Tell Me Now: Ensuring a Patient's Access to Care
Part 11 of a series
L. Lee Isley, Chief Executive Officer, Granville Health System
Tell Me Now: Ensuring a Patient’s Access to Care
Thank you for your continued feedback on this column over the past year; we are giving patients a voice and using that feedback to improve their experiences at Granville Health System (GHS). Well into the new year, we continue to find ourselves reflecting on the opportunities and challenges ahead of us in the coming months.
Opportunities and challenges. In health care, we use these two words often, usually in terms of how we identify solutions for pressing issues. Opportunities relate to areas in which improvements can be made, while challenges address the “roadblocks” that may affect how we achieve solutions.
One opportunity that our community has continued to bring to us is how we manage the escalating cost of health care. Specifically, how we address changes in the health care insurance industry that have effectively created “roadblocks” in delivering care. We’ve discussed in the past how many of our patients are finding that their health insurance companies have built their plans with deductibles of $2,500, $5,000 and even $7,000. Some of the plans are employer-provided insurance plans and some are plans offered through the Affordable Care Act Marketplace.
Clearly, these deductibles are not affordable and sometimes out-of-reach for patients living on tight budgets. In this case, our challenge is in helping our patients bridge the financial gap in receiving the care they need. You see, this financial burden experienced by our patients also affects Granville Health System.
As a community hospital, Granville Health System continues to reinvest all proceeds to improve and maintain the highest standard of care for our community. This investment requires the hospital’s revenue to exceed its expenses. While the hospital ensures care is available to all patients, the Health System must remain a financially viable community resource in order to continue operating as an essential health care leader for the patients it serves.
After all insurance payments are calculated on behalf of a patient’s insurance plan, the patient still owes a portion of the cost for the care they receive. Again, this portion is known as a deductible or co-pay, and insurance companies have been shifting more of the cost of care to the patient. This shift requires the hospital to depend more on the patient payment. In Fiscal Year 2016, the unpaid amount of the patients’ responsibility owed to Granville Health System reached $6.4 million. Of course, this is not a sustainable figure for our Health System.
The Health System, in an attempt to collect the portion identified by the insurance company as the patient responsibility, has worked with our Board of Trustees and medical staff to implement a unique financial counseling program designed to offer surgical patients a full review of their admissions process and costs before their surgical procedure. It’s important to know that this program is in place for surgical procedures defined as being able to be “scheduled.” Examples of these procedures are cataract surgery, colonoscopies and hernia repair. Granville Health System is working with its medical staff to identify surgical procedures meeting this definition. Emergent procedures do not require participation in the program. However, “scheduled” procedures require the patient meet their financial obligations prior to the surgery.
Our Chief Financial Officer, Jeff Armstrong, has shared with me our staff’s commitment to working with our patients. “We realize the insurance companies have set very high deductible dollar amounts that can be a financial burden on our patients and their families,” said Armstrong. “This is why our staff have committed to providing patients with options through a thorough review of their financial obligations, including all co-pays and deductibles. Through the counseling process, our staff helps patients build a plan for their payments before surgery so they can focus on recovery. The counselors work closely with physicians to ensure necessary procedures are not postponed due to financial reasons.”
The program offers patients the opportunity to work with counselors in choosing a payment option which best meets their needs. Patients may choose to pay in full or consider loan options.
In order to offer patients the loan option, the Health System continues to partner with NorthWind to provide a program called “Thrive.” In previous columns, we discussed how Thrive connects patients who are unable to meet their financial obligations upfront with flexible financing options. The program is a great solution for patients with high unexpected deductibles or for those who are uninsured.
Thrive helps uninsured patients by providing credit-based financing for their health needs. The program also serves to strengthen health care in the community by offering credit to patients who have health insurance but are unable to meet their deductible.
Patients who don’t qualify for a credit-based solution also have options. There is a non-credit based program available which helps patients make scheduled payments on their medical procedure and improve their credit score at the same time.
Patients can talk to their Financial Care Counselor at Admissions about the Thrive program. Likewise, our counselors can help set up individual payment plans and review other financial solutions that may be available.
Someone recently asked me why Granville Health System does not establish payment plans between the Health System and the patient. Our past experience has shown more than 50 percent of our patients we placed on payment plans stopped paying after 3 months, contributing to the multi-million dollar debt I mentioned earlier.
In addition, patients have shared this new financial policy is a dramatic change from how GHS approached “scheduled” surgical procedures. They are correct, but $6.4 million in uncollected patient responsibilities is not a sound financial strategy to ensure Granville County has access to quality health care. While insurance companies continue to shift larger portions of the payment to patients, Granville must depend on our patients paying their portion in order to continue to meet the medical needs of our community.
Granville Health System continues to work to ensure access to the care you need, when you need it. Our entire team is dedicated to providing quality care and excellent customer service that will earn a “10” in patient experience from you during each and every visit, from admissions to discharge. GHS will continue to develop new ways and new partnerships to support our commitment to deliver high quality service to the areas we serve. I appreciate the financial demands presented by insurance companies and promise Granville Health System will continue to search for options as we work with you to ensure a strong health care system for our community.
Thank you for sharing your experiences at GHS. Please continue to stop me in the grocery store and at the gym to share your feedback with me. You can also always contact me directly by email at firstname.lastname@example.org.