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Jeff Lin
Host of Payment Matters
Payment Matters is a monthly radio show focusing on real issues happening in healthcare payments. Jeff chats with industry experts and thought leaders to bring fresh perspectives on how providers, payers and consumers are all tackling the evolving healthcare payments market. Join the conversation on Twitter with #PaymentMatters.

On this episode of Payment Matters, Jeff is joined by Katie Buzard, Call Center Manager and Training Manager at Healthcare Administrative Partners. Jeff and Katie discuss how billing and payments processes can be improved by changing the way healthcare organizations engage consumers. Listen to the episode or read the transcript below.

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Jeff Lin: Today, we are talking about consumer engagement and the billing and payments process. As we all know, today’s consumers are expected to pay more for their healthcare bills – not only more bills, but also higher dollar amounts.

Consumers have changed their expectations. When they look at other industries like Amazon, Google and Facebook they see how those companies have really changed the entire experience of engaging the consumer. Unfortunately, healthcare has been a little slow to catch up on these major trends. And really, I call it the high watermark that’s associated with the consumer experience leaders in these other industries. But tied to this, you can see that healthcare is unique. Consumers are confused about their responsibility.

We’ve seen this in the Eighth Annual Trends in Healthcare Payments Report that says only 9% of consumers can really define common healthcare payment terms like copay, deductible and co-insurance. And it really hasn’t changed year over year. With that being said, this has real consequences when you look at all these factors playing in together including the time spent to collect money from patients and also the operational overhead tied to the paper-based and manual processes that a lot of these operations have to deal with.

The key thing here is, how can healthcare engage consumers in the payment process to clear up confusion? And if there are any tools, processes, or even just how we manage people to make paying healthcare bills more seamless and painless.

Today, we want to talk about how healthcare organizations can leverage technology and best practices to improve patient financial engagement. It’s an honor to have Katie Buzard of Healthcare Administrative Partners here. Thank you so much for joining me today, Katie.

Katie Buzard: Thank you, Jeff!

Jeff Lin: Katie, can you introduce yourself?

Katie Buzard: Sure, absolutely. I have been working for the healthcare industry for over 15 years, mostly in customer service. Currently, I’m the Call Center Manager with our in-house call center, which includes 11 representatives. I’m also the Training Manager at Healthcare Administration Partners.

Jeff Lin: Great. Can you tell us a little bit about Healthcare Administrative Partners?

Katie Buzard: Healthcare Administration Partners is a full-service revenue cycle management solution company, and we’re servicing specialty provider groups. We mainly bill for radiologists. However, we do bill for some pathologists, emergency department physicians and pediatricians. Currently, we bill for over 40 different clients in eight states. Our practices are primarily based on hospital settings as well as imaging centers.

Jeff Lin: When you say practices are primarily based in a hospital setting, can you explain for the audience what that means in terms of how you engage with your patients?

Katie Buzard: With the hospital settings, we basically bill for the radiologist – the doctors themselves. So, we’re billing for the professional component as opposed to the technical component. In imaging centers, we bill for both the professional and the technical component.

Jeff Lin: What I’ve heard from the industry is that in the hospital settings, the doctor is typically more of an independent contractor within the hospital and doesn’t have the point of service interaction with the patient. Is that what you see today?

Katie Buzard: Yes, you are correct. Most of the time, when patients go into the hospital to have an x-ray or an MRI, they’re not even going to see the radiologist. The radiologist is more behind the scenes. They get the films, they interpret what they see on the film, they dictate what they see, and then we code based on what the radiologist saw on the films. Most of the time patients don’t see the radiologist, or even talk to them for that matter.

Jeff Lin: Got it.

Katie Buzard: But in an imaging center, it’s kind of the opposite, because we do bill for both and the patients can see the doctors themselves.

Jeff Lin: Wow. So it’s a big difference in engagement models across your clients. And there are clearly some challenges tied to both of those models. What are the challenges you see having to bill and collect, for your clients’ patients?

Katie Buzard: It really stems from the rising rate of patient cost responsibility. You see, the healthcare industry has entered a new era of consumerism that’s truly foreign to providers. Patients are faced with high deductible health plans and premiums that increase every year. Many of those patients cannot afford the cost of out-of-pocket expenses. They’re faced with monthly living expenses that they’re just getting by on.

So, when the healthcare bills start coming in, they are faced with a decision. Do I pay my mortgage or my electricity bill? Or do I pay my doctor’s bill? And the reality is, most patients are going to choose the mortgage or the electricity bill over that doctor’s bill. Trying to get patients to pay those bills in a timely fashion does become a challenge for everybody.

Jeff Lin: And that’s a big change, right? You’ve spent 15 years in customer service and been involved with many customers. And a lot of these callers are not only your clients, but you’re probably talking to a lot of patients that are calling in.

How have things changed from when you started to today? Have you seen more questions from patients about their bills, etc.? How would you characterize the consumer’s viewpoint?

Katie Buzard: When I started, the majority of the insurance plans that were being offered to patients were HMO plans. Where most patients could go to a doctor’s appointment and only have a $20 copay and that’s all they really owed. The insurance covered the rest. Now, times have changed and most of the insurance plans are high deductible health plans and patients aren’t just paying those $20 copays anymore. They are paying $100, $200 for a doctor’s visit just because they had a cold.

I think that’s the biggest change I’ve seen over the past 15 years or so. And that’s made it difficult for patients to be able to make those payments to doctors. Also, the premiums keep going up every year. You see a 15%, 20%, 30% increase in the premiums that they have to pay. Patients are paying a lot more out of pocket than they were 15 years ago. With that comes lots of questions from patients, because they don’t know why they’re paying the bills.

Not a lot of patients are going to receive their benefit packages from insurance companies and actually read them, because most of them are 40 pages long. They don’t take the time to educate themselves and end up having lots of questions and become frustrated.

One of the main things we need to do in the future is educate patients on what’s going to happen when they receive the bill.

Jeff Lin: That’s interesting. These industry shifts are causing some major gaps in terms of consumer expectations. Clearly, there’s been a need for changes from your perspective, in terms of adapting your existing processes to meet these new demands. So, what did you do? How did you identify the changes to your processes? Can you describe that?

Katie Buzard: What we did to identify certain changes we made over the past year was really the easiest solution possible. We listened to our patients. Most patients are willing to voice their concerns, some more than others. As providers, we just need to listen to them and find the right options to engage them in the payment process.

That’s what we did here at Healthcare Administration Partners. We implemented a satisfaction survey to find out what the patients have to say about the services that they receive. With the results from the satisfaction surveys, we were able to start to see a clearer picture and were able to come up with ideas to help patients make payments in a timely fashion.

For example, one of the biggest learnings we obtained from the satisfaction surveys was that one of our clients did not accept credit card payments. When you have a client that doesn’t accept a credit card payment and patients are faced with paying a high deductible health plan, most of them don’t have that amount of money in their checking account. They need the extra cushion a credit card provides to be able to make these payments. By taking that credit card payment option away from patients, it takes longer for a payment to come in for these providers. That was one thing we were able to do over the past year – explain to our provider that they would be able to bring in more payments if they offered this option.

So, really listening to the patients and finding out what is going to best fit their needs to make these payments is key. And then offer those options once you do your research, and see how your payments are going to start to come more quickly and your cash flow is going to increase, as well.

Jeff Lin: That’s great. In terms of your clients that did implement offering credit cards to patients, did you see any benefits? Did they see benefits when that was offered?

Katie Buzard: When we got the results of that satisfaction survey, 40% of their patients that called in were upset that they did not accept credit card payments. Once we were able to offer credit card payments – and not only credit card payments, but also electronic checks – payments are coming in 22 days earlier than they were prior for this client. That’s a pretty big increase from when we received the payment.

Jeff Lin: That’s great. I imagine cash flow is important with all clients. Did you approach any of this differently between the imaging centers or the hospital base or radiologists or was it consistent across both sets of clients in terms of the increased cash flow?

Katie Buzard: This one was for just one of our clients and this particular client was an imaging center. Most of our clients do accept credit card payments. We only have a few that do not. What we’re doing now is gathering data to prove to the client that it does work. We do case studies that we can promote to the providers and see if they will make the change. Because it is significant. If you think about the money they spend on processing paper checks, it costs a lot more to process a paper check than it does to have a credit card payment post to your account. And it takes a lot longer if you think about mail time to get a paper check.

Even taking out the mail time, you’re going to see cash flow come in a lot quicker than you would if you only offered paper checks.

Jeff Lin: Yeah, that makes sense. I don’t even know where my stamps are.

Katie Buzard: Yeah, exactly. Think about that. If you don’t have to send in a check every time, look how much money you’re going to save in just stamps alone. I mean, they go up every year.

Jeff Lin: Right. I don’t know where my stamps are and if there’s no convenient way to pay all my bills, I will forget.

Katie Buzard: You know, 80% of patients would rather make their payment electronically than send in a paper check. 20% of patients still want to have that paper trail and want to mail a check so they know that it gets to us. But 80% of patients, that’s a huge amount. If we could switch another 10%, that would be great.

Jeff Lin: Yeah, it’s interesting. It’s not just credit card, because you can offer credit card via mail, right? Someone can mail it in and write their credit card on there.

When you are confirming options that you’re giving to your clients and their patients, can you describe what type of consumer experience you’re offering? Do you offer online payments? Is it call center? How do you accept payments for your clients, from their patients?

Katie Buzard: We have multiple ways we accept payments. On the statements that we send, our patients have the option to pay online through InstaMed. They can create their own account and they have options. Most clients offer both credit card payments and electronic check payments through the online portal. They can also set up their own payment plans or auto-draft payment plans, where they don’t have to remember to make a payment every month. It’s automatically going to come out of their bank account.

One thing that we did this past year was offer payment over the phone, using the automated phone system. I’m going to talk about that a little bit later. We try to offer as many options as we can. What we’re really looking forward to is pay by picture with iPhone or smartphone. With millennials, everything’s electronic, so by having a link on your phone where you can snap a picture of your statement and make the payment right there, I think that’s going to bring in a lot of payments.

Jeff Lin: There are definitely a lot of changes going on in terms of payment options. I think you highlighted the fact that consumers are seeing new payment options in other industries, and they want to see new payment options available in healthcare. We’re seeing an amazing transformational shift.

Clearly, these things don’t occur overnight. Can you describe your new billing and payment processes today? What were the biggest changes you made and which have been the most successful?

Katie Buzard: You’re absolutely right – those changes don’t happen overnight. The past couple years have been quite busy, as we’ve gathered multiple ideas from our patients after launching our satisfaction survey. So, we started listening to the struggles patients are having, when they called into the call center.

The first idea that we started working on was our statement. Patients are not going to pay for services if they do not know what they’re paying for. Statements need to be clear, they need to be concise, and they need to be easy to read. If your statement is confusing to you, then it will be like reading a different language for the patient.

You want to make sure your statements can be matched to the insurance explanation of benefits, and this will eliminate common questions you might receive from patients calling in. Other options we added to the statement are links to pay online, or the option to pay over an automated phone system. Paying over the phone is a newer feature for us, and the amount patients are paying using that option is outstanding. Each month we’ve had a significant increase in payments made by this option.

For example, starting in January of 2018, our month-to-month increase has averaged 16% and it’s still rising. This last month, we had 2640 patients choose to make their payment through this option. That’s the equivalent of two call center reps taking payments in one month for our call center that we don’t have to pay for.

Jeff Lin: Wow. That’s great.

Katie Buzard: The number of patients making payments over the automated phone system tells us that they like that option. Then we made a bold move, by removing the coupon in the return envelope from our statement. The reason why we made this change is that it costs the facility more money to process paper checks as opposed to processing electronic payments. We wanted to prompt the patients down the path of electronic payment instead of sending in paper checks. Right away, we noticed a decrease in paper checks and an increase in electronic checks. We saw increased portal usage through the InstaMed website. And during the testing phase, for one of our clients, the first month, we saw a 32% decrease in paper checks. In the next month, there was a 47% decrease. That’s pretty huge.

So even though we took away those coupons and return envelopes, patients are finding a different way to pay, and they seem to like making those payments because they can see the money come out of their bank accounts a lot more quickly. And they know what the money went toward.

Jeff Lin: That’s an amazing and bold move. Did you see any negative reaction when you took that step? It sounds like a lot of big benefits here, but any concerns or comments?

Katie Buzard: As I said earlier, 20% of patients want to stick to paper checks. We have had a little pushback from patients calling in, saying, “What do you mean I have to buy my own envelope?” We did some research around different companies and different facilities and noticed that a lot of them are removing return envelopes. We wanted to try that. I would say we probably get maybe 2% of people unhappy with this change, but they adapt. And the longer we go with removing those items, the fewer complaints I have been receiving. Even 2% isn’t that huge of a number of unhappy patients. If they’re really upset, we’ll just send them an envelope and they can mail in their payments.

Jeff Lin: Was there any material impact in terms of increased call center volume or reduced payments that occur for those clients? Did you experience any of those negative things?

Katie Buzard: It’s actually kind of funny. When we analyzed this information, we saw a 20% increase on the online portal and we saw a 10% decrease in the call center. Patients weren’t calling us as much. We were getting our payments faster, and we didn’t have to fuss with mailing out statements and paying for stamps either.

Jeff Lin: That’s great. Katie, these are just amazing results. Not only did you really support and deliver value to the clients, but it sounds like you also were able to engage consumers in a way that they wanted to pay their bills, which is hard to do.

Katie Buzard: It is very hard to do.

Jeff Lin: It’s almost a win-win.

For other healthcare organizations who are looking to improve patient engagement, what’s your suggestion, or what should they be thinking about?

Katie Buzard: My suggestion is, listen to your patients and engage them in the payment process. It will lead you to happier patients, higher payment collection and optimized practice reputation. And it will lower your costs. Give them those options that they’re asking for. A lot of options do take some time to set up, but once you set them up, it’s so worth it and patients are so much happier.

Jeff Lin: And everyone gets paid.

Katie Buzard: Everybody gets paid, and in a timely fashion. Unless people are going to collection companies – a lot of people end up there.

The biggest advice I can give everybody is that it’s good to give your patients options and listen to what they want. Listen to your patients and educate them.

Jeff Lin: Katie, once again, thank you. This is great insight and experience in terms of making a big impact on patient engagement.