Patient assistance programs…the good idea that’s actually draining a little life out of your practice. Plus, 3 things you can do to ease the burden

Hey folks, it’s your blog host and physician practice technologist Michael Patrick here. Today’s post (an 8 minute read) marks the first of a 3-part series about patient assistance programs. Specifically we will…

1. flush out the problems and negative implications practices face in facilitating enrollment for patients + what to do about it,

2. outline the keys to the right policy and procedure framework,

3. share the experiences and stories of practices using technology to transform facilitation of patient assistance programs from a liability to an asset.

So let’s get started!

Your patient comes to the office with a problem. The doctor is ready to solve it with a treatment plan. Part of the plan calls for a prescription. But there’s another problem. The patient doesn’t have the financial means to pay for that part of the treatment, nor do they know much about relevant patient assistance programs.

The implications of this all-too-real scenario can translate to a negative impact in the health of the patient, while creating financial and productivity headwinds for the practice.

According to rxassist.org, there are 381 prescription assistance programs and 87 copay assistance programs. The qualifying requirements and application processes for each program are unique. If you’ve seen one, you’ve seen only that one.

Complicating things further is the nature of change in these programs. Not only are new programs rolled out every year, some are retired, while others are modified with new qualifying requirements and/or application processes.

So it’s on you and your team to not only carry knowledge of the relevant programs, but to invest time in assisting patients applying for assistance. As you may already experience, that usually involves more than just handing out an application.

One of our Practice Administrators described her experience as follows, “We had a policy and procedure in place. But there were always variables. Sometimes the program requirements would change. Of course, we had no way of knowing until an enrollment form, one that historically would be approved, was rejected. Sometimes, patients will miss a step like completing a signature or not answering other qualifying requirements. In these situations, the patient would expect financial assistance only to miss out and receive a bill they cannot afford to pay.”

She went on to say, “Facilitating the refiling process and all that goes with the billing revision becomes a grind very quickly. And usually, the patient is now several days delayed from beginning treatment. Our doctors, out of concern for the well-being of the patient, are forced to consider an alternative treatment plan creating a whole new path of effort that may not deliver as strong an outcome as the original plan.”

So we all get it. It’s a tough situation. But what can we do about it? Here are three things you can do to ease the burden…

1)    Research. Invest the time to thoroughly research the programs relevant to your practice. Consult with your doctors and the program administrators about qualifying requirements and enrollment procedures. Be sure to inquire about the most common triggers for enrollment rejections. Ask how you can be informed of changes as they occur, maybe by email notification for example. You can get started searching programs at rxassist.org.

Secondly, survey your team about their experiences in managing the work associated with facilitating enrollment. Make time to dig into the details to ensure you are achieving accuracy in understanding the real story. It’s important to understand the real workflow and all the impact points throughout the practice like scheduling, billing, and even the delivery of care.

Lastly, look for ways to automate alerts within your EHR to help with pre-identification and follow-up work. Automated alerts are fairly simple but powerful with respect to efficiency gains and higher productivity.

This may seem like a bit of a project. Just break up the effort into 15-30-minute chunks completed daily for a defined number of days.

2)    Prepare. First prepare 1-3 goals for transforming this part of your services from a burden into an asset. For example, you may choose a goal like tracking the financial impact of your efforts. Another example may be to track the total number of enrollment forms to understand volume relative to patient population.

Secondly, prepare and/or audit your policy and procedure documentation for facilitating patient assistance program enrollment. With all the research you just completed, it will be important to ensure your documentation closes any gaps that are preventing value in this service for patients and for the practice. We’ll cover this in more depth in part 2 of this series.

3)    Educate. Educate your team on the keys to success. It’s not enough to deliver a policy document. Engage your team on ideas for how they might like to make it work better. Help them understand WHY it’s important to execute well in this service…WHY for the patient and WHY for them.

Educate your patients. After training your team, patients are next. Make sure they have a clear understanding of their responsibility and more importantly, WHY they want to follow directions.

Lastly, seek feedback…from your team and from patients about their experiences in delivering and receiving the service. This will help you keep on top of your game in supporting the health and well-being of your patients, the team, and the practice.

There’s no question that executing best practice in this important service will go a long way in supporting the best care possible for your patients. It will also support a healthy reputation and the financial vitality of your practice. Invest some focused time on making improvements and save much time during execution.

That’s a wrap for today’s post! If you found the content usable for your practice, feel free to share this story with your network on LinkedIn and Twitter.

Stay tuned for post #2 in our 3-part series where we’ll reveal the keys to the right policy and procedure framework.

In the meantime, if you want to visit more about best practices in this area or have technology strategy questions, let me know. Otherwise, I look forward to your comments below!

Michael Patrick, President at Systeem

With more than 20 years of technology and technology sales experience, Michael has led Systeem’s operations since day one, connecting our clients with technology, processes and ideas that make their lives easier and happier.