Patients as Payers? Adapting to the New Era of ‘Healthcare Consumerism’

February 14, 2017 by Antonio Arias, MBA, CHBME

Topics: Meaningful Use Stage 2, Practice Management, Medical Billing Company

Over the last two decades, health insurance costs of have grown in ways few could have predicted, with patients now paying for a full 25 percent of their medical costs out-of-pocket. 

High-deductible health plans purchased through the U.S. government’s Healthcare Marketplace (following the passage of the Affordable Care Act) are far from the only reason: Since 1999, insurance premiums have risen 213 percent for family coverage purchased through an employer.

Even following so many years of increases, many patients’ deductibles, copays, and coinsurance amounts are predicted to continue to getting higher in the years to come. And the growing amount of financial responsibility being placed on the shoulders of patients is beginning to turning the traditional relationship between patients and their providers on its head.

Gone are the days when patients could embrace a given course of treatment with full confidence that their health insurance – employer sponsored or individually purchased – will cover it. As a result, patients are increasingly becoming more discerning and cost-conscious about the care they pursue, leading some to refer to the present moment as a new era of “healthcare consumerism.”

Broadly, the concept of “healthcare consumerism” represents the idea of patients behaving more like shoppers than ever before. In order to be so discerning and cost-conscious about their care, patients are putting more proactive effort and research into their care options and associated costs. The increasing shift to a more consumer-driven healthcare space could have broad, wide-ranging consequences. According to PwC:

“The rise of consumerism is likely to precipitate a sea change in how business is conducted in every sector of the healthcare industry. The industry, which has been focused on its institutional stakeholders – insurers, employers, and hospitals – will shift to a new basis, in which health plans, care delivery, and even administrative services are reoriented to focus on individuals and families.”

It’s up to hospitals to and medical practice to tackle that ‘reorientation’ in the months and years to come, in part by reconsidering the way they look at patient financial responsibility. After all, with 25 percent of medical costs now coming out-of-pocket, patients are essentially payers too.

As such, re-evaluating your approach to reimbursements, collections, and costs (with the aim of becoming more patient-centered) may help you achieve stronger revenue results in the long run. As your healthcare organization and your trusted medical billing service navigate an increasingly consumer-first ecosystem, you can increase your odds of success by embracing the following efforts.

Get Smarter About Collections:

If patients are payers, then you should be just as diligent about getting patients to pay up as you are with insurers. Only 59 percent of physician practices report collecting from patients while they are in the office (and just 35 percent of hospitals collect at the point of service) yet 85 percent report collecting patient financial responsibility post-visit is “not a simple task.” Before you start launching any other consumer-driven initiatives, making sure your administrative team andmedical billing company are collecting every dollar owed to you by patients – ideally, at the time of the encounter itself.

Get Technologically Savvy:

In 2017, consumers start almost every major purchase the same way – online. And the same goes for their healthcare purchases! Enhancing the online options and ‘digital availability’ of your practice is key to success in a patient-first landscape. Consider adding telemedicine to your care arsenal, implementing digital appointment-booking options, and making online medical records and payment options as accessible as possible.

Get More Price Transparent:

Posting cost information online can make a big difference to patients, as well. Make the prices of any services you provide to non-insured patients readily available on your website (as well as inside your office). While you’re at it, consider expanding the type and amount of retail options you deliver: Many experts predict a more hybrid model of healthcare organization – the Doctor’s Office slash Urgent Care Clinic – to see success in the years to come. Perhaps your office should be ahead of the curve!


Are you interested in learning more revenue cycle management tips? Visit our blog! 

...and if you need help from a medical billing company...


Subscribe to Our Blog

Stay in-the-know on trends, best practices, and news affecting the medical billing industry!