TPAs with William Ranes and Dan Quall
Some people believe that if they have hearing loss, all they need to do is get a hearing test and a set of hearing aids—problem solved. As health care professionals, we know that the patient’s care doesn’t end with the purchase of hearing aids. Our job is to maintain the continuum of care that goes beyond the initial purchase of hearing aids. Some services are not covered by third-party administrators (TPAs), so offering “out-of-network” options is sometimes necessary. This Ask Fuel First article answers the following question: What kinds of service plans should I consider offering?
William Ranes, Fuel Medical’s Taskforce Officer, had a chance to sit down with Dan Quall, Fuel Medical’s Director of Strategic Initiatives, to discuss the impact of TPAs on the audiology industry. Here are some of the highlights of that conversation.
Services Outside of Contractual Requirements
Maintaining the continuum of care is necessary to ensure patients’ best overall health outcomes, but HABPs (hearing aid benefit plans) managed by TPAs often cover minimal services. HABPs exclude essential services that patients need for long-term health maintenance, such as re-evaluating hearing loss sooner than contractual requirements, reprogramming devices and re-evaluating patients for comorbidities associated with hearing loss—all of which occur after the initial purchase of hearing aids. Both William and Dan felt that offering out-of-network service options is one way to support patients beyond their benefits.
The Patient Experience
With the uptick in TPA patients, defining the patient journey up front is now more important than ever. Frustrations over the lack of services or hearing devices covered by TPAs may leave patients with an unpleasant feeling, even though it’s not your fault. Instead of reacting to annoyed patients, strive to be proactive by anticipating any pitfalls in your patients’ journey through your practice.
To understand the patient experience, ask yourself, “How am I going to deliver my services to the patient? What do they experience when they come in for a check? What do they experience when they come in for a reprogramming or a retest?” Service plans are also a part of the patient experience. In the end, you and your staff are in control of creating an experience that brings patients back to the practice. Whenever staff interfaces with patients, they have an opportunity to create raving fans of the practice who recommend your services to their friends and family, regardless of whether they’re in-network or not.
Bundled Service Plans
Bundled service plans give patients another option if their HABP covers some services but not others, thus helping them avoid unnecessarily stressful decisions and improving their overall experience. Start by listing the services that aren’t covered by the patient’s plan that you’ll provide over a set time frame, typically a two-, three- or four-year period. Then, create a service contract that identifies the services that will be available for a bundled fee with a clear timeline. This is an effective strategy for managed care patients and those interested in the upcoming OTC category of products. Develop the right program, materials and message to deliver a high level of service to your patients.
Fuel Medical can walk you through our Service Plan Calculator and Revenue Per Clinical Hour Calculator to determine your practice’s break-even point. Your regional team can also help you establish a personal plan to meet the needs of your unique patient population.
Over-The-Counter-Devices
Bundled service plans are also useful for patients with limited or no HABP who purchase OTC (over-the-counter) devices at a big-box store. This could make more financial sense for them if they’re on a limited budget. Although you aren’t selling them hearing aids directly, you can still benefit from having them as patients. Your practice can run diagnostic tests before purchasing OTCs and then offer appropriate services like programming and basic maintenance, such as assistance with changing batteries or simple troubleshooting when there’s an issue.
Pay-As-You-Go Services
Although we recommend offering bundled service plans to patients first, pay-as-you-go services are an option that many audiology and ENT practices have begun to embrace. William commented on this option during his conversation with Dan: “The pay-as-you-go piece is so new for many practices working in audiology, so we know that the idea of developing a service plan can be fairly daunting, but the financial component is probably the easiest thing to figure out. You get out your pencil. You read what you’re going to give them, and you do the math. The more challenging parts are the patient engagement, staff management and change management,” which is part of the patient experience mentioned above.
A Comparison
There are pros and cons to bundled service plans and pay-as-you-go services. Bundled services are easier for you and your patients to navigate. The details are clearly outlined, so patients know the progression of their treatment and won’t have to worry about itemized costs. However, pay-as-you-go services are attractive to some patients as this option offers more freedom to pick and choose services, especially for patients on a low budget. Paying for a bundled service plan may be out of some patients’ reach, so paying as they progress through their treatment allows them to pay only for services as needed.
Sometimes, patients may ask to pay for services one or two at a time because they want to minimize their care. Although this isn’t recommended, we do understand that may be the reality for a fraction of your patient population. Patients may skip certain services, not fully understanding how this could impact their hearing health. With this option, it’s important to explain that unforeseen issues may arise, requiring additional services that would be automatically included in a bundled plan.
Managing patients who have HABPs managed by third-party companies can be challenging. After reviewing your contracts with each TPA, consider which hearing aids and services are contractually required. Then, create a service plan that fills those gaps in coverage. Some patients might be satisfied with the bare minimums generally offered through TPAs, but many won’t. Medically managing and treating hearing loss requires the patient and provider to look beyond the technology to focus on the partnership between the provider and patient. Patients need to know that your practice is there for their entire hearing health journey, for which a service plan is ideal. If you want to set up service plans, reach out to your regional team. Also, let your regional team know if you want to learn techniques on how to discuss service plans with patients—they can connect you with our professional development team.