Insights from the Outside The Financial Conversation — Enabling Patients to Get Care

Insights from the Outside is a group of practicing clinician-owners. They are a diverse group from many medical specialties, including dentistry, veterinary medicine, cosmetic surgery, ophthalmology, audiology and optometry. Uniquely created by CareCredit, the group’s purpose is to capture and share “best practices” to some of the common challenges all healthcare business owners face, such as attracting new patients, patient barriers to care, care acceptance, patient retention, social media, team training and empowerment, and much more. This article features Nola Aronson M.A., CCC-A, owner of Advanced Audiology, veterinarian Dr. Kathy Wentworth, Medical Director and owner of PetPoint Medical Center and Resort, and dentist Dr. Howard Ong, owner of Seal Beach Dentistry.

The financial conversation has been called one of the most important dialogues in the practice. Why is this conversation so important?

Ms. Aronson It costs money to buy a hearing aid. As hearing professionals we have to make patients understand the value that hearing aids can bring to their lives, why it's important and why it costs what it does. It's getting harder and harder to talk about price in audiology today because there are a lot of competitors out there who only talk about price — making hearing aids seem more like a commodity instead of a medical device.

Dr. Wentworth I think it’s very important that patients understand the value of the recommendation. We don’t make price or cost the primary focus of the conversation — we focus on the necessity of the care needed by the client or patient. I tend to find that clients are not as concerned with the total price if they understand the overall value of what is being recommended. That takes good communication about recommendation and the outcomes expected.

Dr. Ong In our practice the financial conversation is important because it's part of the “trust building” between our patients and team. It's not so much the conversation that takes place; it's what happens after the conversation. It’s actually doing what you say — making a plan or a financial arrangement and sticking to it. You don't add on and you don't have surprise fees or additional treatment that you didn't discuss. I have found over the years, trust builds with patients when you actually do the treatment that was discussed, and the financial arrangement was exactly what they anticipated.

Why do you think it’s uncomfortable for some team members to talk about money?

Dr. Ong Whether it's personality or training, some team members are simply not equipped to discuss financial arrangements or financial conversations effectively. I believe — at least in dentistry — there should be a bit of a buffer or a little distance between the medical recommendation and the financial discussion. That’s why we focus our training on the front office team, making sure that they are equipped and able to have those important money conversations.

Ms. Aronson I think when team members are uncomfortable having the financial conversation it’s usually because they themselves don't feel comfortable about money or they might not believe in themselves, or have confidence in themselves as the expert. I remember when I started in the field 40 years ago and I thought, “Oh, my God, how am I going to do this?” But I learned to believe in what I'm doing, and believe that I'm helping people.

Dr. Wentworth That’s so true. Look, discussing financial concerns is sometimes uncomfortable for almost everyone. Team members may have their own financial concerns but at the end of the day, clients or patients need to make their own decisions. We should never assume our clients or patients are not able to afford what is appropriately recommended.

Do you think it’s even more uncomfortable to talk about money because you’re talking healthcare?

Dr. Wentworth Yes. Of course everyone wants the best outcome. In veterinary medicine, for example, if clients don’t have enough money to get what is needed for the pet, they can feel guilty about not approving recommended care. That’s why it’s so important to provide the information necessary for the client or patient to prioritize care and then to offer them a financially viable option.

Ms. Aronson When it’s time to talk about money in healthcare, I always say, “I'm not selling you something. I'm solving your problem.” I say that because it's not about the money. Yes, it is about the money from a financial standpoint — but it's not about the money when it comes to the help that is being provided. So I try to emphasize that I care about them and want the best for them, so that it's not just about money.

Dr. Ong I think in healthcare, obviously, the unique thing about healthcare is the person treating is the person that could benefit most directly from the financial aspect of the treatment. So, that's where it becomes a little bit uncomfortable but with proper training, proper protocols in the practice and proper verbiage, the conversation can actually be remarkably easy because it's straightforward. It's facts, it's treatment and cost and the patient can decide if that cost is a value or appropriate.

What do you do to make it more comfortable for your team to talk about money?

Ms. Aronson We have sales meetings in our office to review how we approach patients and what we say. I also try and help the team understand they are the experts and they’re there to help and solve problems. Luckily today hearing aids help you in all kinds of communication environments. You can communicate on the phone, listen to music or listen to TV. They're more than just a hearing aid. They're solving people's communication problems and that's one of the most important things in people’s lives - to be able to communicate and be in social situations.

Dr. Wentworth We try and make it as comfortable as possible for the team and the client or patient by putting together a plan for the most appropriate treatment recommendations and, if possible, a more conservative approach. Then we work with the client on a solution that fits within their budget. This is also the time we usually discuss various financial solutions like the CareCredit healthcare credit card.

Dr. Ong It’s important to us that the team member having the financial discussion is familiar with each aspect of the treatment. So we ensure that they understand the clinical situation. We say to them exactly what we've said to the patient from the standpoint of the treatment itself, the value of treatment, its benefits, the consequence of doing no treatment and anything from time constraints to anxiety so that they feel like they know what’s going on and can confidently have the financial conversation.

Where along the patient journey does the money conversation come up?

Dr. Ong Right away. First the clinical team discusses all aspects of treatment with the patient. Then we invite the administrative person to come in and after they’ve been informed of everything that we’ve talked about with the patient, they have the financial conversation.

Ms. Aronson We usually have the financial conversation after testing, once we’ve gone over the results and the patient has agreed they need help.

Dr. Wentworth The approach we use in our practice is to first discuss what we are recommending and why. Then we provide an actual estimate of the costs. This gives the client a sense of medical necessity along with the reality of price. They can then make a decision to decide to move forward or to ask for an alternative. This approach allows us to place value ahead of actual cost.

Do you feel that “cost” or money is the “real” reason patients don’t move forward with care? Or is it more of a personal prioritization?

Dr. Wentworth Cost and the perception of what is needed are the biggest concerns I see. Clients need to trust the recommendations to move ahead — whether it is an emergency procedure or an elective procedure. Many times clients have surprised me — knowing they are on a budget — with wanting to do what is really recommended, even though they may have shared financial concerns.

Ms. Aronson We try and address the cost associated with hearing aids by introducing them as a possible solution early in the patient interaction. We start by asking questions related to needing a hearing aid and what they think about it. When we do our testing we gear it towards showing the patient how a hearing aid might benefit them. If you have someone who is in denial about hearing loss and they are only there because their spouse sent them there, it’s going to be really hard to convince them they have a problem in the first place. So price comes in at the end and frankly I don't think that's usually the real reason patients don't buy. I think they don't buy because they aren't convinced that they have a hearing problem. That’s why we let people try hearing aids in their own environment without buying them first so they can see for themselves how the hearing aid works.

Dr. Ong I agree. I don’t think cost is the only reason or not the main reason. It's one of the reasons. But in dentistry it's more about weighing the personal desire, the time investment and the value. There are two categories when it comes to care — care that’s urgent and care that's not urgent. Care that’s urgent is obviously a much easier conversation. When care is not urgent the conversation is more about the patient fitting treatment into their lifestyle at the moment. It becomes more of a personal choice — is this the right treatment for them at this time and what are the benefits and the consequence of no treatment.

Often cost and money are “uncovered barriers to care” because people don’t want to talk about it. What are ways to gently but effectively uncover patient cost concerns?

Ms. Aronson Most of the time when it comes to hearing loss, people really don't feel they have that bad of a hearing loss. So often it’s about convincing and showing the patient the impact that their hearing is having on their lives. Once you've done that, I think it’s very important to let the patient have a trial. A lot of people just try the hearing aid out in the office, but I don't think that's effective because the office is not a real situation. So I don't do trials in the office. I just let the patient take the device home. Now, if they're willing to put a hearing aid on, then they're willing to agree that they do need some help. And that’s the gentle way of uncovering the costs concerns. Showing them that you're not just in it for their money. You're not just trying to sell them the highest price hearing aid. You're trying to do what's best for them.

Dr. Ong I go with the straightforward approach by talking to the patient directly and just asking them. We ask patients if the treatment recommended is the right treatment for them at this time. We also ask if there's any barrier to care like money and if there is, then we address it. We provide the patient with options like financing through CareCredit or other means. But I think asking the patient directly is probably the easiest and most professional and gentle way to effectively uncover cost concerns.

Dr. Wentworth We initially offer a treatment plan and if the client expresses a concern about the amount, we offer a more conservative plan if possible, along with payment options.

What are some money dos and don’ts? What should you say? What should you never say?

Dr. Ong I think you should always say how the finances are related to the benefits, how it will make them feel better, look better or get out of pain. Plus, it will probably save the patient time and money in the future. I think that those are all dos. The biggest don't is to imply that treatment costs will be completely covered by this program or that program or this insurance or discount fee because that can be a gray area. Being direct and letting the patient know their portion is important because it helps to get them invested in their care as much as you are. And it keeps the value of the treatment upfront.

Dr. Wentworth I agree and would add that the recommendations for treatments and procedures should always be sincere — no matter the amount. It is up to the client to decide the value and ability to pay. We also never make someone feel guilty about not being able to spend what is medically recommended — and we always try to work within what they can afford, whether it’s through financing or a revised treatment plan.

Ms. Aronson What should you say? You should always say that you're there to help them. What should you never say? You should never say, “Well, you need this, and this is what it costs,” period. You have to explain to the patient why you're charging what you're charging and if you say it in the right way, like, “Well, if you make this investment now, you’re not going to have to spend more money later to replace a lesser quality device that won’t help you in noisy environments and that won’t provide the clear sound you desire. This is the device you really need and we are here to try and help you figure out how to make it happen.” Lastly, when patients bring up Costco or some other big-box retailer, you should never say, “Well, Costco is bad.” Instead I say, “Well I'm not in competition with them on price, because I can't compete. But do you want individual and personalized service? Do you want someone who knows you, knows your hearing concerns and challenges and knows how to program your hearing aid to provide optimal results? If you want that level of knowledge, care, expertise and service, that’s what we provide.”    
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