Money Matters: How the Hospital Revenue Cycle Impacts Patient Satisfaction

Written by Rachel Fields | December 19, 2011

Hospital leaders are increasingly prioritizing patient satisfaction, understanding that the experience of the patient impacts hospital finances, reputation and physician satisfaction. But one of the most crucial parts of the patient experience — the revenue cycle — is still neglected in favor of pushing customer satisfaction during the clinical encounter. Scott Morgan, chief strategy officer for Avadyne Health, discusses how the revenue cycle impacts patient experience — and what hospitals can do to improve their satisfaction ratings through interactions about money.

How revenue cycle affects the patient experience

According to Mr. Morgan, a patient’s revenue cycle experience has a significant impact on their perception of the hospital and the care they received. The revenue cycle affects health and money, two of the most stressful issues for patients — “If you look back to psychology 101, money and health are at the top of the human stress meter,” Mr. Morgan says. For these reasons, patients are likely to remember negative revenue cycle experiences — such as bad customer service or limited options for payment — as an indication of the hospital’s performance.

Mr. Morgan says the vast majority of revenue cycle experiences for the patient occur post-discharge, after care has been completed and the hospital nurses and physicians have limited impact on the patient. Because these interactions generally happen over the phone, patients may have a harder time understanding their financial responsibilities or having a positive interaction with the hospital billing staff. No matter the quality of care the patient received during the hospital visit, a bad interaction with a billing staff member can sour the entire experience by leaving the patient confused, frustrated and anxious about his or her finances.

“In the best case scenario, you’re still talking about a difficult interaction,” Mr. Morgan says. “It’s about health and money, and it’s over the telephone.” He says because the scenario is fraught with potential pitfalls, the most successful hospitals are those that spend time and money on training and coaching the billing team on customer service.

Why do hospitals fail?

Hospitals often concentrate their energy on the interactions that happen within the hospital walls, Mr. Morgan says. “Oftentimes, the individuals dealing with the revenue cycle and the self-pay accounts are the least experienced, least trained and least compensated,” he says. “The picture I like to paint is that [the hospital experience] is a relay race. In a relay race, the anchor leg is the fastest person on the team, and yet if you look at how healthcare does it, the anchor leg is the individual I described — with less experience, less training and less compensation.”

Hospitals may not understand patient priorities when it comes to their healthcare experience, Mr. Morgan says. In an interview with 1,100 hospital customers, his colleague broke down patient fears into a “top 11” list and found that concerns about money fell at number four. In comparison, the patient’s diagnosis and prognosis was number nine. Once the patients left the hospital, concerns about money jumped to the number one concern on the list.

Mr. Morgan says hospitals, which deal with financial issues and strained budgets every day, may become desensitized to money issues over time. “If you’ve been sitting in the business office for 10 years and dealing with this every day, you get jaded to it because it’s just the world you deal with every day,” he says. “You don’t really take into consideration when you pick up the phone that the patient is in a difficult position. You don’t think about how you would be feeling in that situation, and you come off as uncaring.”

1. Give patients financial expectations upfront. While it may not be possible to give patients an exact estimate of their financial responsibilities before surgery, you can give them an idea of what they will be expected to pay, Mr. Morgan says. “I think a happy patient on the back end starts with education on the front end,” Mr. Morgan says. This education will obviously not be possible for a patient who comes to the hospital comatose from a car accident, but hospitals may be able to set expectations for patients undergoing non-emergent surgery.

For example, if the patient is undergoing knee replacement, the hospital can explain the average cost range of knee replacements. “The patient then at least has an idea of the range of what the bill is going to be, so when the bill does come, his or her anxiety level is lower,” he says.

2. Teach your billing staff to recognize personality types. When calling patients to discuss financial obligations post-discharge, hospital billing staff should understand the kind of person they are talking to, Mr. Morgan says. His company educates customer service representatives by explaining that personality types fall into four general groups:

• Directive. This type of personality wants information clear and to-the-point. The patient does not want to discuss family matters or the weather, but rather get straight to the financial issues at hand.

• Logical. This type of personality wants data to back up your claims. If you explain how much the patient owes, the patient will want to know why the procedure costs that much, how much the procedure costs at other hospitals and how the insurance affects the total cost.

• Spontaneous. The spontaneous patient likes to talk. Instead of approaching with direct facts, the caller should ask about the patient’s family, talk about current events or chat about the weather before getting down to business.

• Agreeable. This patient hates conflict and wants the conversation to go as easily as possible. Do not approach this patient in a confrontational manner: Instead, make it as easy as possible for the patient to complete the required task.

3. Encourage active listening. Billing staff should be taught to actively listen to patients to make sure they understand the patients’ concerns. This means asking questions when the patient speaks, making a note of important information and following up with the patient on those concerns in a later correspondence. If patients feel that billing staff do not listen to them, they are more likely to ignore the hospital’s request for payment because they feel ignored themselves.

Callers should also be encouraged to express “care and empathy” when talking to a patient. No one wants to feel completely alone in their financial situation; teach callers to empathize with patients by saying things like, “That sounds like a really hard situation” or, “I know you must be feeling frustrated right now.”

4. Identify which kind of patient you’re dealing with. Mr. Morgan says most hospital patients fall into a four-quadrant matrix when it comes to their posture towards bill-paying. The matrix combines the patient’s ability and willingness to pay. Patients in the top-left quadrant are willing to pay and have the financial ability to pay. These are the easiest patients to deal with because they both want to and can pay their bill in a timely fashion. Patients in the bottom-left quadrant are able to pay but unwilling to pay. For example, this patient may have the money to pay his or her bill, but will not proactively address the bill out offear, uncertainty and confusion about the complex bill they received.. This patient may end up in bad debt but with a proper customer service model these customers can be saved the negative experience of dealing with collections.

In the top-right quadrant are the patients who want to pay but don’t have the money. These patients can be sent to short- and long-form charity. In the bottom-right quadrant are the patients who are both unwilling and unable to pay — these patients are sometimes written off by the hospital or sent to bad debt (which may be fruitless if the patient cannot pay in the first place).

5. Resolve the problem and inform the patient about the solution. Before your callers hang up the phone, they should resolve the problem and let the patient know how the hospital will proceed. For example, if the patient still needs to provide additional information the caller could say, “Mr. Green, so you’ll be sending us your accident information? Then we will process your information and resubmit your claim for payment.” Give a firm date on when you will follow up and stick to it. Also give the patient a deadline to take action.

6. Thank the caller. Sometimes creating a positive phone interaction is as simple as thanking the patient for their time. Institute “thank you” as a policy by taping a note to every billing staff member’s desk that reminds them to express gratitude before hanging up.