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Preparing for patient financial responsibility and consumer expectations in 2017

By ZirMed | December 09, 2016
Patient Financial Responsibility

No matter what changes occur around the Affordable Care Act (ACA), there’s one certainty: patient financial responsibility will continue to make up a greater and greater portion of healthcare organizations’ revenue, a fact that is as true for independent practices as it is for hospitals and health systems.

Consider: 

  • If the ACA is repealed and replaced, and if some patients lose their coverage or do not enroll in a plan, those patients will become (or revert to being) self-pay.
    • For patients who gain coverage under the model that replaces the ACA, there may still be a gap in coverage—during which they will be self-pay.
  • If the ACA is not repealed and replaced, patients who are insured under a plan purchased on the state or federal exchange will still likely be covered under a high-deductible health plan (HDHP).

And as an aside, patients who participate in their employer’s plan are more and more likely to be covered under an HDHP—in fact, that may be the only option their employer offers.

So what does this mean for provider organizations? A few things. First, it means that investing in technology and training that helps improve patient collections and the patient-payment experience is certain to pay off. It also means that large healthcare organizations will need better insight into patients’ true propensity to pay—insight far beyond what a traditional credit score provides. And finally, it means that consumer-friendly patient processes and technologies will fully move from “nice to have” to “absolutely necessary.”

The trend line—high deductibles, growing out-of-pocket costs

A recent article from Becker’s Hospital Review sums it up nicely: patients are paying more out of pocket, and that’s creating new challenges for hospitals and health systems. The article references a study from Crowe Horwath, and notes that in the third quarter of 2016:

“…insured patient financial responsibility has grown from 23.3 percent to 26.9 percent for outpatients and 10.2 percent to 12.1 percent for inpatients.”

That’s pretty striking. And it’s exactly why hospitals and health systems need proven, consumer-friendly approaches to communicating with patients around the topic of financial responsibility and payment—in addition to technology that streamlines collections and provides transparency and convenience for patients.