Waiting on Congress to fix healthcare could be hazardous to physicians

With startling serendipity, a month to the day after the ACHA passed out of the House, Anthem joined Aetna, Cigna, and Humana in quitting the ACA health plan marketplaces in Ohio. The very next day, Premera Blue opted to end participation in two counties in Washington state, adding another region of the country poised to be without coverage through the ACA. Blue Cross and Blue Shield of Kansas City is also planning exits impacting some 25 counties in western Missouri.

And now that we’ve seen what’s in the Republican’s Senate healthcare bill, it’s unlikely those health insurers will reverse their business-driven decisions. In the process, the problems for individuals and families with coverage through an ACA marketplace will get worse in all probability. What’s more, those who have employer-provided health plans are contending with their own set of healthcare-related troubles.

According to the Kaiser Family Foundation, 83% of workers who are getting some form of coverage through their employers have plans with deductibles. That dollar amount has gone up nearly 50% in the last five years. Data from the Centers for Disease Control and Prevention show one-quarter of those covered have high-deductible health plans (HDHPs), and most anticipate this form of policy will soon become the standard. Kalorama Information, a medical market research firm, noted recently that Americans will be shelling out a stunning $608 billion from their own pockets by 2019.

Hospitals’ new reality: Patients as payers

Healthcare organizations have been slow to react to the fact that an increasing percentage of their revenue is coming from patients. It’s been occurring over the last ten years.

In 2006, just 5 percent of employer health plans had members enrolled in high-deductible health plans (HDHP). Last year, nearly one out of three covered employees was in an HDHP, according to Kaiser Permanente. Along with that enrollment growth is the rise of deductibles, which, notes Kaiser Permanente, is outpacing earnings and savings rates by a factor of six.

Four years ago, the management consultancy McKinsey & Company took a look at revenue cycle operations in hospitals and made the following observations:

Paper-Based Billing is Ancient History in Healthcare

"Today's realities are that managing a practice is more complicated than ever…"

That's how an assessment begins on what it takes to successfully run a medical group in 2017 by Triple Tree, a merchant bank focused on healthcare. In a recent report, the bank also looked at the forces driving mergers of specialty groups. Chief among them is the realization by administrators and their physicians that the healthcare business isn't what they hoped it would be.

The mounting pressures are affecting medical groups' top and bottom lines. The bank's report suggests that while opting to be part of a larger group might sound attractive to an independent practice, the non-clinical demands are the same, just more complex.

And that is why all medical group administrators must realize the way to manage their group should sync with the business environments in which they operate. According to TripleTree, a critical success factor is administrative and operational efficiency, due to the significant burden created by government regulation. It also noted that groups need to support and keep pace with changing consumer preference.

The key to understanding consumer-centric healthcare

The changes that have occurred thus far are likely to pick up speed, in part because of who will be working for the White House. Trump’s choice for Secretary of Health & Human Services, Tom Price, MD, is a supporter of consumer-centric health plans. Further, Vice President Mike Pence brings with him experience as governor of Indiana where he oversaw the implementation of consumer-centric healthcare policies. Adding to that, Pence’s health plan architect was Seema Verma, who’s been tapped to head the Centers for Medicare & Medicaid Services (CMS).

The essentials of consumer-centric healthcare include empowering the patient to make choices, be involved in the decision-making process for her/his care and, it should be emphasized, understand what the costs are upfront by way of transparent pricing and candid conversation.

The driver behind this consumerism is the emergence of high-deductible health plans (HDHP). Back in the day, a patient’s financial responsibility for their healthcare was often a single digit percentage of the cost, if that. Now, with HDHPs, a patient is confronted with 30% to 50% of the financial responsibility for their care.

NextGen-Powered Healthcare Provider Chooses PatientPay To Improve Cash Flow, Decrease Time to Pay

Jacksonville Children’s & Multispecialty Clinic Makes Move As it Grows, Seeks Greater Efficiencies

Durham, NC (February 21, 2017) -- PatientPay℠, the leader in paperless patient billing solutions for the healthcare industry, today announced Jacksonville Children’s & Multispeciality Clinic has paired the PatientPay Paperless℠ solution with its NextGen practice management software to collect more patient payments, faster and at less cost.

“After an evaluation of the clinic’s billing process, it became clear we managed a high percentage of self-pay balances, coupled with high statement and collection costs,” said Cheryl Myers, CMPE, the Jacksonville, North Carolina-based clinic’s Director of Revenue Cycle Management. “It was necessary to take new steps to improve communications with our patients and, as a result, collect payments from them in a more timely manner, with less effort and expense.”

The PatientPay Paperless solution integrates with most popular practice management software products to increase the speed, reduce the cost to produce and distribute statements and secure payments from patients electronically. It also affords automatic reconciliation of patient payments to a provider’s accounting system, just like it reconciles insurance payments today, so there is no change to existing workflows.