Rise of high-de­ductible plans has providers boost­ing col­lec­tion ef­forts

Modern Healthcare - - NEWS - —Dave Barkholz

Hos­pi­tals and health sys­tems face the prospect of grow­ing un­com­pen­sated care costs fol­low­ing the loom­ing re­peal of the Af­ford­able Care Act and its Med­i­caid ex­pan­sion. So providers will have to fo­cus on im­prov­ing col­lec­tions and help­ing pa­tients cope with in­creas­ingly high out-of-pocket pay­ments un­der high­d­e­ductible health plans. One ap­proach is re­quir­ing pa­tients to pay up­front for non-emer­gency pro­ce­dures.

Some hos­pi­tals may fol­low the lead of St. Louis-based As­cen­sion. The Catholic-spon­sored sys­tem waives de­ductibles or un­paid bills for pa­tients with in­comes be­low 250% of the fed­eral poverty level at its 141 hos­pi­tals and other fa­cil­i­ties in 24 states.

Hos­pi­tals are strug­gling to col­lect that in­creased pa­tient share, said Brian San­der­son, man­ag­ing prin­ci­pal of Crowe Hor­wath’s health­care ser­vices group. A re­cent study by Crowe Rev­enue Cy­cle An­a­lyt­ics, based on data from 660 hos­pi­tals, found that over­all man­aged-care net rev­enue over the past year de­clined 2.5% for out­pa­tient care and 1.4% for in­pa­tient care. The cause was lower col­lec­tion rates for the “pa­tient re­spon­si­bil­ity” share of the bills.

“It’s im­per­a­tive that health­care or­ga­ni­za­tions es­tab­lish ef­fec­tive point-of-ser­vice col­lec­tion pro­grams by train­ing and ed­u­cat­ing front-line staff,” San­der­son said.

The prob­lem will only get tougher be­cause more em­ploy­ers and in­sur­ers are mov­ing to high-de­ductible plans, ac­cord­ing to a re­cent sur­vey by the Kaiser Fam­ily Foun­da­tion/Health Re­search & Ed­u­ca­tional Trust. In 2016, for the first time, more than half of all workers (51%) with sin­gle cov­er­age faced a de­ductible of at least $1,000, the study found. Hos­pi­tals are re­ly­ing on their col­lec­tions staff and rev­enue-cy­cle ven­dors to com­mu­ni­cate clearly with pa­tients be­fore ser­vices are de­liv­ered about what they will owe out-of-pocket. They’re also of­fer­ing them a range of pay­ment op­tions, in­clud­ing pre-pro­ce­dure pay­ment.

Gwin­nett Med­i­cal Cen­ter in Lawrenceville, Ga., has fi­nan­cial ad­vis­ers who call all non-emer­gency hospi­tal pa­tients slated for high-cost sur­gi­cal pro­ce­dures and ad­vanced imag­ing tests at least a day be­fore the sched­uled ser­vices. They dis­cuss which costs will be cov­ered by in­sur­ance and which will have to be paid out of pocket.

The ad­vis­ers use pre­dic­tive, rev­enue-cy­cle soft­ware from Re­layHealth. The soft­ware eval­u­ates credit scores to de­ter­mine how much par­tic­u­lar pa­tients are able and will­ing to pay. They also try to get pa­tients to pay de­ductibles via credit card over the phone. Or else they col­lect the bills at bed­side after the pro­ce­dure.

The key to sur­viv­ing this era of high-de­ductible plans is to eval­u­ate non-emer­gency pa­tients be­fore their treat­ment and com­mu­ni­cate clearly with them about their prospec­tive out-of-pocket costs.

As­cen­sion be­gan waiv­ing out-of-pocket costs for low­er­in­come pa­tients be­cause that’s con­sis­tent with its re­li­gious and not-for-profit mis­sion, said As­cen­sion CEO An­thony Ter­signi. Plus, putting these pa­tients through a col­lec­tions wringer typ­i­cally pro­duces lit­tle rev­enue. “We be­lieve that ev­ery­one de­serves qual­ity, per­son­al­ized health­care, and our new char­ity-care pol­icy re­lieves some of the cost pres­sures as­so­ci­ated with get­ting the care needed by in­di­vid­u­als and their fam­i­lies,” he said.

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