Hospitals prepare for a cash-pay future

MDsave also works with patients who would like the amount they paid through the platform applied to their deductible, Wojtalewicz said. MDsave keeps a percentage of each procedure sold, though she did not offer specifics.

Baptist Health South Florida, where Miri is senior vice president and chief digital and information officer, in July started allowing patients to use Apple Pay and Google Pay to pay for healthcare procedures for their co-pay or procedure. The health system previously collected most of its payments over the phone or in-person, he said. Patients could pay through personal check, credit card or cash.

The move to additional payment options presented a workflow challenge, rather than a technical hurdle, Miri said.

“What’s hard is getting a zebra to change its stripes,” Miri said. “If you’re a health system who has been around for 65-plus years, like Baptist, you’ve always collected payment a certain way, right? And if I’m going to change that on you and go very modern and digital, a lot of people were like ‘Whoa, man, what are you talking about?’ That’s the heavy lift.”

Listening and directly addressing employee concerns about implementing new payment processing systems helped soothe staff skepticism, Miri said. Baptist Health conducted several meetings in which groups of front desk, revenue cycle management, clinical and other employees talked about what the workflow should look like for serving self-pay patients. The health system also developed staff initiatives to address patient questions about using Apple Pay and other types of payment. Baptist Health staff were trained to help patients recover their Apple Pay passwords, for example, he said.

In the first 45 days after launch, Baptist Health encountered a few issues with accounting staff transferring payment to the incorrect general ledger account, Miri said. He plans to monitor the books daily for the first quarter to ensure minor errors are caught early and resolved. The patient experience has not been affected, he said.

While just 5% of Baptist Health customers pay directly for healthcare services, it was important to implement Google Pay, Apple Pay and other cash capabilities because that is where the industry is headed, Miri said.

“When you look at the directionality of demand, this is only going to go up,” Miri said. “Patients are going to start seeing their total estimated bill and say, ‘I want to spend my $500 at a health system that was really transparent with me, and made me feel comfortable, versus the health system down the road that I’ve always gone to, but that simply can’t tell me what my actual amount due is.”

In response to requests from providers, Smith, of Surgery Center of Oklahoma, has begun licensing his claims clearinghouse to help hospitals accept cash-paying patients and determine the appropriate rate to charge. For hospitals looking to develop cash rates, Smith recommended health systems start by pricing their services as a percent of Medicare.

But when thinking about his own rates, Smith eschews the government program. Instead, he asks clinicians how much they expected to be compensated for each procedure, factors in expenses like surgical equipment, medical implants and office space, and then tacks on a 10% to 15% profit margin. If the surgery ends up costing the center more than the patient has agreed to pay, the center eats the cost, he said. If the procedure was quoted too high, oftentimes Smith said he will refund the patient.

“It’s kind of on a bell curve,” Smith said. “I make mistakes on both ends, and it evens out. I’ve got a marginal profit that is built in, and that protects me.”