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by Antonio Arias, MBA, CHBME

What High-Deductible Health Plans do to Your Bottom Line


Opinions about the Affordable Care Act – and all of its repercussions – continue to vary widely among stakeholders in both the health care industry and the public at large. One of its most prominent (and provocative) consequences has been the rise of the high-deductible health plan.

These plans place more up-front financial responsibility on patients than traditional plans. That shift has a direct impact on medical practices, which is why so many providers limit the number of exchange-purchased plans they participate in.

Yet it is possible for practices to operate successfully amidst the new landscape, and it’s wise for them to try. The trend of increased patient responsibility isn’t going away any time soon; one in five Americans is already covered by a high deductible plan. To effectively adapt their practice management techniques, doctors should know what to expect with the new plans and how to proactively mitigate the effects.

They Change Patients’ Choices

Knowing that they’re on the hook for the bulk of the cost, patients with high deductible plans often delay recommended treatments or skip care altogether. Studies have shown that a patient’s health care spending goes down 14 percent, on average, when he or she shifts into a high deductible plan. In 2014, 30% of Americans whose deductibles represented 5% or more of their annual income chose not to visit a doctor when they had a medical problem.

The Fix – Communication & Honesty: Beyond preventive care, patients can have a hard time understanding the importance or value of a procedure or test. Ultimately, it is always the patient’s decision to opt for or against a treatment plan or course of care. But the doctors who will succeed best in the new health care landscape will be those that can be direct and straightforward, with themselves and with patients, about what care is truly important. Communicate the “why” behind your medical decisions and follow up with patients who skip critical visits.

They Involve HSAs

Many higher deductible plans are paired with health savings accounts – tax-free savings plans designed to encourage patients to save up front for potential health care expenses. Others involve employer-sponsored health reimbursement arrangements or HRAs. (Some refer to HSA- and HRA-inclusive plans as “consumer-focused health care plans.) The problem is that many physician practices skimp on insurance checks or neglect to consider that a savings plan is involved in the patient’s financial situation and simply bill as usual, causing problems down the road.

The Fix – Staff Education & Diligence: HSAs are one aspect of the new high deductible reality that efficient revenue cycle management routines can’t ignore. Train your staff on how to verify if savings or reimbursement plans are part of a patient’s coverage and insist that they be diligent about eligibility checks. If patients don’t understand how their consumer-focused plans work, they should be able to learn from the staff at your practice. 

They Make it Harder to Collect

It’s only logical that patients who incur hefty medical expenses under higher deductible plans will have sticker shock when their medical bills arrive in the mail. Along with the shock often comes a resistance to pay: hospitals and medical practices alike are seeing an increase in “bad debt” (i.e. unpaid bills) to the tune of $41 billion, 25 percent of which can be attributed to insured patients.

The Fix – Transparency & Flexibility: The key to avoiding sending your patients to collections is to be up front and clear about pricing from the get-go. Consider creating a rate sheet with your self-pay pricing details and posting it in your office, or sharing it with every patient when they check in or when they’re making decisions about their care. After the procedures are rendered, encourage patients to pay by being flexible about how and when they do: Offer payment plans right away if you notice patients postponing payment. 

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by Antonio Arias, MBA, CHBME

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