Blog, The Hospital Finance Podcast®

How to discuss patient responsibility during COVID-19 [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Keith Gruebele from BHG Lending to discuss how hospitals can balance their financial health while being accommodating to patients during the COVID-19 pandemic.     

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Highlights of this episode include:

  • How conversations with patients about financial responsibilities are evolving during the COVID-19 pandemic.
  • Why waiving of insurance deductibles for COVD-19 patients has affected the conversation about patient financial responsibility.
  • How hospitals should approach the conversation about financial responsibility with uninsured patients.
  • What hospitals can do now to strengthen their revenue cycle processes in preparation for after the pandemic.
  • And more…

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Setting expectations around patient financial responsibility is an increasingly important part of the hospital revenue cycle. To discuss how hospitals can balance the financial health of their organizations while being accommodating to patients during the COVID-19 pandemic, I’m joined by Keith Gruebele. Keith is an innovative and driven executive with more than 22 years of finance experience. As president of business development for BHG Patient Lending, he builds strategic relationships with healthcare facilities to help them implement an industry-leading patient-lending program that increases revenue and improves their patient experience. Keith, welcome to the show.

Keith Gruebele: Thanks so much for having me, Michael. Appreciate you accommodating me and getting me on the air with you.

Mike: We’re looking forward to the discussion here, because this is certainly going to be an interesting area for hospitals over the coming weeks. And Keith, in good times, having discussions with patients about their financial responsibility can be a delicate matter. With the spread of COVID, how has this conversation changed, in your opinion?

Keith: You’re 100% spot on that it’s always been a delicate conversation, and I think it’s one that we’re still learning to embrace a lot in the healthcare industry. I don’t know that– we were at a point where we were really great at managing the expectations around patient responsibility before COVID. Now with this pandemic going on and all the obvious changes that are happening to what is getting billed and who is getting billed and how to manage it, the conversation continues to evolve. I think the most common feedback out there is that it’s a very challenged time and we shouldn’t be talking about finance. And I will say very, very loudly that I believe that it’s a very unfortunate timing, absolutely, but it’s a mandatory conversation that we cannot walk away from and we can’t shy away from. I think it’s got to be definitely much more delicate in nature, but the conversations have to continue, and we’ve got to actually set the right expectations, because the reality is that the patients that are coming back or getting back home– in the coming weeks, the coming months, hopefully, we’re able to jump-start the economy and get everything back on track, but a lot of people’s financial position is going to be very different. If we’re not setting expectations for them and letting them know, “There may be a bill coming in the mail. There may be some charges. Your insurance coverage requires that you pay a certain portion of your medical-related expenses, and that’s going to be coming to you. And by the way, we have plans. We can work with you. We have options for you.” If we don’t start opening those conversations again and embracing them, I think we’re setting up our patients for a bad experience, and I think we’re setting ourselves up, and as far as the healthcare facilities, for a really rude awakening when things start settling down and these bills actually make their way into people’s inboxes.

Mike: Over the last few days, several major health payers and CMS itself have– they’ve decided to waive patient coinsurance and deductibles for any COVID-related treatment. Keith, how does this affect the discussion about patient responsibility?

Keith: Well, a couple of things. Number one, if it is a COVID-related case, I think it’s important that you still inform these patients of the fact that their providers are going to be waiving their fees, their deductibles. I think that we still have to educate the patient as best as we can, because this is obviously changing almost daily, like you just said. Just a couple days ago a new ruling comes out. But you’ve got to be educating your patients and talking them through what the potential bills might look like coming from this. If it is a 100% COVID-related case and there is not going to be one, well, how are they doing that? Are you supposed to be collecting and the patient, and the patients getting reimbursed? How are the payers making those deductible adjustments, are we just not collecting anything? If that’s the case that’s perfectly fine, but again I go back to over-communicating the reason why. Because unfortunately what you could create is a culture of kind of “Well I went to the hospital, I never got a bill, so now am I not going to pay for healthcare anymore? Is everything going to be covered for me?” So I go back to the same point of setting the expectations right now, especially in this heightened sense of awareness and this moment of concern where people are very sensitive. I understand it’s a fragile conversation. It’s one that should be handled very, very delicately and very humanely. But it still has to happen because if we do not have the conversation you could be setting the wrong tone with patients only to be setting them up for the potential of real true “surprise billing”. If we don’t talk about it, we don’t create rulings around it, we don’t take proactive approaches as healthcare facilities, unfortunately, the anecdotal evidence becomes the real evidence. And so the stories of that one-off billing mistake, I bet you’ve already seen a couple news stories where people said “I went to the hospital for COVID-19 and I have a $35,000 bill.” Unfortunately a lot of times we hear those stories but if we don’t have a process in place that says no, that is absolutely not the fact and this is exactly how we handle it. We’re not communicating it, we’re putting ourselves in a position to fail.

Mike: Keith, what about individuals that are uninsured, how should a hospital be approaching the financial conversation with them at this time?

Keith: Very, very similarly. I would be very big on educating about the tools that you have in place and I’d be researching programs and let them know, “Unfortunately there are costs associated with your healthcare, you don’t have insurance.” Obviously, I’m sure we are screening them for any additional benefits that they may be able to be eligible for. I heard there’s a lot of charity available, obviously. A lot of charity that these people may be eligible for. But you should also be telling them, “As much as we’re going to go through a screening process and we’re going to try to get you every benefit that’s available to you from the government or from whatever charity care that you’ll have funding available for. You still might have a responsibility, and if you have a responsibility please make sure you pick up the phone and you call us. We can work with you. We will find ways to create affordable payment plans for you.” And set those up. Which kind of brings me to a second point which is, honestly, this is an ideal time to be revisiting all of your financial policies when it comes to patient responsibility and understanding how we can serve the patient better. How you could be more flexible on programs or partner with vendors that will allow you to offer more flexible programs so your patients’ affordability goes up. That’s really what it’s going to boil down to when all of this is said and done is making sure that we’ve set the right expectation, and not just set the expectation but have the tools available, have the programs available for patients to be able to pay. Because I mean, I say often times I don’t believe people are bad, I don’t believe people don’t have the intention of paying, I believe that people don’t have the right tools to pay. And that fear often paralyzes people. The best way to overcome that financial fear is to have those conversations.

Mike: At some point, we all hope that things will settle into a more normal routine for hospitals and for all of us. What should hospitals be preparing for now so they’re in a strong position once a more typical cadence begins to reemerge?

Keith: So God willing that happens sooner than later. I think that we’re all longing for the days of a little bit of more normalcy and to kind of get everything back into the normal day-to-day living. I think right now it’s an important time – and I’ve been preaching this across all healthcare facilities – to really be looking at the state of finances and the articles that you’re seeing coming out over, and over, and over again are getting increasingly concerning as far as how much the healthcare industry overall is losing in potential revenue because of the closure of elective services, because of the limited amount of people that are actually going into healthcare facilities, and the cost of care for all this emergency preparation to be prepared to handle COVID cases. And there’s a lot of lost revenue right now. And so one of the things that I keep telling everyone is this is the ideal time to be looking at your revenue cycle processes and understanding what we can do better. What KPIs are we really measuring? How we’re offering support to our patients. Do we have enough programs? Are the programs that are in place flexible enough to make sense and make it affordable for patients? Because at the end of this, as I keep going back to, affordability is going to be the key thing. Patients have to figure out an affordable way to make payments. And unfortunately a lot of our traditional plans that we’re accustomed to where it’s maybe a 12-month payment plan or on the long-term an 18-month payment plan for a patient. That’s not long enough. And especially with potential economic challenges happening, layoffs and unfortunate closures in some business in the economy. With the way things are right now you’ve got to have flexible solutions available to your patients and you’ve got to really start revisiting the revenue cycle during this period of time and making sure that it’s prepared for what’s eventually going to come. And that is going to be a large wave of patient responsibility potentially needing to be collected. Hopefully, all of your elective cases coming back into the hospitals, a lot more patients coming that have been putting off care during this time out of fear of contracting COVID or just not wanting to bog down the hospital facilities that may be caring for patients with COVID-19. You’re going to see a huge resurgence of patients coming into healthcare facilities. If we’re not prepared financially for them now we could really, really be putting ourselves even further into a hole or even further into financial hardships if we don’t have flexible programs that allow patients to be able to pay for those services.

Mike: That’s good advice, Keith. If someone wanted to learn more about you and the services that your firm provides, where can they go?

Keith: They can go to They could actually go to to redirect them to the same site. Or they could feel free to reach out to me via email or phone call. I’m not sure if you’ll post that with the podcast or if you want me to share that now, but I’m happy to help anybody that I can, answer any questions that I can. And really just help people hopefully get a better grasp of their financial situation and what we can do to work through this together and make sure our industry comes out of this challenge with the opportunity to really survive.

Mike: We will definitely have links to your site from the blog post associated with the podcast. So any listener that would like to get in touch with you can do that. Keith Gruebele, thanks so much for joining us on the Hospital Finance Podcast today.

Keith: My pleasure. Stay healthy, stay safe, thank you for all what you’re doing to continue educating healthcare providers out there and giving them such valuable resources. It’s really appreciated, Michael.

Mike: Same to you Keith.

COVID-19, better known as Coronavirus, has spread throughout the world. Symptoms of this respiratory disease may include fever, cough, and shortness of breath. These symptoms may show up 2 to 14 days after exposure. If you are experiencing these symptoms and have come into contact or are in an area with an ongoing outbreak, please call a hotline and/or consult with a physician. Clean and disinfect high-touch surfaces. For more information, please visit Thank you.

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