Kremmling Memorial Hospital District takes hard look at billing system
July 11, 2013
Have you ever gone to visit the doctor and then received a bill in the mail weeks later for an amount that shocked you? This bill delay may be a thing of the past in Grand County, as the Kremmling Memorial Hospital District will be moving billing to the front end of their care model.
"We moved almost our entire billing staff from the back end to the front end, so they are literally engaging patients at the time of discharge, and they are creating a bill to go out with the patient right then," said Cole White, CEO of the Kremmling Memorial Hospital District.
The new protocols will allow for price transparency and consistency, he said, and will allow patients to know what they are paying for and how much it will cost at the time of service — not weeks after the care is given.
"We need to get to that point where we are that transparent," White said. "Maybe we can't give an exact number, but we can give them an estimate as close as 3 or 4 percent."
"It allows people to shop around and also allows them to understand what their responsibility is going to be for that visit, whether insurance will cover the visit, or how much out-of-pocket a patient is going to pay," he said.
The change could potentially hold some other benefits for the hospital district and the patients it serves by allowing patients to make informed decisions about their health care.
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"Knowledge is power," said Jodi Docheff, patient services manager for the hospital district. "If you empower your patients, the ripple effect is going to be huge."
"Studies show, when a patient is involved in the decision-making for their health care, their health and the outcomes improve," White said.
The new billing process will bring staff into the patient's room at the time of service to allow for a private consultation about the cost of services rendered, the cost of possible treatment or prescription options, and discussion about what financial aid may be available to the patient if there is no insurance coverage.
"At the end, when they leave that clinic, they are going to know what exactly is going to happen," Docheff said.
"When they walk away, from a financial standpoint, they can begin planning how to meet their financial obligation," White said.
White noted the value in health care is seen at the time of service. "People are more likely to pay their bills when that value is still fresh in their minds," White said.
If you receive a bill in the mail weeks later for that same visit after, say, a wound has healed, it is much harder to see the value in the visit to the doctor than if you were to pay for those costs at the time of service.
White compared this billing model to a hypothetical Subway restaurant. If you had your sandwich made and got to the end of the counter and asked "how much?" and the worker said "I don't know, we'll send you a bill," then you received a large bill in the mail weeks later, it would be hard to identify the value in that sandwich, he said.
"You probably wouldn't go back to that Subway," White said.
Helping with health care costs
A valuable service Docheff and her staff offer is helping patients to find financial aid for individuals who qualify.
White and Docheff report seeing a change in health insurance in which people are paying lower premiums and higher deductibles.
"What we are finding is a lot of people have health insurance, which is great, but the deductible is what hurts people," White said.
"People are gambling," he said. "They end up being on the hook for more money than they can come up with."
One of the largest programs that can offer financial aid to people is the Colorado Indigent Care Program, which is a discounted health care program partially funded by the state and can help people meet their deductibles.
The program can help individuals with copayments based on the income and number of people in a household. The program acts as a secondary to insurance, except for those on Medicaid or veterans insurance.
The Hospital District also works closely with the Rural Health Network, which can be another form of financial aid to help people meet co-pays, as well as offers an in-house sliding fee scale that can be a little more user-friendly to some patients, according to Docheff.
The Hospital District is also planning to roll out an urgent care division at the Granby location to offer another option for people to receive health care.
The cost to visit an urgent care unit is much lower than an emergency room visit, which usually runs over $1,000, according to White. While urgent care costs are more than a clinic visit, it is a way to get immediate care while not paying an arm and a leg.
"Probably half of our [emergency room] visits are actually urgent care visits," Docheff said.
The urgent care unit would be open 24 hours a day, seven days a week, and would allow people to get health care while not having to pay for the elevated level of service an emergency room visit provides.
"It's not just health care, its community care," White said. "How do we engage everyone in the community to get healthier and to stay healthy and to take responsibility for their own health."
White and Docheff believe the steps the hospital district is taking now and in the future will empower people to get affordable, exceptional, and local health care they need, when they need it — helping all to stay healthy.
Reid Tulley can be reached at 970-887-3334