SURVEY REPORT PATIENT PAYMENT CHECK-UP · • Providers today say they collect only 1/3 of patient reimbursements, yet patients say they pay all that’s requested of them. 2 Paying

PATIENTPAYMENTCHECK-UPTM

S U R V E Y R E P O R T

2018CONDUCTED BY

2018 PATIENT PAYMENT CHECK-UP REPORT 2

PATIENT DEMAND REMAINS AHEAD OF CURRENT HEALTHCARE ORGANIZATION ADOPTION

Waystar’s assessment of a national survey of patients and providers conducted by HIMSS Analytics. For more details on survey participants and methodology, see pages 57-59 in the report.

of patients receiving a bill estimate said they’d recommend the organization to a friend. Get more cost estimate insights on page 8.

While younger patients continue to lead the way in seeking digital convenience, a surprising

32% of patients over 75 said they’d prefer to pay their next bill using a credit card on file (CCOF).

Get more billing preference insights on page 38.

69%

1/3 of all reimbursements are successfully collected from patients, yet patients say they pay the full amount requested of them. What’s behind the communication disconnects? Learn more on page 31.

ONLY

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EXECUTIVE SUMMARYHealthcare providers continue to face pressure to improve clinical outcomes and meet patients’ needs while making care more convenient and cost-effective. Consumer habits are changing, driven by digital convenience in many other areas of their lives including banking and retail. When it comes to healthcare, high-deductible health plans mean patients are paying more for their healthcare than ever before – and paying more attention to the quality and cost of care they receive. As a result, patients’ needs are evolving in how they want to receive billing details from their providers; they’re open to new ideas. However, not all healthcare providers are aware of how to identify and address those pain points to help create a better, more modern patient experience.

Comparing the billers and the billedWith those trends in mind, our 2018 Patient Payment Check-Up™ survey compares differing perceptions in attitude and behavior of providers, those who bill for healthcare, and patients who are taking on more responsibility for a larger portion of their healthcare bill. Conducted by HIMSS Analytics in January 2018, nearly 900 personnel at provider facilities and 1,000 patients were surveyed. The study focused on three key areas: cost estimates and collections, financial communications and billing methods.


Digital communication options benefit patients and providers alike. They’re especially important to help address ongoing perception gaps in bill payment between patients and providers.• 84% of patients feel the same responsibility to pay for their healthcare services as other

professional services, but 35% of patients say it is inconvenient to pay for healthcare services, a 15% increase from 2017.

• Providers today say they collect only 1/3 of patient reimbursements, yet patients say they pay all that’s requested of them.

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Paying by debit or credit card is the preferred payment method for patients and providers. Offering a variety of payment options greatly improves both convenience for patients and a provider’s revenue cycle.• While younger patients (aged 18-34), show greater preference for e-billing than older demographics

(aged 35-75+), and have a higher preference for paying charges of $200 or less on a credit or debit card, the desire for digital options is growing across age groups. In fact, nearly 1/3 of patients aged 75 and older said they’d prefer to pay their next bill using a credit card kept on file (CCOF).

• A growing number of provider respondents in 2018 (compared to our 2017 survey) believe CCOF and automated payment plans will improve collections overall, reduce days in AR, bad debt and write-offs. Consumer credit lines are less preferred than last year.

• Patients are not aware about other, more flexible payment options that may be available to them. Many providers offer payment plans (49.2%), credit lines (21.5%), online bill pay (42.2%) and increasingly, keeping a credit card on file to cover small balances. However, survey respondents say they were offered only a couple of these options during their last visit.

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EXECUTIVE SUMMARYProviding patient cost estimates makes a big difference in how quickly patients will pay…and whether they’ll return or recommend an organization to someone else.• When receiving a cost estimate, 46% of patients indicated they would be more likely to pay more

of their bill up front, before or during time of service; 68% said they would be more likely to return for future care; and 69% said they’d be more likely to recommend the organization to a friend.

• 87% of providers have the ability to share cost estimates, but only 18% of patients currently receive one without asking; 60% of patients said they will ask for an estimate in the future.

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EXECUTIVE SUMMARYIt’s worth noting that our 2018 Patient Payment Check-Up™ findings closely parallel the results of our 2017 survey. This indicates two things:

• Healthcare consumerism is here to stay, reflected in continued demand for revenue cycle convenience from patients.

• Providers, while making progress, continue to face challenges in meeting those demands.

What’s behind the continued gap between what consumers want and providers offer?

Providers address these revenue cycle challenges as they push forward:

• While providers increasingly understand the need to close the digital divide, they’re perhaps just beginning to adjust their budgets to meet that need.

• Organizations are working to grasp ongoing shifts toward fee-for-value that will drive further changes in revenue cycle approaches and offerings.

• Younger patients will continue to further push the expectations of digital convenience; by the same token, over time younger providers will likely build and grow practices with digital convenience in mind.


KEY FINDINGS& ANALYSIS


PATIENT COST ESTIMATES CREATE TRANSPARENCY, WHICH RESULT IN FASTER PAYMENTS AND HAPPIER CLIENTS

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KEY FINDINGS & ANALYSIS



As patient payment responsibility continues to rise and healthcare consumerism increases, patients are more likely to seek transparent billing practices. By proactively offering estimates up front or at the time of service, providers have an opportunity to improve patient satisfaction, keeping patients coming back visit after visit.

Demand for estimates is growing – and providers are responding.The vast majority (87.2%) of providers are able to provide a cost estimate upon request, a marked improvement from our 2017 survey, where 75% of providers could do so.

However, it appears many are not taking advantage of this capability. Only a slight increase of patients received a cost estimate without asking last year - from 16% in 2017 to 18.4% in 2018 - representing a missed opportunity.

At the same time, a growing number of patients are requesting cost estimates. Nearly 1/3 of patients asked for an estimate for their last visit, an increase from 25% in 2017.

Patients with commercial insurance were more likely to request a cost estimate (33%) compared to those with government coverage (28%) or those with both government and commercial insurance (5%).

1KEY FINDINGS & ANALYSIS




Yes

Yes

No

No

83.8%

16.2%

87.7%

Acute Inpatient Care Hospital/Healthcare Delivery System

Is your organization able to provide patients a procedural cost estimate on request?

Ambulatory Organizations

12.3%




TAKE ADVANTAGE OF AN EASY WIN FOR PATIENT SATISFACTION AND REVENUE CYCLE HEALTH: USE YOUR COST ESTIMATION TOOL REGULARLY. YOUR PATIENTS WILL THANK YOU.

Did you request a procedural cost estimate from your provider’s staff for your last visit or procedure, and if so, when?

No, I never asked for a cost estimate

Yes, I asked for an estimate prior to scheduling my appointment

Yes, I asked for an estimate after scheduling my appointment and before seeing my provider

Yes, I asked for an estimate when I checked in for my office visit or procedure before seeing my provider

Yes, I asked for an estimate after seeing the provider, but in the facility before I left

Yes, I asked for an estimate after I left my provider’s facility but before I was billed

67.4%

14.4%

7.6%

6.0%

2.7%

1.9%

Only 5% of respondents with coverage from

both government and commercial insurance

asked for a cost estimate; compared to 28% with only

government coverage; and 33% with solely

commercial insurance



Timely cost estimates bring clarity.Both providers and patients agree: when a cost estimate is provided, it’s generally before the time of service. From the cost estimate, most patients (86%) understand and are clear on what they owe versus what portion of the bill insurance would cover.


You said that you requested a cost estimate at some point before or after seeing your provider. When did you receive your estimate?You indicated that your organization is able to provide a procedural cost estimate. When do you provide these estimates?

Before time of service

PatientsProviders

Even though I requested an estimate, I never received one because my provider’s office could not provide it

After or at the time of service while patients are still in the office/hospital/facility

After the patient left the office/hospital/facility, but before we send a bill

75.8%62.8%

35.1%18.9%

2.1%

5.2%

After time of service




As a patient, when you received an estimate, were you able to understand how much of the total you would owe versus the portion that insurance would cover?

86.0%

14.0%

Yes, I understood from the estimate how much I would owe

No, the estimate did not break out how much my insurance policy would cover versus what I would owe


Clarity brings transparency.Increased cost transparency through patient cost estimates goes a long way in improving the patient experience, including their willingness to pay more of their bill sooner. When receiving a cost estimate:



of patients indicated they would be more likely to pay more of their bill up front at the time of service

said they would be more likely to return for future care

said they would be more likely to recommend the organization to a friend

46%

68%

69%


Yes

No

Indifferent



How does receiving a cost estimate for your medical servicesimpact your future behavior?

PATIENTS RECEIVING A COST ESTIMATE ARE MORE LIKELY TO: • PAY MORE OF THEIR BILL FASTER • RETURN FOR FUTURE CARE • RECOMMEND THE ORGANIZATION TO A FRIEND

I would be more likely to pay more of my bill up front

46.1%

24.4%29.5%

I would be more likely to recommend the physician or hospital to a friend

64.9%8.3%

26.7%

I would be more likely to return for future service

68.1%8.7%

23.1%


That’s true regardless of the accuracy of the estimate.Pinpoint accuracy isn’t as important as a ballpark estimate. Similar to last year’s survey, patients say an estimate within 10% of the actual cost is adequate.



Any estimate is helpful

Within 5%

Within 10%

Within 20%

Within 30%

Other

18.7%

11.7%

31.3%

4.6%

32.4%

1.4%

How close to your actual cost would an estimate need to be in order for you to consider it a good estimate?

An estimatewithin 10% of

actual cost is adequate




No current plan

Yes, within the next 6 months

Yes, within the next year

Yes, within the next 2 years

Unsure

43.4%

8.0%

17.7%

17.7%

13.3%

* This question is presented to those who said they are unable to provide a procedural cost estimate upon request.

If your organization is not able to provide cost estimates, do you currently have plans to offer them to improve your organization’s patient experience, and if so, when?

Those without cost estimate capabilities aren’t moving quickly.Additional gaps appear when providers don’t have any immediate plans to offer cost estimates to meet the growing number of patients who will ask for them going forward.

Of the healthcare organizations unable to provide patients with procedure cost estimates, 43% said they have no plans to offer cost estimate tools to improve the patient experience.

At the same time, more than 60% of patient respondents said they would request a cost estimate in the future, an increase of 5% from the 2017 survey.




Would you plan to request a cost estimate from your healthcare providers in the future, and if so, when would you find it most useful?Yes, before scheduling my appointment

Yes, between scheduling my appointment and seeing my provider

Yes, when I check in before seeing my provider

Yes, after seeing my provider, but in the facility before I left

Yes, after I leave the facility, but before I receive my bill

Sometimes but not always, depending on the purpose of seeing my provider

No, an explanation of costs with my bill is fine

31.6%

6.0%

12.7%

2.5%

12.9%

25.3%

9.0%




When patients compare prices, it makes a big impact.Similar to our 2017 survey, and despite continued awareness of the healthcare consumerism trend, patients today don’t compare prices between providers before they schedule a visit. Only 13.5% of respondents compared prices between potential providers before their last visit. Interestingly, 58% of those patients that did compare prices have a combined annual household income below $60,000. Another detail worth noting: the desire to shop for different providers and compare prices is shifting slightly across age groups from 2017. Last year, 75% of patients comparing prices were between 18-34 years old. This year 62% of respondents in the same age group price shopped.


When patients comparison shop for their healthcare services, the results they find make a substantial impact on the provider they choose. On a scale of 1-10, the influence of their findings in choosing their provider rated at 7.49, which is consistent with our 2017 findings.

WHEN PATIENTS COMPARISON SHOP FOR HEALTHCARE SERVICES, THE RESULTS THEY FIND MAKE A BIG IMPACT ON THE PROVIDER THEY CHOOSE.



Prior to scheduling an appointment or seeing your provider for your last visit, did you compare healthcare prices between potential providers?

13.5%

86.5%

Yes, I compared prices between providers

No, I did not compare prices between providers

62% of patients that compared prices are between 18 and 34 years old;58% of patients that compared prices have a combined annual household income below $60,000




AVERAGE7.49

(0.52 decrease in influence from 2017)

How much influence did price comparison have in choosing your provider?

1.5%

11.9%7.4%

16.2%

19.1%

18.4%

18.4%

1

2

3

4

5

6

7

8

9

10

1.5%

5.9%

0.0%

In what ways did you compare prices between providers?Providers’ websites

Called each provider

My insurance company provided me the information

Website showed what procedures cost for each provider considered

Asked others (e.g. friend) who had the same procedure at the considered provider

44.1%

36.8%

30.9%

30.1%

5.9%



2018 PATIENT PAYMENT CHECK-UP REPORT


Patients understand their obligation but find paying healthcare bills inconvenient.While 85% of patients polled noted they felt the same responsibility to pay for healthcare as they do for other services, like a lawyer or dry cleaning, less than 20% of patients with commercial insurance plans find it “easy to understand and convenient to pay for” healthcare expenses.

However, when supplied with proactive and clear billing communications, that statistic rises dramatically: 86% of patients who received cost estimates noted they understood their payment responsibility.


A proactive stance on cost transparency is wise as healthcare consumerism continues to evolve

KEY INSIGHT ABOUT ESTIMATES

Healthcare consumerism is here to stay, but there’s still time to improve the patient experience. Much like last year, patients don’t always know they can obtain a cost estimate, and they’re not routinely shopping for healthcare – yet. But when patients do take advantage of cost estimates that are provided, it makes a big impression. Organizations benefiting from this low-hanging fruit tend to increase cash collections and make patients happier at the same time.


PATIENTS CONTINUETO WANT ELECTRONICBILLING COMMUNICATIONS

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PATIENTS CONTINUE TO WANT ELECTRONICBILLING COMMUNICATIONS

When it comes to billing, electronic communications benefit both patients and providers. Simple, effective and proactive financial communications are especially important when it comes to addressing ongoing perception gaps around bill payment between patients and providers – and thus key to improving both collections and patient satisfaction.

Patients say it’s inconvenient to pay for healthcare services.Whether or not they understand what they owe, more than 1/3 of patients believe it’s inconvenient to pay for healthcare services. That’s close to double the results from our 2017 survey (20%).


Easy to understand and convenient to pay my healthcare expenses

Difficult, but it is convenient to pay for the services that I receive once I understand

Relatively simple, but it is inconvenient to pay for the services that I receive regardless of affordability

Difficult, plus it is inconvenient to pay for the services that I receive

25.3%

39.7%

24.5%

10.5%

35% of patients say it is inconvenient to pay for

healthcare services, a 15% increase from 2017

Understanding what I owe my healthcare provider is:



45% of patients today prefer their bill be sent via email, a patient portal or text message. Despite this fact, nearly all of providers surveyed continue to send paper statements.


How do you (or would you) prefer to receive bills from your providers?How does your organization send bills to patients?Paper bills via the mail

Electronically via email through a patient portal

Electronically via email as an attachment

Electronically via text message

54.9%96.3%

17.9%

20.3%8.9%

Patient PreferenceProvider Billing

23.9%

2.3%7.0%



Patients remain very comfortable sharing digital contact info to improve billing communications.Patients are slightly more comfortable sharing their email addresses with providers than their cell phone numbers. On a scale of 1-7, the email average rated 5.76; and the cell phone number average rated 5.69. On a percentage basis, 80.5% said they were comfortable sharing their email address and 78.2% were comfortable sharing their cell phone number.





How comfortable are you with submitting your cell phone number and email address to your providers when requested?

EmailCell phone number

CELL PHONENUMBER AVERAGE5.69

EMAIL AVERAGE5.76

2.2%2.5%

3.2%3.2%

8.8%10.9%

12.2%12.3%

17.9%16.5%

50.4%49.4%

1

2

3

4

5

6

7

5.3%5.3%


When it comes to a shared perception between patients and providers, patients are somewhat less comfortable sharing cell phone numbers than providers believe, while both patients and providers feel similar towards sharing email addresses.



CELL PHONE NUMBER

PATIENT AVERAGE5.69

PROVIDER AVERAGE6.47

2.5%0.7%

3.2%0.4%

10.9%

12.3%5.6%

16.5%21.3%

49.4%67.8%

1

2

3

4

5

6

7

3.1%

5.3%1.0%

PatientsProviders

How comfortable are you with submitting your cell phone number to your providers when requested?




EMAIL ADDRESS

PATIENT AVERAGE5.76

PROVIDER AVERAGE5.68

PatientsProviders

2.2%2.2%

3.2%3.2%

8.8%

12.2%19.0%

17.9%

50.4%

28.8%

35.0%

1

2

3

4

5

6

7

5.3%1.8%

9.9%

How comfortable are you with submitting your email address to your providers when requested?



Younger patients are more likely to prefer e-billing than older patients.Not surprisingly, when comparing preference for e-billing among age groups, the younger the respondents, the higher the preference for digital options. The 18-34 age group consistently shows the highest preferences for the range of e-billing options, followed by the 35-54 age group.


How do you(would you)prefer toreceive billsfrom yourproviders?

18-3435-5455-7475 or olderOverall

Paper bills via the mail

Electronically via email through a patient portal

Electronically via email as an attachment

Electronically via text message

54.9%

17.9%

20.3%

7.0%



Communication gaps lead to payment disconnects.Nearly 75% of patients say they pay the full amount owed to provider organizations, but 75% of providers say patients pay somewhere between half and all of the requested balance, demonstrating a disconnect between patients and providers. This disconnect may point to overall communication issues or a lack of clear, concise billing statements.


73.8%

21.7%

4.5%

No payment requested/ covered by insurance

No

Yes

If you were asked to pay something during your last office visit or procedure – a co-pay, unpaid balance, down payment on procedure or a combination – did you pay the full amount that was asked of you at the time it was requested?




If patients are asked to pay something by the time of service – a co-pay, unpaid balance, down payment on procedure, or a combination – what percentage of patients pay the full amount?

1-25%

26-50%

51-75%

76-100%

None

Patients not asked to pay by the time of service

10.2%

12.7%

44.5%

0.4%

2.8%

73.8%74% of patients pay

at least half of their requested balance at time

of service (if organization asks)



Furthermore, providers say only about 1/3 of all reimbursements are successfully collected from patients. Most of the time, patients say waiting for the bill to arrive was the reason they didn’t pay the balance at the time of treatment. Interestingly, providers also report successfully collecting 76-100% of reimbursements from insurance providers. When you compare this high percentage to the 1/3 of reimbursements collected from patients, it’s easy to see the urgency of prioritizing patient payment processes.


Less than 25%

26-50%

51-75%

76-100%

1.2%

6.0%

65.4%

27.4%

What percentage of expected reimbursements would you estimate your organization successfully collects from insurance providers?

What percentage of expected reimbursements would you estimate your organization successfully collects from patients?Less than 25%

26-50%

51-75%

76-100%

11.4%

19.1%

30.4%

39.1%

ONLY 1/3 OF REIMBURSEMENTS ARE SUCCESSFULLY COLLECTED FROM PATIENTS. WITHOUT PROPER PROCESSES IN PLACE TO CLOSE THAT GAP, GROWING PATIENT RESPONSIBILITY MEANS GROWING REVENUE CYCLE RISK.



Patients and providers continue to disagree on how long it takes patients to pay.There continues to be a fundamental gap in how much time patients believe it takes them to pay their bill versus how long providers view the process. Nearly half of providers say it takes patients an average of more than three months to pay their full balance (down from 51% in 2017); while only 25.7% of patients claim it took them longer than three months to pay their last balance (up from 17.7% in 2017).

Additionally, patients report paying the full balance of their bills slightly quicker than providers receive payment; however, 82% of providers report receiving full payment within six months. Not receiving a statement (according to 17.4% of respondents) or potential confusion from receiving multiple paper statements may be the culprit, a problem that could be easily resolved with electronic bills and online payment options.


17.4% OF PATIENTS SAY THAT NOT RECEIVING A STATEMENT IS THE PRIMARY REASON THEY HAVEN’T PAID THEIR BALANCE DUE. WITH E-BILLING, PROVIDERS CAN SEND STATEMENTS SOONER AND MORE FREQUENTLY IF DESIRED, WHILE ALSO SAVING THE COST OF PRINTING AND MAILING.




On average, how long did you take to pay the full balance of what you owed?

On average, how long do your patients take to pay the full balance of what they owe?

PatientsProviders

19.6%

15.1%

10.5%32.6%

13.2%15.1%

5.5%

16.4%

27.9%

18.7%5.0%

2.9%

17.4%

Less than 1 month

Between 1-2 months

Between 2-3 months

Between 3-6 months

Longer than 6 months

I never paid any of what I owed

Most patients don’t ever pay all of what they owe

I have not been billed yet


The significant disconnects regarding amounts collected, timing of patient payments and perceptions of how much and how quickly patients pay should compel providers to take a fresh look at their revenue cycle: How it could better meet their patients’ needs, and theirs?

KEY INSIGHT ABOUT BILLING COMMUNICATIONS

Patients’ portion of healthcare bills already makes up a significant amount of a provider’s revenue, yet providers indicate they’re only collecting 1/3 of what’s due from patients. Improving financial communications by tapping into digital offerings can help:

• Bring clarity to the billing process• Reduce disagreements related to billing• Reduce paper and mailing costs• Improve patient AR


FLEXIBILITY ANDCONVENIENCE CANMAKE THE DIFFERENCEWITH PATIENT BILLING METHODS

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FLEXIBILITY AND CONVENIENCE CAN MAKE THE DIFFERENCE WITH PATIENT BILLING METHODS

Although patients want convenience and flexibility in their payment options, electronic billing continues to remain low on the adoption list for providers. As this method can reduce the risk of debt for both the patient and provider—and avoid ongoing confusion for patients so providers get paid more quickly—providers are learning patients are comfortable paying by credit or debit card and that they’re open to methods that can be used to collect payment faster.

Patients and providers overwhelmingly agree:use debit/credit card for small balances.Debit/credit cards are the preferred method of payment by patients and providers. That’s true whether payment is made on the provider’s website, patient portal, over the phone via a credit card kept on file (CCOF) or using an automated payment plan. Among those methods, patients prefer the digital options over mailing in checks or paying over the phone.





If you owe a charge of $200 or less after the insurance company pays what it owes, how would you prefer to PAY what you owe for your next appointment/procedure?

If a typical patient owes a charge of $200 or less after their insurance pays what it owes (if anything), which is your organization’s preference for how the patient PAYS what they owe?

PatientsProviders

Write and mail checks, or send via bank website

Provide a debit/credit card number over the phone

Pay via debit/credit card on provider’s website

Authorize office to charge debit/credit card one time up to a maximum of $200

Pay via debit/credit card via electronic patient portal

Automated payment plan that provider sets up to charge credit card or checking account monthly

Automated payment plan that patient sets up online with payment parameters set by organization

Other

1.2%



Younger patients continue to show a strong preference toward automated electronic payment options.Similar to our 2017 report, younger patients prefer digital convenience when it comes time to pay their healthcare bills. However, this year’s survey indicates that preference is beginning to spread across the range of other patient age demographics. While overall 20.3% of patients say they’d want to pay their next bill by authorizing a one-time charge via a CCOF, this year there was a significant jump in the number of respondents aged 75 and older who said they’d prefer that option (32% in 2018 vs. 16.7% in 2017). Another indicator of growing preference for electronic billing options: while roughly the same small number of patients would prefer to pay by phone (less than 10%), far fewer patients across all age ranges want to pay their next bill by check or via their bank’s website (16.5% in 2018 vs. 27.4% in 2017).


WHILE YOUNGER PATIENTS SHOW THE STRONGEST PREFERENCE FOR DIGITAL BILL PAYMENT OPTIONS, THE DESIRE FOR AUTOMATED CONVENIENCE IS STARTING TO SPREAD ACROSS PATIENTS OF ALL AGES.




If you owe a charge of $200 of less after the insurance company pays what it owes, how would you prefer to PAY what you owe for your next appointment/procedure?

18-3435-5455-7475 or olderOverall

13.0%7.0%

8.7%

4.0%

Automated payment plan that the patient sets up online with payment parameters set by organization

9.2%5.8%

12.4%

8.0%

Automated payment plan that the provider sets up to charge credit card or checking account monthly

17.0%11.8%

24.8%

4.0%

Pay via debit/credit card via electronic patient portal

18.4%23.6%

18.0%

32.0%

Authorize office to charge debit/credit card one time up to a maximum of $200

18.7%14.7%

18.6%

12.0%

Pay via debit/credit card on provider’s website

9.2%10.5%

9.6%

8.0%

Provide a debit/credit card number over the phone

14.4%26.5%

7.8%

32.0%

Write and mail checks, or send via bank website

9.5%

9.1%

17.6%

20.3%

17.3%

9.7%

16.5%



Patient comfort levels are split.Patients’ desire for digital convenience and their comfort levels regarding electronic payment options are slightly at odds. This year, 10% fewer patients say they’d be comfortable with automated payment plans than last year and slightly fewer patients would not feel comfortable with a provider keeping their CCOF to be charged later.


51.1%48.9%No

Yes



While patients aren’t fully comfortable having a provider organization store their credit card information, they are more comfortable than providers believed.


I would feel comfortable submitting my debit or credit card to be charged onetime for what I owe, up to $200, after my insurance company pays its portion; the rest would be billed or paid via an automated payment plan

I would provide my card to be charged one time for what I owe, up to $200, if required to see my provider; however, I would not feel comfortable doing it

I would refuse to provide my healthcare provider with my debit or credit card to be charged one time for what I owe, up to $200, even if it meant that I could not see my provider

34.2%

23.5%29.4%

42.3%29.8%

PatientsProviders

For you to see your provider, if staff required you to submit your choice of a debit or credit card to store securely in its system, and charged your card up to $200 only one time after your insurance company paid its responsibility (if applicable), how comfortable would you feel:




Regardless of comfort level, a large majority of patients (76.5%) would authorize a one-time payment of $200 or less, which is consistent with our 2017 survey, where 78% of patients would agree to the CCOF charge. Only 23.5% would refuse to pay via this method, again showing the importance of providing a range of payment options to address varying patient preference. Perhaps most interestingly, providing a cost estimate increases the likelihood a patient will allow their debit/credit card information to be stored.

IT’S POSSIBLE PATIENTS ARE HESITANT REGARDING THE SECURITY OF DIGITAL PAYMENT OPTIONS. SHARING SAFETY PRECAUTIONS THAT ARE BEING TAKEN, INCLUDING THE BUILT-IN SECURITY OF YOUR PAYMENT TOOLS, IS A GOOD PRACTICE AS YOU IMPLEMENT NEW PAYMENT OPTIONS.

PROVIDING COST ESTIMATES MAKES IT MORE LIKELY THAT PATIENTS WILL ALLOW YOU TO STORE THEIR DEBIT/CREDIT CARD INFO FOR FUTURE PAYMENTS.



Younger patients are most comfortable with CCOF.Younger patients (aged 18-34), show greater preference for e-billing than older demographics (aged 35-75+), and have a higher preference for paying charges of $200 or less on a credit or debit card.

As these younger generations become increasingly larger consumers of healthcare services, providers should consider adding these e-billing and digital payment processes to their workflows to better address these patient preferences.





In order for you to see your provider, if staff required you to submit your choice of debit or credit card to store securely in its system, and charge you up to $200 one time only after your insurance company pays its responsibility (if applicable), how comfortable would you feel:

48.4%41.8%

36.7%40.0%

38.2%31.1%32.9%

27.1%30.4%

13.4%

20.0%

40.0%

I would feel comfortable submitting my debit or credit card to be charged one time for what I owe, up to $200, after my insurance company pays its portion; the rest would be billed or paid via an automated payment plan

I would provide my card to be charged one time for what I owe, up to $200, if required to see my provider; however, I would not feel comfortable doing it

I would refuse to provide my healthcare provider with my debit or credit card to be charged one time for what I owe, up to $200, even if it meant that I could not see my provider

18-3435-5455-7475 or older Overall

42.3%

34.2%

23.5%



Despite broad acceptance, CCOF is underutilized today. The good news? It’s growing.Despite broad acceptance of CCOF (76.5%), only 30% of providers currently store patients’ debit/credit card info today. However, this is a significant increase from last year’s report, when only 20% of providers used CCOF.


69.9%

27.7%

2.3%

Yes

Unsure

No

Do you store each or at least some patients’ debit/credit card numbers and charge their card after their insurance company pays its responsibility (if applicable)?

62.9%

17.2%

19.9%

2018 2017



Providers believe CCOF and automated payment plans will improve patient collections overall. Storing credit card information and automated payment plans remain the most favorable strategies to reduce patient debt/write-offs, days in patient AR and cost of collections, according to provider respondents. 24.7% of providers see CCOF as a strong method to reduce the cost of collections; 27.3% view it as the most likely way to reduce days in patient AR; and 28% believe it will reduce patient bad debt and write-offs. Compared to last year’s survey, a growing number of providers prefer CCOF as the best way to improve patient payment results. Automated payment plans are also growing in preference among providers. Consumer lines of credit show the largest decline from 2017.





What payment option do you think would be the most likely to create reductions in the following areas?PATIENTS?

25.7%Automated payment plans

Consumer credit line e.g. CareCredit

5.5%

Electronic statements

8.8%

Insurance coverage detection that identifies all eligible patient coverage in advance5.5%

Online bill pay

5.5%

Other

Cost of collectionsDays in patient ARDays in patient baddebt/write-offs

Secure credit card on file, and charging one time up to $200 once patient responsibility is known and pushing the rest to either a payment plan, credit line or bill

11.2%

14.2%

24.7%

9.9%

25.8%

4.9%

7.4%

14.1%

16.1%

27.3%

4.5%

25.0%

8.0%

2.8%

20.0%

11.1%

28.0%

5.0%



Overall, patients may not be aware of available payment options. Waiting to be billed before paying the full balance due is the primary option patients say they’re offered. This passive activity is a prime target for improvement as providers seek to update processes and tools that speed payment from patients. Additionally, it’s one that’s easily solved with a combination of electronic billing, providing a cost estimate and training staff to ask for the full balance up front or establish an automated payment plan. Furthermore, it appears patients don’t know about other, more flexible payment options that may be available to them. Many providers offer payment plans (49.2%), credit lines (21.5%), online bill pay (42.2%) and increasingly, keeping a credit card on file to cover small balances, but respondents say they were offered only a couple of these at their last visit.


LACK OF PATIENT AWARENESS OF THE AVAILABLE PAYMENT OPTIONS MAY BE DELAYING YOUR AR. IMPROVE YOUR COMMUNICATIONS AROUND THE SERVICES AVAILABLE AND WATCH YOUR COLLECTIONS RISE.




Were you offered options to pay the full amount due over time, and if so, which one(s)? Does your facility offer any of the payment options listed?

Paying some or none at the time it was requested, and the rest would be billed later

Payment plan that automatically charges your checking or credit card account a fixed amount each month over time

49.2%

67.1%

16.4%

Consumer healthcare credit line through a third party, e.g. CareCredit, that may require you to apply for credit, and if accepted, requires you pay a minimum amount each month

16.4%21.5%

Patient initiated payment plans with payment parameters set by the facility

Other

65.5%

2.1%

42.2%Online bill payment via your organization’s website

PatientsProviders

68.8%


As the revenue cycle mix continues to shift toward greater patient responsibility, offering payment options such as CCOF and automated payment plans will improve patients’ convenience as well as providers’ ability to collect balances

KEY INSIGHT ABOUT PROVIDER BILLING METHODS


SUMMARY


SUMMARY1,000 healthcare patients and nearly 900 providers participated in the study, designed to better comprehend and recognize patient understanding of their healthcare bills and expenses as well as provider payment methods. The study revealed different patient and provider attitudes about three key areas: cost estimates and collections, financial communications and billing methods. Healthcare organizations have an opportunity to improve patient satisfaction and patient payments processes, thus improving their bottom line, in each of these areas:

Providing Cost Estimates

Adopting digital, convenient patient payment capabilities

Improving patient financiaI conversations


SUMMARYProviding cost estimatesOur research shows more patients will be asking for cost estimates in the future – and shopping around for healthcare services. Organizations proactively providing costs estimates, even if they aren’t exact, keep patients informed and involved in their care, thus increasing patient satisfaction and engagement. Since plenty of organizations today can offer estimates, implementing processes to do so will reap a trifecta of rewards: faster payment, return clients, and more patient-to-patient recommendations.

Adopting digital, convenient patient payment capabilitiesWhile the healthcare industry’s patient billing and payments have traditionally lagged other industries due to perceived barriers to digital patient payment preferences, the research indicates otherwise. Healthcare organizations have an opportunity to decrease the cost of patient collections, decrease bad debt and reduce patient AR by adopting patient payment solutions such as CCOF, online bill pay, electronic statements and automated payment plans.

Improving patient financial conversations With providers and patients disagreeing on how long it takes patients to pay, organizations can improve this disconnect—and the speed of getting paid—by providing clear, digital and timely communication with patients regarding what they owe and why, plus offering convenient payment options such as CCOF.

Key findings Overall, key findings from the survey support the growing need for hospitals and health systems to adopt new technologies that enable greater patient engagement and education, and online payment options. These technologies address emerging trends in healthcare consumerism—namely, how healthcare services are sought out and paid for. While the healthcare payment landscape is changing and organizations are making key advancements, there are still gaps and room for improvement. Many patients are becoming impatient for providers to offer the convenient and transparent payment processes they have become used to from other industries. These trends are at a flashpoint, and as these statistics suggest, the time to act is now. Healthcare organizations ready to address these patient preferences can adjust their revenue cycle strategies with the proper technologies, processes and partners in place.


WAYSTAR CAN HELP CLOSE GAPS IN PATIENT BILLINGHealthcare consumerism will continue to influence patient demand and put pressure on providers to continually improve the patient experience. Currently, patient demand is ahead of existing health system and practice adoption. Transformative billing and communication solutions can close these gaps between what patients want and what providers deliver, offering convenience while bringing greater clarity to the overall billing process. Waystar provides healthcare technology that simplifies and unifies revenue cycle management in every care setting. Our software streamlines payer reimbursement and patient billing and payments, while continuously improving results with reporting and analytics solutions. Our goal is to financially empower healthcare organizations so they can focus on improving their communities. Our clients have seen impressive results including:

DECREASEin yearly paper

statement costs1

75% 43% 70% 22%INCREASE

in patientcollections2

FEWERdenials and

appeals3

DECREASEin AR days4

Learn more about Waystar. Call 1-877-577-4826 or visit www.waystar.com.

1 Urology practice with 8 physicians 2 Billing service with 48 physicians 3 Rural health facility with 10 physicians 4 Hospital-affiliated multi-site practice with 33 physicians

http://www.waystar.com

2018 PATIENT PAYMENT CHECK-UP REPORT 572018 PATIENT PAYMENT CHECK-UP REPORT

METHODOLOGYConducted by HIMSS Analytics and fielded in January 2018, the company surveyed 895 personnel at provider facilities and 1,007 patients in a blinded web-based voice-of-customer quantitative study. Deployed as a combination of two quantitative surveys, research assessed both patients and providers.


METHODOLOGYPATIENTSPatient survey participants visited an in-patient or outpatient provider setting within 12 months of completing the survey, were 18 years of age or older, were not covered by parent or guardian insurance, were not treated at an emergency room and did not work for a healthcare IT company. Patient respondents represented a variety of ages, education levels, insurance coverage types and locales. Notably, 51% had a college degree, and 42% had an annual household income of less than $61,000. Additionally, 66% of respondents were 35 to 74 years old and 50% were covered by commercial insurance.

51% 50% 42%

86%50%66%

1,007Respondents

College Degree Male/Female Annual Household Income >$61,000

Suburban or Urban Locale

Insured by commercial insurance

35 to 74 years old

Visited a physician in the past 12 months & received care from a healthcare provider >1 times a year


PROVIDERS63% of provider respondents are practice administrators or office managers, and 61% have 10+ years of responsibility and/or influence on revenue cycle operations. Participants are employed by varying organization types and specialties: the vast majority (86% work) in an ambulatory organization and 13% work in an acute inpatient hospital or healthcare network.

METHODOLOGY

895Respondents

86% 13%Ambulatory Hospital or

Healthcare Network

77%63%61%Suburban or Urban Locale

Practice Administrator/Office Manager

10+ years responsibility/influcence on ECM ooperations

Directly involved with payer billing and patient billing/payments or understand technology and process

around payer and patient billing

Documents

SURVEY REPORT PATIENT PAYMENT CHECK-UP · • Providers today say they collect only 1/3 of patient reimbursements, yet patients say they pay all that’s requested of them. 2 Paying