HCAHPS produces 11 publicly reported measures of patient experience. Not one of them asks about a bill. The financial/billing experience sits outside most ways this industry uses to define patient experience. And it arrives with your logo on it.
Chris Boyer and Reed Smith discuss what that gap costs. The financial experience decides whether the next clinical experience happens at all. In most health systems, brand standards govern the digital experience, website, campaigns, and the call center. But the statement, the denial letter and the financial assistance page are managed separately. They also discuss the requirements to reach the people in the community most likely to need financial help but describe how these efforts read like a marketing campaign, but marketing never got this memo.
Then Cassandra Skinner from Xsolis makes the case for collecting correctly rather than collecting less, arguing that compassion and accountability were never opposites. She also describes how patient advocacy acts as quiet work that lives in questioning one authorization or catching one coordination of benefits error. On automation she draws the line at can versus should. And she lands somewhere worth sitting with, that patients do not lose trust because a machine was involved, they lose trust when nobody will own the decision.
- Why the instrument that defines patient experience has no question about cost, and what that does to budgets and attention
- What marketing gave up when the billing statement became somebody else’s document
- The financial assistance requirements already written into federal law, and why satisfying them has not made patients aware
- Why a decade of mandated price disclosure produced more published data and not more patient understanding
- What revenue cycle sees about a patient that marketing never does
- Where accountability has to sit when part of the decision is automated
If your health system’s financial assistance page would fail the standard you apply to any campaign you would sign your name to, you just found work that has been yours the whole time.
Mentions from the Show:
- IRS, Financial Assistance Policy and Emergency Medical Care Policy, Section 501(r)(4): https://www.irs.gov/charities-non-profits/financial-assistance-policy-and-emergency-medical-care-policy-section-501r4
- AHRQ, CAHPS Adult Hospital Survey (11 measures effective January 1, 2025): https://www.ahrq.gov/cahps/surveys-guidance/hospital/about/adult_hp_survey.html
- CMS, HCAHPS Patients’ Perspectives of Care Survey (administered 48 hours to six weeks after discharge): https://www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/hcahps-patients-perspectives-care-survey
- KFF, Americans’ Challenges with Health Care Costs, updated April 2026 (about half of adults could not pay an unexpected $500 medical bill): https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/
- KFF Health Care Debt Survey (41% with health care debt, 51% of those with debt skipped recommended care): https://www.kff.org/health-costs/kff-health-care-debt-survey/
- KFF, Hospital Charity Care, How It Works and Why It Matters: https://www.kff.org/health-costs/issue-brief/hospital-charity-care-how-it-works-and-why-it-matters/
- Dollar For, Fixing Hospital Financial Assistance Programs (52% never informed, 65% unaware it existed). Patient advocacy nonprofit, labeled as such on air: https://dollarfor.org/fixing-hospital-finaid/
- AHA, Hospital Price Transparency, Current Landscape and a Better Path Forward, June 5 2026: https://www.aha.org/fact-sheets/2026-06-05-fact-sheet-hospital-price-transparency-current-landscape-and-better-path-forward
- AHA, Improving the Patient Billing Experience issue brief, October 2021: https://www.aha.org/system/files/media/file/2021/10/Improving-Patient-Billing-Experience_IB_Final_10-22-21.pdf
- CMS, CY 2026 OPPS and ASC Final Rule, Hospital Price Transparency Policy Changes: https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes
- HFMA, CMS’s latest transparency rule aims to make price estimates more exact, November 2025 (named executive on the machine-readable file): https://www.hfma.org/price-transparency/cmss-latest-transparency-rule-aims-to-make-price-estimates-more-exact/
- Ways and Means Committee, H.R. 9504 Tax Exempt Hospital Transparency Act reporting elements, July 2026: https://waysandmeans.house.gov/2026/07/20/what-they-are-saying-ways-and-means-committee-bringing-transparency-to-americas-nonprofit-hospital-sector/
- Cassandra Skinner on LinkedIn: https://www.linkedin.com/in/cskinner-health/
- XSOLIS website: https://www.xsolis.com/
- Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
- Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
- Chris Boyer website: http://www.christopherboyer.com/
- Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
- Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social

