With insurance coverage shrinking and healthcare costs on the rise, patients are being asked to shoulder more of the burden.
How has patient financial responsibility changed over the past several years and what can ASCs do to help their patients cover expenses? Here are seven statistics to know and three tips to follow.
7 Stats
1. Patient responsibility increased 11% in 2017. An analysis by TransUnion Healthcare revealed that patients experienced an 11% increase in average out-of-pocket costs in 2017. The figure rose from $1,630 in the fourth quarter of 2016 to $1,813 in the fourth quarter of 2017.
2. Premiums and deductibles on the rise. According to a Kaiser Family Foundation survey, annual premiums for employer-sponsored family health coverage reached $18,764 in 2017. That's up 3% from 2016. Workers pay, on average, more than $5,700 toward the cost of their coverage. The average deductible for workers rose from $303 to $1,505 between 2006 and 2017.
3. Orthopedics, plastics and urology with the highest out-of-pocket costs. TransUnion Healthcare also analyzed costs by specialty. The top three specialties with the highest out-of-pocket cost estimates for patients were 1) orthopedics ($1,663), 2) plastic surgery ($1,566) and 3) urology ($1,415). Across all specialties, the average patient out-of-pocket cost estimate was $1,000 in the fourth quarter of 2017.
4. Costs for surgical visits rising. From 2012-2016, out-of-pocket costs for commercially insured surgical visits experienced a 13% inflation-adjusted increase, according to an athenahealth analysis. This topped specialties such as primary care (9%) and pediatrics (8%).
5. Outpatient surgery prices also experiencing a significant increase. From 2012 to 2016, the price for outpatient surgery increased 19%, according to a Health Care Cost Institute report. The average price in 2016: $4,722.
6. Americans avoiding or delaying care. Roughly one in four Americans forgo medical care because of costs, according to a Bankrate survey.
7. Majority of Americans fear a high medical bill. According to an Amino survey, 53% of Americans believe that receiving a medical bill they cannot afford is the equivalent of being diagnosed with a serious illness (10% view such a bill as actually being worse than the diagnosis). That's not surprising when you consider that 55% of Americans reported receiving a medical bill they could not cover.
3 Tips to Follow
1. Provide patients with advanced notice on responsibility. Whenever feasible, provide patients with cost estimates prior to surgery — and do so as far in advance as possible. This will allow them to determine the best means to cover expenses. Most patients will also appreciate the gesture.
2. Train staff on patient collections. In the past, patients were less likely to have questions or concerns about their payment responsibility because the figures were low. With patients’ growing awareness of their increasing responsibility, they are more likely to have questions about their procedure costs, insurance coverage and an explanation of why they owe your ASC fees.
If staff are unable to answer these questions, patients may become frustrated and upset. After all, not only are they mentally preparing for surgery, they are also trying to better understand the complex insurance system and determine how they will pay for their care.
Consider training staff on insurance, specifically the key areas patients are most likely to ask about (e.g., deductibles, co-pays, why rates have increased), and how to appropriately discuss financial responsibilities. Patient-centered care is not limited to clinical areas.
3. Offer payment options. The more options you can offer to patients for how they can cover their expenses, the more likely it is that you will collect what is owed to your ASC in full. Options include accepting credit cards, payment plans and providing access to a flexible financial solution where patients can secure a loan to cover their surgical care costs. Innovative, ASC-specific lenders are now funding providers promptly after surgical procedures, managing all the collections activities and extending credit to a wider patient population. This will ultimately accelerate ASC revenue cycles and build case volume.
Randy Bishop (rbishop@surgicalfunds.com) is a partner with Surgical Funds, which facilitates patient financing solutions to supplement out-of- pocket expenses for ASC procedures.