Practice Strategies

Are You Ready For The New Healthcare Consumer?

They’re coming, and they have questions (and demands). They are the newly minted crop of healthcare consumers.

Thanks to the rising popularity of Medical Savings Accounts and Health Savings Accounts, and a recent shift to “consumer driven health plans,” these consumers may very well hit your office with new expectations of the doctor-patient relationship.

In the past, many of them had little concern for the cost of their healthcare. They paid a $10 or $20 copayment and received services. Now these patients are more likely reaching into their own pockets or their HSA plans to pay.

Business (Not) As Usual

The spread of consumer driven health plans could have a profound impact on how you and your staff interact with patients. For example:

• You may very well need to “defend” your fees to a newly cost-conscious patient. In the past, the physician-patient relationship was transactionally buffered by the insurance company. Now, you may need to be prepared to provide tangible quality and service justifications for your fees.
• You may need to retrain front-line office staff. All that was really important before was getting a copy of the patient’s insurance card. Now, they’ll need to investigate further: Is this an HSA? Has the patient met the deductible? What payments need to be collected?
• You and your staff will need to learn the fine art of point-of-service collection (see page two), professionally and sensitively soliciting payment directly from patients. This is especially critical in light of the substantial deductibles that many Health Savings Accounts carry (family deductibles of $4,500 are not uncommon) and the fact that accounts may not be funded early in the year.

The Challenges

Sicker patients. If patients have to dip into their own pockets or their HSAs, they may delay visits or opt out of lab work or treatment. Physicians will need to pay attention to situations in which the patient is declining care for cost reasons and have strategies in place to address this kind of noncompliance.

Shopping patients. When patients are paying for services out of their own resources, they may consider two or three physicians before deciding which one to use, asking a lot of questions about cost and quality.

Negotiating patients. Because the money is now coming out of their pockets, patients may very well ask for discounts, try to negotiate a lower price or bargain for less-expensive options.

Some Strategies

Market your practice . The best defense may very well be a good offense. Do more marketing and community outreach to let patients know why yours is the preferred practice. Ask yourself what steps you can take to gain the edge over other practices in your area (adding services or expanding office hours, for example). Attract new patients with postcards mailed to targeted ZIP codes, or sponsor talks at senior centers, health fairs and schools.

Have the answers. Be ready for patient queries. Collect data on less-expensive alternatives, including outcomes and rates of complications.

Train your staff. Much more due diligence will be required of front office staff. As benefits and plan options increase, office staff and patients will need to understand the terms and conditions of each, including eligibility, covered and noncovered services, deductible thresholds, how to determine if the patient's deductible has been met, and how to calculate the patient portion of charges. Note also that more and more plans are providing members with debit cards linked to their account. Make sure your the receptionist/billing office understand how to utilize this payment option.

Provide the service. Finally, walk the talk. When patients have more choices, issues such as appointment availability and timeliness, staff courtesy and proper billing become much more important.

A Problem Of Payment

At the heart of an HSA is a high-deductible insurance plan — most commonly a PPO. Many of these plans eliminate copays until the deductible has been met, and others eliminate them entirely. Further, to spare patients from making incorrect payments, many traditional PPOs forbid doctors from collecting deductible amounts at checkout, requiring them to simply submit the bill for adjudication. Having to bill the insurer and then the patient can certainly drag out payment.

So, i n addition to verifying eligibility and benefits coverage, you’ll need to pin down the deductible and how much has been met. Then find out the collection rules. Some preventive services may not count toward the deductible, for example, and you can bill the insurer for them right away.

For more information about our services to the healthcare industry, Contact:
Maxine Lawyer, Director of Healthcare Services at 972.448.6905.

The articles in this newsletter are general in nature and are not a substitute for accounting, legal, or other professional services. We assume no liability for the reader's reliance on this information. Before implementing any of the ideas contained in this publication, consult a professional advisor to determine whether they apply to your unique circumstances.
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