Don't Wait on Congress to Fix Healthcare

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.

Take Action

Congress’ absence of collaborative behavior on healthcare legislation, fewer insurance choices from fewer health plans and skyrocketing patient out-of-pocket expenses should set off alarms in your head to take swift action to ensure the financial health of your medical group.

If you are waiting for our elected officials in Washington, D.C., to save the day, you might be in for a rude awakening soon. The situation you’re facing will only get more severe. Regardless of what healthcare law eventually gets signed at 1600 Pennsylvania Avenue, HDHPs will become more prevalent as all market dynamics point to that being the case. By extension, the amount of financial responsibility sitting with the patient will most certainly increase. Today we’re seeing 20%, 30% or as much as 50% of a medical group’s revenue coming from patients.

In challenging times, the business—and, make no mistake, your medical group is a business—that succeeds is the one that tosses off the status quo and embraces new, better and more efficient ways to do things.

A “Modern” Approach

To begin with, look at the way you seek payment for services rendered. The Healthcare Financial Management Association (HFMA) suggests the rise of patient financial responsibility calls for a “modern billing approach.” I’ve visited countless business offices of all sorts of medical groups across America. “Modern” is not the word I’d use to describe the patient payment collection methods used by most. In this digital age and the ubiquity of mobile phones, nearly nine out of 10 healthcare bills go out from medical group offices in paper form. In contrast, 56% of all bills presented to Americans are paid online.

The methods used by retailers and utilities to secure payments from their customers are readily available for you to collect from yours. In addition, you should also look to bill electronically to collect more, reducing significantly the 90-120 day payment cycle created by paper statements and the cost to collect.

Time of Service

But let’s start the collection process before the patient enters the exam room. Time-of-service collection methods are cropping up in medical groups, and for good reason. You can get some portion of the patient’s expected financial obligation immediately to aid cash flow and better manage account receivables. And, if you have an electronic billing capability, the remaining balance can be quickly and easily moved to a digital bill.

Payment Plans

Whether a patient has or doesn’t have insurance, the cash outlay for your treatment may force a patient to choose between paying you or properly feeding their children. Yes, that’s stark but it’s the world some of your patients live in. So give them options as to how they can pay. By offering payment plans, you’re extending the empathy and care shown during treatment to the often and unnecessarily awkward collection process. Here too, systems abound to let you automatically integrate payment plans into an electronic billing process without having to manually call and process these payments each month.

Understandable Statements

Then there’s the statement itself. Human behavior is such that if one doesn’t understand a bill, it won’t get paid. Far too many medical groups send out statements that are utterly confusing, especially when attempts are made to align charges with an insurer’s Explanation of Benefits. Again, it does not have to be this way. You can provide patients with statements that provide that alignment and clarity.

Customer-Friendly Staff

And lastly, you need to instill in your front desk and back office staff the sense that they are as much a part of the patient experience as any of their colleagues dressed in scrub suits or lab coats. They are crucial to the collection process. A truly “customer-friendly” attitude is necessary, blended with clear, concise communications that serve to make patients aware of their financial obligations and willing to fulfill them.

It is foolish to depend on Congress to eliminate the financial trials and tribulations with which your medical group is contending. Still, I suggest you heed with words of a statesman from ancient Roman, Marcus Porcius Cato: “He who hesitates is lost.”