The Satisfaction Trap: How Bad Patient Statements Harm Quality Care

February 25, 2014 Brian Watson

patient statement satisfaction trapIn a healthcare financial environment that's increasingly complex and constantly changing, patient statements are a refreshingly unambiguous throwback.

Sure, some of the delivery channels might be new.  And more bills are incorporating value-added elements like social media links, marketing messages, or flowery brand-speak.

But the mission has remained unchanged for decades and decades.  Patient statements inform and collect – bringing in self-pay revenue that providers depend on to pay employees and vendors, reinvest in tools and technology, and otherwise keep the lights on.


And yet, for something with a very narrow purpose – billing and payment – patient statements can have all sorts of far-reaching consequences.

For example, if a patient is confused about what they owe or what they’ve paid, or question the accuracy of a charge, or aren’t exactly sure who they need to pay, it decreases your chances of getting paid. 

But it also erodes the trust they have in your organization, its practices – even the quality of care you provide. 

According to the 2013 Connance Consumer Impact Study – a patient survey designed to uncover links between billing quality and overall satisfaction with the treatment process – 88% of patients that gave the billing process a top score would recommend a hospital to friends and 96% would return for treatment. 

On the other hand, of patients that were less than satisfied with business office practices, only 15% would recommend the hospital and 49% would return for another elective procedure.

How ACA Is Increasing the Importance of Patient Satisfaction?

It’s difficult to up the ante on customer satisfaction.  From strong word-of-mouth support to long-term brand loyalty, satisfaction already provides myriad benefits for businesses that cultivate raving fans.

But – by tying Medicare reimbursement rates to patient satisfaction – the Affordable Care Act has done just that.

Under new ACA guidelines, nearly $1 billion in Medicare reimbursements are tied to how facilities score on the CMS’ Hospital Consumer Assessment of Healthcare Providers and System survey.  The survey is designed to gather patient feedback on a wide range of experience metrics: doctor and nurse communication, responsiveness of hospital staff, cleanliness and quietness of the facility, and discharge information – as well as patients’ overall rating of the hospital.

Because the billing process is generally the last chance you get to make any kind of impression – good or bad – any experience that leaves patients with a bad taste is especially troublesome from a patient loyalty perspective. 

And with the new CMS reimbursement policies, patient satisfaction with the billing process is taking on an all-new level of importance – making the already clear financial incentive provided by best-class billing practices just that much more attractive.

Developing a Satisfaction-Centric Patient Statement

Given the financial benefits of patient satisfaction, it makes sense to build quality into every part of the care process – registration, access, treatment, payment – and all points in between.

But what does that mean from a patient statement standpoint? 

Well, a good place to start is by indentifying what makes statements difficult for patients to understand and pay – the stuff that confuses and annoys them the most about the bills they receive – then implementing strategies that address those root frustrations.

In the rest of this post, I'll do just that: highlighting three common patient complaints about the bills they recieve and some of the simple tools providers can use to overcome those objections and deliver a satisfaction-centric statement.

The Problem: Too Many Bills

Depending on the specialization of treatment, it's not uncommon for patients to receive dozens of bills for a single encounter – from a primary care facility, other physicians involved in the treatment process, and the patient’s insurance provider.

That can make it extremely difficult for patients to stay on top of what they owe, who they owe, and how much has already been paid.  For example, one in five patients is unsure whether to pay their doctor or an insurer.  Of those, Gen Y patients are most unsure, with 28% reporting confusion over where to send payment.

The Solution:

• Consolidated statements that integrate charges from several providers involved in the treatment experience – like hospital services, lab charges, and physician fees – into a single bill.

The Problem: Billing Jargon

Larger insurers and federal payers often require specific language to be used on statements in order for healthcare providers to get paid.  The result is that patient statements can be laden with jargon and industry-speak that’s extremely confusing to the average consumer. 

And patients aren’t likely to pay statements that they don’t understand – which goes a long way toward explaining why over half of patient have reported they’ve allowed at least one medical bill go to collections. 

The Solution:

• Use simple, familiar words and short sentences – shoot for a sixth-grade writing level to effectively convey billing instructions and cues to a wide range of potential patients.

• Get rid of overly-technical, jargon-heavy, insider language and terminology.  Payers may require statements to contain certain language, but that doesn’t mean you can’t do everything possible on your end to make it easy for patients to understand what they’re being charged and what they’re asked to pay.

The Problem: Balance Issues

To say healthcare billing is a unique transaction would be an understatement.  Patients generally agree to service without a strong idea of what they’ll be asked to pay – until a bill arrives in their inbox. 

Given the ambiguity – and the costs involved – it’s easy to see why many patients are quick to question their bills and dispute what they owe.  An Intuit Health study from 2011, for example, reported that 41% of patients surveyed did not have confidence that amount billed on their statement was correct. 

That lack of trust can have major repercussions, both on your ability to collect from patients and in how satisfied they are with your organization and its services.

The Solution:

• Simplify the transaction with a clear, clean, plain-language account summary that details what’s been paid by the patient and their insurance, any payments pending, and the dollar amount that they owe out-of-pocket – all in terms patients can easily understand.

• Clearly define and communicate your charity care and financial assistance policies.

• Include billing tools and resources – like a list of frequently asked questions –along with your statement or by including a link to your website.

• Use intelligent suppression and pre-production statement proofing to prevent delivery of statements that might cause patients additional confusion about what they owe – like zero balance statements or bills that contain both an account credit and collections warning.

Learn more smart statement design tricks that delight patients by downloading a free copy of our billing best-practices whitepaper, Building a Better Bill: Why Good Statement Design Matters (And How You Can Get It).

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