Medical debt carries a considerable burden for patients and families across the country, with about 40 percent of adults having health care or dental debt. Driven by a complex mix of health care costs, insurance coverage, and financial policies, medical debt can undermine patients' trust in health care and their willingness to seek needed care.
While no single individual or organization can solve this problem, hospitals and clinicians have an important role to play. Even when broader systemic challenges are beyond their control, they can take meaningful steps to protect patients' interests and reduce financial harm.
In a new publication, Addressing Medical Debt: A Playbook for Hospitals and Clinicians, AcademyHealth, with support from the ABIM Foundation, draws on an environmental scan and interviews with health care and community leaders to identify opportunities for balancing patient affordability with hospital sustainability. The playbook presents three “plays” focused on key areas for action to address patient health care costs.
The plays focus on (1) organizational values and culture; (2) policies and practices that shape the patient financial experience; and (3) partnerships with organizations outside the hospital to support patients. Each play provides the reader with questions to consider within their own organization or practice, as well as recommendations and practical tools for implementation.
The playbook also shares four case examples drawn on perspectives from a hospital, a clinician, and two community-oriented organizations to highlight effective approaches in their settings. Together, they encourage readers to consider opportunities for preventing medical debt, along with strategies for addressing debt after it has been incurred.
Hospitals and clinicians face many competing pressures; the playbook offers practical steps that can be adapted to different settings. The goal is not to do everything at once, but to identify where meaningful change is possible.
What hospital leaders can do
If you're a hospital leader, here are some actions to explore that can help align organizational practices with professional values and build trust:
- Develop an inclusive committee for establishing hospital policies related to financial assistance, billing, and collections. Include leaders and frontline staff representing financial, revenue cycle, clinical care, community benefit, social work, legal and regulatory affairs, hospital boards, and patients.
- Assess the return on investment of medical debt collection activities. Given the resources needed to collect payments, pursuing such collection efforts may not be worth the costs.
- Treat the financial experience as part of the overall patient experience of care. Include questions about the patient’s financial experiences in hospital patient experience surveys to provide a more complete picture of their care.
- Make financial assistance easier to access by increasing awareness of financial assistance programs and simplifying applications, processes, and requirements.
- Adopt ethical billing and responsible debt collection practices. Provide timely and transparent billing notices so patients can understand the charges. Avoid extraordinary collections actions, such as selling debt, credit reporting, or suing patients.
- Build partnerships with community-oriented organizations to help patients navigate financial processes. Patient advocacy and medical debt relief organizations can extend hospital capacity by providing trusted support to patients and connecting them with available resources.
What clinicians can do
Clinicians also have an important role to play. Many experience moral distress when patients face financial hardship and are looking for practical ways to help. Building on the principles of Choosing Wisely, which encouraged conversations between clinicians and patients about avoiding unnecessary care, clinicians can help patients navigate the financial implications of care and avoid unnecessary costs. Supporting patients with medical debt, or helping them avoid it, offers another opportunity to act on their professional commitments while identifying organizational practices that may undermine trust.
- Become familiar with the hospital’s financial resources for patients. Know where to find the hospital’s financial assistance policy and understand how the policy and application process works.
- Refer patients to trusted organizations that can help them apply for financial assistance, understand their bills, navigate insurance coverage, and address medical debt.
- Share insights with hospital leaders about how medical debt affects patients, trust, and care-seeking behavior. Providing a deeper understanding of how health care costs play out for patients can be helpful for hospitals in designing effective solutions.
- Reach out to fellow clinicians for peer support, learning, and exchange. Connect with other clinicians to exchange experiences and strategies that have been effective in engaging with patients about the costs of care.
Financial policies and practices shape patients' experiences and their trust in health care. No hospital or clinician can solve medical debt alone, but each can take meaningful steps to help. We hope this playbook offers a practical starting point for making changes that ease patients' financial burdens and strengthen trust.
Access the playbook and accompanying briefs here.