Upfront discussions crucial to help patients avoid debt issues, and other letters

Regarding the recent Best Practices column headlined “HFMA eyes wide adoption of medical-debt collection guidelines,” it's a very good article. The only comment I might disagree with is about credit reporting. We have found that while it is kinder and gentler to not report patients to credit bureaus, a real threat of credit reporting for nonpayment increases collections.

My firm always gives provider clients the option to credit-report or not based on their internal policies. The best way to collect the most money is to handle all payment discussions upfront with the patient to secure a form of payment, identify the assistance they qualify for, or set up a payment plan before the procedure whenever possible. When not possible, internal discussions with the patient, followed with an external collections process—which allows patients to make payment arrangements and provides transparency to the hospital or provider—is the most effective combination of efforts.

Matthew BeckerFort Lauderdale, Fla.

Regarding “Patient-data-access advocates remain frustrated but hopeful of benefits,” the fundamental problem with patient “access” to their records is similar to the fundamental problem with U.S. healthcare. Patients, by and large, are treated like sheep, and then we are surprised when they act that way.

No consumer would tolerate a banking system or brokerage account that failed to provide useful interactive access to their accounts, failed to provide cost transparency (for stock/bond prices and brokerage fees), including the ability to transfer their accounts to competing institutions.

Most consumers believe their financial health is their responsibility, as is the related record-keeping. And if they make bad decisions or screw up their records, they pay the price. In healthcare, however, the only apparent consumer responsibility is the ubiquitous “Ask your doctor.”

Gain weight, smoke, don't take your meds? It costs you nothing. You pay the same insurance as those silly folks who take care of themselves. Don't bother keeping your kids' immunization records. The state registry or pediatrician has that responsibility, you have none.

With a system like this, how can we possibly expect consumers to take responsibility? Fortunately, rising healthcare costs are driving price-transparency demands, and it will be through those doors that consumers most rapidly march into online healthcare issues including cost options, records, etc. As costs are shifted onto consumers, they will engage.

Dr. Edward FotschSausalito, Calif.

Regarding “Heart docs say better care slowed by bad metrics,” this is an important article reinforcing and validating the fact that it is critically important that physicians establish the metrics by which they will be measured. The leadership of each medical specialty is the best source for establishing the quality and value metrics sought by the industry. Otherwise, we all run the risk that we are measuring factors that either badly miss the mark or, frankly, have nothing at all to do with furthering the health of the American people.

John HolsteinDirector of client developmentZotec PartnersBala Cynwyd, Pa.