As the effects of the COVID-19 pandemic continue to grip the country, the stakes have never been higher for the healthcare industry. The way providers address—or don’t address—healthcare costs with patients is critical.
It’s not hard to understand why staff may want to avoid conversations about payment during difficult times. They may feel it is insensitive, or they simply may not have answers. They may be deterred by negative responses from stressed, angry or scared patients.
However, avoiding the conversation can have disastrous consequences for providers and patients alike. Providers without financial resources cannot provide care to the community. Patients may avoid needed care because of cost concerns that could have been addressed with a payment plan or financial aid.
The problem will not go away with the pandemic. Even before COVID-19, patients struggled with healthcare affordability. According to the Kaiser Family Foundation, the average deductible has risen by over 150% from 2009 to 2018. Wages have not kept up.
Here are several ways to help staff communicate with confidence and empathy, in this time of crisis and beyond.
Realign Your Workflow to Include Cost of Care Conversations
Patients are the new payer, but provider workflows haven’t kept pace with the change. Patients need to know how much they’ll pay out of pocket prior to service, but the answers too often aren’t there. In a 2018 Connance Consumer Impact Survey, only 35% of patients said their providers contacted them prior to treatment to discuss their financial responsibility. In a 2019 report conducted by Survata on behalf of Cedar, 60% of patients said they have requested a price estimate before receiving care, but 51% couldn’t get an answer easily or accurately.
What does this have to do with staff communication? Everything. Staff cannot communicate with confidence when they don’t have answers (or a way to get them) to their patients’ most pressing questions. A recent study of two Kaiser Permanente regions discovered that staff wanted to address patient financial responsibility questions but often had to “find creative workarounds to existing workflows.”
Realigning your workflow isn’t a quick or easy task, and it will look different for every provider. Here are some best practices:
1. Integrate cost of care conversations prior to service. This will require dedicated staff and resources. In the Kaiser study, staff members advised identifying or hiring an employee who is responsible for cost of care conversations and providing real-time access to cost data. Larger providers may need a pre-access team.
2. Provide out of pocket cost estimates prior to service. A lack of data on out of pocket costs makes communication ineffective. Staff may have access to a chargemaster or fee schedule, but those prices are not reflective of what a patient will actually pay.
Empower your staff with the training, technology, and data to calculate out of pocket cost estimates. These estimates should take into account the specific procedure, provider location, and the patient’s insurance coverage (including the deductible met to date).
3. Train staff to identify cost distress and take appropriate action. Ipsos Public Affairs reports that 55% of Americans have received an unaffordable bill. Cost distress is prevalent and has a negative impact on patient outcomes and experience.
There are a number of different tactics providers can employ to identify cost distress. Some providers have found success using a series of screening questions, while others use scripted cost of care conversations that identify verbal and nonverbal cues from patients. From there, staff can help set up a payment plan or financial aid if appropriate.
You can read more about this topic in our articles, “Improving the Patient Financial Experience” and “Patient Friendly Revenue Cycle: Transparency in Billing.”
Empower Staff to Help Patients With More Payment Options
Staff cannot communicate with confidence when the only response they have to patients’ financial distress is, essentially, “sorry, there’s nothing I can do.” Providing more ways to pay, or to receive financial assistance, empowers your staff to assist patients with confidence and empathy.
1. Implement patient financing plans. Patient financing gives patients the opportunity to spread payments out over months or years. Options include external funding, medical credit cards, and internal funding (Medical Line of Credit). Our Patient Financing Options article covers the benefits and drawbacks of each.
2. Reevaluate your payment assistance/charity programs. At a time when it’s more difficult than ever for patients to pay their medical bills, some providers are expanding their eligibility. It is important to screen patients to make sure the people who need assistance the most receive it, and to review negotiated payer contracts.
Train for Empathy and Understanding
Empathy is the ability to sense or read other people’s emotions, combined with an ability to imagine what someone else may be feeling or thinking. “Cognitive empathy” in particular is the ability to identify and understand other people’s emotions, even when they aren’t explicitly communicated.
While some people are naturally more empathetic than others, it is possible to promote empathetic behaviors through training and practice.
Train your staff to…
1. Use validation statements, such as:
- “I’ve been through a similar situation; I absolutely understand your frustration”
- “I can appreciate why you feel that way”
- “I can understand why you’d be frustrated”
- “That sounds so challenging”
- “That must be difficult for you”
- “Thank you for sharing that concern with me”
- “What I’m hearing is that you are feeling______. Is that right?”
- “If I am understanding you correctly…”
- “I’m sorry you’re going through that; I’ll do my best to help you”
2. Use empathetic phrases that convey good intentions, such as:
- “Help you”
- “For you”
- “With you”
- “Share with you”
- “Assist you”
- “Reach out to you”
3. Staff should listen more than they talk, and give the patient time to outline their thoughts and feelings. They should ask questions and seek to understand the issue. Sometimes what a patient wants most is to be heard.
4. Use the patient’s name. It’s simple, but incredibly powerful in creating an empathetic and caring connection.
5. Reframe negative attacks and judgments from difficult patients by remembering that the patient is likely stressed and perhaps even desperate. It doesn’t excuse the patient’s behavior, but it does help depersonalize it. This can help staff turn their response from irritation and rudeness to empathy and a desire to solve the problem. Listen for content and not delivery.
Equip Staff With Verbal and Non-Verbal Communication Skills Training
Communication training has a proven positive effect on HCAHPS scores and patient satisfaction scores, and can give staff the tools they need to communicate with confidence even through difficult patient interactions.
Training can take the form of in-person classes, online workshops, interactive/role-playing training, or a combination. A comprehensive training program will teach specific techniques as well as overall verbal and nonverbal communication skills.
The latter is important. Only 7% of communication is our actual spoken words! Of the remainder, 55% is body language and 38% is tone of voice. That’s why customer service scripts, while a helpful guide, only go so far. Seemingly simple actions such as remaining standing while talking with a seated patient, poor eye contact, or typing while the patient is talking can send a message of a lack of care and attention.
RevCycle offers several courses in verbal and nonverbal communication designed to help your staff request payment with confidence. You can see course descriptions on our Training page.
Appreciate Their Challenges and Work Towards Solutions
Empathy shouldn’t only be extended to patients. Front line staff often feel that back office staff and management don’t understand what they go through.
- They want to help patients and give them undivided attention, but they’re rushed because there isn’t enough staff to handle in-person patients and the phones
- Dealing with irate patients takes its toll
- Patients and families take out their stress on the front line staff
Confidence comes from knowing someone has your back. Listen to your front line staff. As with patients, being heard and understood goes a long way. Some ideas:
- Schedule regular “feedback forum” meetings with your front line team
- Offer a confidential survey system where staff can share feedback honestly without fear of a negative reaction
- Ask them for their feedback and observations during one-on-one meetings, rather than just discussing job performance
However, you shouldn’t stop there. Work directly with your staff to develop and enact solutions. Front line staff have a finger on the pulse of your facility and often understand better than anyone what the true challenges are.
Together, you can navigate this time of uncertainty with confidence, transparency and empathy.
Improve Your Patient Experience With RevCycle
From patient financing options to communication training, RevCycle offers a variety of solutions to increase cash flow, reduce collection costs, and improve patient satisfaction and loyalty. Send us a message or call 888.576.5290 to schedule a phone consultation at your convenience. We’re happy to address any revenue cycle concern!