PITTSBURGH – The emerging popularity of low-premium, high-deductible health insurance plans that hold patients responsible for a greater share of their medical care costs is exacting a financial and administrative toll on small physician practices and ambulatory surgical centers.
The CEO of a Pittsburgh company that handles billing for local independent physicians says one of her client practices has seen its outstanding accounts receivable double in the last four years, a trend directly tied to patients who can't pay their deductible at the time they receive care.
"Many of my clients are just resigned to it, that it's just another layer of management that is not welcome," said Donna Kell of the Kell Group billing services that works with local physician practices. "But it's slowing their ability for paying themselves. Their take-home pay is going down."
High-deductible plans are proliferating as employer-based plans look to lower or contain their annual health-care costs.
The benefits consulting firm Mercer recently said its annual employer survey showed that nearly half of larger employers now offer a high-deductible plan. Meanwhile, enrollment in those plans has jumped from 18 percent to 23 percent in the past year, with individual deductibles in some plans averaging $2,500.
While consumers are moving to the high-deductible plans, "very rarely do patients understand deductibles, and co-pays and co-insurance," said Ashley Santoro, practice manager for Cardiovascular Disease Specialists of Pittsburgh, a three-physician group. "If we bill an insurer, we would be reimbursed in seven to 10 days. If a patient gets a bill for $600, you're lucky if you can get paid $25 a month."
Susan Koerner, practice manager at the Hand and UpperEx Center, said some patients say they didn't realize they had a deductible, and others say they simply can't pay the entire bill. Now the physician practice is considering adding a staff member to ensure patients know ahead of time what they will owe.
Santoro said they are wrestling with the same issue at her practice but noted that discussing the bill ahead "is like a Catch-22. We don't want to make it about money." And they don't want people to forego a procedure because of cost.
They've already had patients with conditions such as congestive heart failure or uncontrolled diabetes either cancel appointments or ask that their quarterly check-ups be reduced to twice yearly, she said.
Terry Bohlke, president of the Virginia-based Ambulatory Surgery Center Association, said high-deductible plans are "definitely a two-sided issue" for them.
As a less expensive alternative to hospitals, ambulatory surgical centers likely will see more patients as consumers with high-deductible plans become more cost-conscious, he said.
On the other hand, "collecting from individuals is that much more complex and risky than collecting from insurance companies," he said. "The facilities are at additional risk for bad debt, but I think that will be offset by the additional cases they are able to do."
Bohlke, the office managers and Kell all said providers try to work with patients struggling to pay for their care, accepting credit card payments or setting up a payment plan.
But Kell pointed out that there are legal aspects to consider in collecting from individual patients on top of the added administrative burden and cash flow issues. Under federal law, as just one example, there are only certain times of the day a creditor is allowed to call about an outstanding bill.
"Collecting from the patients requires knowledge and an attention to detail," she said. "It's a totally different skill set."
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