Patient-Friendly Billing Task Force Reviews Focus Group Results - Brief Article

Healthcare Financial Management, April, 2001

The Patient-Friendly Billing Initiative Task Force met at the HFMA National office on February 14 to continue work on the first phase of the initiative, which focuses on financial communications by providers. The task force reviewed information compiled from focus groups and explored best practices in 10 areas, including billing, revenue-cycle shared services, managed care contracting, and legal and regulatory issues.

Seventy-five people participated in eight focus groups conducted by the American Hospital Association (AHA) in January. Some of the focus groups were composed exclusively of senior citizens, women, or guardians of children. All participants had experienced within the past 12 months an encounter with a hospital, either by being patients themselves or by accompanying a family member.

Among the major themes emerging from the focus groups were the following:

* Consumers believe that billing problems reflect larger problems within the healthcare system.

* Consumers are frustrated that communication is fragmented even before care is delivered, requiring information to be submitted before each new encounter even if multiple, recent encounters have occurred.

* Consumers believe that insurance and managed care organizations are a source of confusing and vague billing information to beneficiaries.

* Consumers do not wish to learn about billing issues during their hospital stays, when their health is their primary concern.

* Consumers often are unable to distinguish the source and order of billing information and are confused about what, if anything, they need to do after receiving the information.

* The multiple bills and statements consumers receive stymie their efforts to determine the bills' accuracy.

* Consumers view the payment process as a struggle between providers and insurance companies, and often feel caught in the middle between doctors and hospitals and insurers.

"The public is sending a clear message that improvement is needed in the very complex and confusing process of billing patients," commented Richard L. Clarke, FHFMA, HFMA President and CEO.

In mid-May, the task force will present a working paper to an advisory group composed of healthcare executives. After further refinement based on recommendations by the advisory group, the paper will be submitted to a group composed of representatives from the Federal government, insurance companies, consu mers, and information technology organizations. Following consideration of comments from this group, a final paper will be developed for dissemination within the healthcare industry and to the public.

The final paper is expected to review research, summarize legal and regulatory issues, identify best practices, and offer recommendations. Plans for communication and possible implementation of some of the recommendations also will be determined. Clarke said that the task force's ultimate goal is to envision a "best-case" scenario for patient billing and offer recommendations that could help achieve that scenario.

"This was a positive meeting that helped us move forward in identifying key areas where the process needs improvement," said Clarke. "It is exciting that we are beginning to frame recommendations to bring about actual changes in the process."

The second phase of the project, which is expected to begin in fall 2001, will focus on medical practice and payer financial communications.

The Patient-Friendly Billing Initiative was organized in October 2000 to develop recommendations for improving billing communications of provider and payer organizations to patients and their families. The initiative is led by HFMA and the AHA.

In addition to HFMA and the AHA, task force members represent the following organizations:

Arthur Andersen, LLP

Cap Gemini Ernst & Young US, LLC

Deloitte & Touche, LLP

Ernst & Young, LLP

HCA-The Healthcare Company

Mayo Clinic

Northwestern Memorial Hospital

PricewaterhouseCoopers

Quorum Health Group

Stevens & Lee, PC

Representatives from HCFA and the Medical Group Management Association are participating in the initiative as observers, and a new member of the task force, SSM Health Care, St. Louis, Missouri, recently was added. The project manager for the initiative is Thomas Prince, PhD, MS, CPA, professor of health services management and professor of accounting and information systems, Kellogg Graduate School of Management, Northwestern University, Evanston, Illinois.