Strategies for Accommodating Self-pay Patients

Randal Roat
Jana LandrethAs the ranks of the uninsured continue to grow, it is increasingly important for radiology practices to implement strategies for dealing with self-pay patients, according to Randal Roat, CHBME, and Jana Landreth, CPA, MBA, of Medical Management Professionals (MMP), a physician billing and practice-management company based in Atlanta, Georgia. Based on a dataset of around 50 geographically disparate sites, Roat, vice president of radiology services for MMP, has seen an 11% increase in uninsured patients from 2008 to 2009 in the hospital environment; in the imaging center environment, that increase was a more measured (but still alarming) 5%. Practices also might face difficulties in dealing with insured patients. As deductibles rise and copayments represent an increasingly high percentage of the overall cost of a procedure, Roat cautions that there’s more out-of-pocket payment, even among the insured.

“We need to be a lot more flexible and creative in how we work with our patients to allow them to pay for the services that we render.” —Randal Roat, CHBME, vice president, radiology services Medical Management Professionals, Atlanta, Georgia

Payment Schedules and Discounts One technique for accommodating the self-pay population is the creation of flexible payment plans incorporating either prompt-payment discounts or extended payment schedules. Landreth, who is director of practice management for MMP’s east region, advises imaging centers not to shy away from these strategies because of administrative hurdles. “If you’re in a small market, you might not want a reputation for turning away self-pay patients,” she says. “You may also expect these patients to have insurance again one day and want to keep them. You have to know your market—know your patients.” Roat says that prompt-payment discounts are a promising approach for practices concerned about their bottom lines. “If you can work with the patients, offer them a discount to pay the bill promptly and get it taken care of; that’s a great way to get payment right after services are rendered,” he observes. “Each practice should examine a discount policy within the confines of its pricing schedule, as well as any other contracts it has signed.” An older concept involves offering patients the option of an extended payment plan, through which they pay off the bill gradually over the course of a year. “We have to be mindful that we’re running a business,” Roat notes, “but one of the great things about the medical industry is that, at its core, most physicians truly believe that their first order of business is patient care, and the money part is a necessary evil.” Landreth also suggests that practices consider leaning on their affiliated hospitals to provide better outreach for Medicaid-eligible self-pay patients. With up to 15% of the uninsured population potentially eligible for government-subsidized health care, Landreth asks, “Does your hospital have a Medicaid liaison? Is there someone who can go talk to these self-pay patients about receiving Medicaid benefits? That’s a win–win for the patient and the provider. It does require a hospital resource, but the hospital sees an immediate return on it—as will the radiology practice.” Help From Hospitals A more complicated approach for hospital-affiliated imaging practices, but one that Roat and Landreth have seen work in several situations, is preauthorizing patients’ credit cards for a fixed charge before their visit to the imaging center. “The amount you want the patient to authorize might change, ranging from $25 to $500,” Landreth says. “You are collecting it sooner, but it’s very crucial that you work with the hospital, to the extent of its ability, so it doesn’t seem like you’re frisking the patient at the door. The relationship your physicians have with the hospital, the hospital’s attitude toward patient payments, and the best way to help these patients are all factors that should come into play.” The challenge inherent in this strategy is reliance on the hospital. “It’s another piece of paper for the registration department to deal with at a time when hospitals are very focused on their costs,” Landreth says, “so you have to be sympathetic to their costs and their time constraints.” She advises emphasizing the benefits to patients, explaining, “This process can be as much about convenience for the patient as making certain you ultimately collect this money. Understanding your self-pay consumer is very important.” Hospitals can be given incentives to participate if the radiology group is suffering to the degree that staff reductions or other changes that could have an impact on patient care have become necessary. “In order for radiologists to have a long-term presence at the hospital, they need to be financially viable,” Landreth says. “This is something the hospital can do for the group that will ultimately keep the hospital from suffering financially as a result of the group’s suffering. It can be a mutually beneficial solution.” She cautions, however, that this strategy does require a certain investment of time and money to ensure that patient financial information is protected. “You need to be certain you’re transmitting credit-card information securely,” she notes. “You need a plan for securely capturing the information and getting it to the billing office, and for how it will be accepted and handled in the billing office.” Hospital stipends are another technique that can ease the financial burden on radiology practices struggling to accommodate patients who can’t pay (or can’t pay in a timely manner). “If a radiology group’s insurance billings can generate only enough money to pay, for example, four of its five radiologists, because of the environment the hospital’s in, then the group might ask for the difference to be made up by the hospital,” Roat says. “It’s never comfortable when you’re asking someone for money, but if you can make a solid business case that your group needs to be competitive financially or you won’t be able to recruit radiologists to serve the hospital, then it’s in the best interest of both parties.” However a radiology practice approaches dealing with self-pay patients, Landreth warns, the problem is not going away—and might be worsening. “We know things are happening that should require us at least to monitor what’s happening with uninsured patients,” she says. “We know employers are saying they cannot afford to continue providing health insurance for employees. We know unemployment is on the rise and that some former employees are currently on COBRA, which has a timetable to it. The key is recognizing that self-pay patients are good people who want to pay their bills in a timely manner. They’re trying. Let’s help them.”Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.