Independent medical practices need to answer more and more questions around patient responsibility – “How much is this going to cost? Moreover, cost conscious patients are asking whether they really need to have a procedure or whether it can wait.
For example, a surgeon may be asked to answer the question of how long a procedure can be put off as patients calculate their annual deductibles and whether they should fit it in this year, next year, or not at all. As patient responsibility for medical bills has increased so have the questions. With deductibles and co-insurance exceeding $6,000 and going as high as $10,000 or $12,000, and even more when going out of network, it’s no wonder why patients are asking about costs, necessity and value before making the decision.
The conversation with physicians can be a helpful one that avoids unnecessary charges, but at the same time can get in the way of quality care when patients don’t hear the response they want. If treatment or tests are delayed there can be serious consequences for long-term health and potentially even greater costs incurred.
As costs for patients increase, overall healthcare spending has decreased according a past article in Modern Healthcare. High deductible employer plans are asking consumers to spend out of pocket. The National Business Group on Health found that 32% of businesses plan to offer just high-deductible, “consumer-directed” plans to their workers. Another impact is an increasing number of narrow network plans that limit patients to save costs. To help pay for expenses these employers may also be offering Healthcare Savings Accounts and matching contributions.
As costs go up for consumers the overall impact can be less traffic in the pharmacy, doctors office and hospitals. Health spending for people with employer plans increased 3.9% in 2013 according to the latest report from the Health Care Cost Institute, below increases in previous years. The Institute also found that emergency room visits declined by 1.6% last year and outpatient surgery dropped .7%. Also of note, prescription-drug prices increased over 21% in 2013 while at the same time there was a drop of 15% in brand-name drug use and an increase of 4.5% in generic drug use.
From one perspective this is a positive turn – patients are using healthcare more conservatively – but is healthcare being used more wisely? If patients delay or resist expensive tests this will ultimately impact the overall effectiveness of the doctor. There may also be costs seen as unnecessary by patients, such as an appointment to get a prescription renewed or a follow-up after a surgery that could be conducted by phone, that patients may resist. However, not having the opportunity to review medical status with patients can also create the opportunity for error in prescriptions or unknown complications following a surgery.
Unfortunately, doctors can only do so much and are limited when patients refuse services. Moreover, doctors can’t always know what the costs will be with each insurance company handling bills differently. The layers of complexity of healthcare insurance and billing, deductibles and co-insurance, networks, co-pays, and HSA savings are incredibly complex to calculate when what you need to be concerned about is whether to access the care or make a decision to forgo.
As patient responsibility estimates and insurance “calculators” become more common, this may improve. Outsource Receivables offers patients estimates on surgeries and procedures to help in the decision making process. In addition, assisting patients with setting up a payment plan is part of everyday customer service offered.
If your practice does not have a comprehensive, timely and consistent patient collections process, you are missing out on clinic reimbursement and hurting your overall margins. Outsource Receivables offers a comprehensive patient collections process of statements, phone calls and letters for every account. It is just part of what we do for full service revenue cycle management services at Outsource Receivables. Contact ORI for more information on how our services can improve your business model in 2016.