Healthcare is a basic need for all people, but its cost often makes it into a luxury millions can ill afford. Efforts to contain costs while promoting quality of care are going forward, but patients still live with the reality of handling the bulk of the financial responsibility for their care. In response, healthcare's patients are becoming active consumers. How can providers cater to this new payer group and remain successful?
The rise of the high deductible health plans
Even as more and more people gain access to coverage, price remains a concern. A quarter of working-age adults covered by private health insurance find healthcare costs unaffordable, according to a 2015 survey from The Commonwealth Fund. High deductibles are one of the core reasons behind the struggle to pay for healthcare, and these plans are becoming a commonplace option. The majority the ACA Metal Plans are considered high deductible. Additionally, the number of employers offering their works this option is increasing. The number of employees enrolled in high deductible health plans increased from 13 percent in 2010 to 24 percent in 2015, according to The Kaiser Family Foundation's 2015 Employer Health Benefits Survey.
Of patients with this type of plan nearly half (43 percent) reported their deductible as difficult or impossible to afford, according to The Commonwealth Fund report. Consequentially, 40 percent of patients with high deductible plans have avoided going to a physician if sick, skipped a follow-up test, forewent preventative care or failed to get specialist care because of their deductible.
Patients as healthcare shoppers
When patients do decide to get healthcare, cost looms large. The days of selecting physicians and provider location based on mere convenience or referral are rapidly dwindling. Patients are now consumers, carefully shopping for their healthcare. "With a higher portion of the costs shifting to the patient, they now have a greater personal and financial stake in their healthcare than ever before," says April Sackos, CASC, vice president of revenue cycle management with Meridian Surgical Partners. "Patients are looking for transparency in regards to cost and quality and intuitive tools to help them compare in order to make the most cost-effective healthcare decisions."
What ASCs can do to remain relevant
ASCs have long been considered a low-cost, high-quality healthcare venue, but this reputation means little if surgery centers do not adapt to the current environment. "As patients take on a greater share of their healthcare costs, ASCs may see an increase in bad debt and a decrease in utilization," says Ms. Sackos. Here are four tactics ASC leaders can employ to preserve the bottom line and offer patients access to the care they need.
1. Maintain a stringent benefits verification system. A patient's insurance coverage should be no surprise to ASC leaders. Establish a strong system for verifying patients’ benefits, and use this system to generate a cost estimate for patients. How much will their insurance plan cover? How much will the patient be expected to pay?
2. Do not shy away from upfront collections. Once a patient's financial obligation becomes clear, share this with the patient prior to the procedure date. Communicate clear, up-front expectations for payment. If payment in full is not being collected prior to the date of service, lay out a clear plan for payment after the patient's discharge. "Ensuring that the business office staff is well-trained on all payment processes and openly communicating these options with patients is perhaps the most important indirect driver that can have an impact on your bottom line," says Ms. Sackos.
3. Offer financial counseling for patients. Copays, deductibles and the healthcare payment system can be confusing even for those working in the industry. Eliminate as much confusion as possible by offering patients access to financial counselors. Counselors can explain how and when a patient can pay, as well as offer alternatives for patients who might otherwise struggle to meet their financial obligations.
4. Consider cash pay. While payers, CMS and private insurance company alike, remain the primary means of reimbursement for ASCs, some centers have opened the option for consumers to be the sole payer. Cash pay has long been an option in healthcare, but is becoming increasingly appealing for some patients. Surgery centers, such as the Surgery Center of Oklahoma in Oklahoma City and Stony Point Surgery Center in Richmond, Va., are developing cash pay price estimate and posting the information. Patients shopping for their care can see prices upfront, prices which may be more affordable than those offered through a traditional insurance plan.