in clinics where you may only have 10-15 minutes with each patient. Still, it’s true that the more time you spend talking to your patients, the better their experience will be.

Another thing you can do is start to set expectations early. When your team calls a patient to remind them about their clinic appointment, they can tell patients what their clinic visit will be like. If you have to see 30 patients a day and they only get 10-15 minutes of your time, let them know that so they can be prepared with questions and not spend half the visit on idle chit-chat.

4. Dress for success

This can vary widely among specialties. In general, patients will expect business casual, business professional, or scrubs, so that’s a good place to start. I used to say, “wear whatever you would wear to church,” but sometimes that now suggests a level of formality below what would be expected at a physician’s office.

Scrubs may be more typical in surgical subspecialties, especially if you go back and forth between clinic and procedures all day.

White coat or no white coat? I find this to be an individual decision. I still wear mine to clinic every day, but not everyone does. I think it comes down to personal comfort for most people. The white coat is a symbol that adds a degree of confidence to the patient encounter, but it’s not something everyone necessarily wants to wear every day.

Set expectations with your staff on a daily dress code. Again, business professional or at least business casual should be a minimum expectation. If you have theme days like coordinated colors, football jerseys or Halloween costumes, that can be a fun way to break up the monotony.

5. Clinic layout

Think like a retailer. When you walk into a department store, everything is laid out meticulously. Signs point the way to the different departments. The floors are clean and lights are bright. You may be greeted by an energetic and bubbly salesperson. The checkout areas are obvious. You need to take the same approach to setting up your clinic.

Is it easy to find your building? If you’re in a large building, how easy is it to navigate to your office? If people tend to get lost, put up signs to show them exactly where to go when they get off the elevator.

When you walk into the office, your patients should see a person waiting for them (usually behind a counter). The patient may be nervous or anxious, and putting a human face in front of them puts them at ease. This person sets the tone for the visit, so they should be smiling, caring, and have a helpful attitude.

Pay attention to the décor in your waiting room. It should be designed to put patients at ease. Invest in some comfortable chairs, since people may be waiting a while. Are there current (not 10 months old) magazines available for people to read? Also, you should think about having an area for kids to play. Trust me, moms and dads will appreciate you so much if you have a way to help them entertain their kids while they’re waiting.

you your business more remarkable.

You probably had the patient fill out a form on a clipboard. Are the forms easy to follow? Are they highlighted and obvious? An even better option is to direct patients to an app or website where they can fill in this information electronically for you, saving time on data entry.

The best option would be to have them fill out this information before they even get to your clinic. If they can do that from the comfort of their own home, when they’re not wrangling three kids in your waiting room, they’ll be much more at ease.

When your team member gets the patient to walk them back to the exam room, what does the walk look like? Are they walking past physicians’ offices that are messy and cluttered? Is the scale for the patients out in the hallway where anyone can hear their current weight being announced?

When they get to your exam room, they may wait for you for 10-20 minutes. Think about their experience. Is the room well-lit? Is the temperature comfortable? Are the decorations in the room nice?

The patients go back to the front to pay after the visit. Does someone escort them? Are those instructions clear?

These things matter. Think about the last time you went to a used car lot. Was it comforting and relaxed, or high-pressure and anxiety-inducing? Take a deliberate approach to designing the patient encounter in terms of the physical space. Patients will definitely notice the difference.

6. Be different!

I remember the orthopedist who signed my leg cast in 8th grade. He signed it, “I’ll be back. – Arnold Schwarzenegger.” Did he set my broken leg better than anyone else might have? I don’t know. I imagine he did it about as well as anyone would. But, I remember the experience because it was different.

That was a fun experience, highly memorable, and it cost him nothing How would people remember you if you did something that was different?

• The doctor who sings to his patients?

• The guy who always tells a “dad joke”?

• Maybe you’ve got the wackiest scrubs anyone’s ever seen?

Offer patients an opportunity to promote you by giving them a story to tell.

Amplify yourself!! Amplify things that energize you. What gets you excited? Is it empathically listening to patients? Being the “funny guy”? Take the things that are exciting to you and do those things bigger, better, faster, funnier, or more creatively than everyone else.

Focus on the best parts of your personality as you look for ways to make your business more remarkable. What do people already enjoy about you? Ask your staff and patients for their ideas.

7. Make it easy for patients to contact you.

Almost nothing drives me crazier than spending 10 minutes navigating through an automated phone menu. If you have one of those to help you out, don’t make it an epic choose-your-ownadventure story. It shouldn’t take more than a few steps to get a patient to an actual person to talk to.

You should also have a way for people to contact your team by email or through an online service. Everything is electronic these days, and that’s how most people communicate now.

I don’t give out my cell phone number or personal email to patients, though I know some people who do. I want to have the opportunity to enjoy time with my family when I’m not working, and it’s hard to do that if 5,000 patients have 24/7 access to you and an expectation that you’ll respond right away.

When patients contact your team, you should try to respond to them as quickly as possible. Your team can help you triage these issues. Some administrative items can be handled by your front desk team, medication refills can be addressed by mid-level providers, and then truly complex issues can escalate to you. Be careful to delegate some of these patient contacts or you’ll get drowned by the deluge of calls and emails that will flood your office every day.

Do you have a way for people to give you feedback on their visit? Ask people to fill out customer surveys, either in the clinic or online. You do have to be a little careful how you do this. Some people will post a bad review just because they have a bad disease that you can’t fix, regardless of how excellent your care is. Internal surveys are valuable because they offer a confidential way for patients to tell you how to make the encounter better.

Conclusion

None of this happens by accident. Highly successful people don’t wait for things to happen to them, they make things happen. If you’re just starting a practice, go spend some time with a physician you respect and see how their clinic operates. If you have been in practice for a long time, hire some people to be “secret shoppers” and secretly come evaluate your team and your processes. Get feedback from your patients on ways to improve their experience.

Make this a priority. After all, this is a business, so you have to think like a businessperson. If the patients have a bad experience, they’ll go to someone else and they’ll tell all of their friends to do the same. Make each encounter excellent, and you’ll build a loyal base of patients who enjoy coming to see you and make you excited to come to work every day. 1

Douna Montazer MD