ASC success in the age of consumer responsibility: 3 thoughts on high deductible patients

Carrie Pallardy - Print  |

From January 2013 to January 2014 the number of people enrolled in health savings accounts/high deductible health plans increased from 15.5 million to 17.4 million, according to an American Health Insurance Plans survey. HSA/HDHP enrollment has grown at an annual rate of 15 percent since 2011.

As healthcare stakeholders continue seek ways to curb rising costs, the trend of high deductible plans will only gain steam. Many of the plans offered through the ACA exchanges qualify as high deductible and employers are increasingly shifting employees to plans with higher deductibles and co-pays. These plans shift financial responsibility away from payers to the patient, but this changes how providers are reimbursed for their services.

This trend is changing ASCs' patient population. Patients are no longer passive recipients of care, but active consumers that are rapidly becoming a payer group. Vickie Begy, vice president of managed care contracting with Surgical Management Professionals, shares three key points on serving high deductible patients and maintaining financial success in ASCs.

1. What more high deductible plans mean for ASCs. A surge of high deductible patients could drastically slow a center's revenue cycle. "Failure to have an effective process in place for collecting upfront puts the ASC at risk to forfeit a portion of the negotiated allowable rate and reduce the profitability forecast during the budgeting period," says Ms. Begy. Days in accounts receivable have the potential to rise, as ASC collections offices chase high deductible accounts.

"The exchange plans also are a consideration.  If the exchange premium is in delinquency status, the ASC may risk denial of claims due to retroactive termination of the patient's policy," says Ms. Begy.

2. What ASC leaders can do to limit financial impact. Upfront collections are becoming a necessity. Patients want to know their financial obligation and collecting a set amount – if not the entire amount – upfront will minimize the possibility of non-payment after the date of service. "Establish a solid upfront policy and procedure to financially prep the patient prior to surgery.  This includes thorough verification of benefits, medical policy review for the procedure to be performed and layering the negotiated rate with the insurance company," she says. Maintain open channels of communication with patients. The less of a surprise the bill is, the more likely an ASC will be paid in full.

3. How ASCs can improve the experience for high deductible plan patients. While ASC leaders must establish strong processes in place to ensure high deductible patients meet their responsibility, it is important to consider how this affects the patient experience. "A patient is referred for surgery due to a medical issue and this is a stressful situation," she says. "Lessen the stress by being transparent, mindful of the physical and emotional challenges the patient may be facing. Providing upfront expectations and options based on your ASCs established policy will be better received upfront versus on the backend."

Ms. Begy recommends evaluating staff members' ability to estimate cost and ask for payment and involving interactive role-play in staff training. There may be resistance from patients and staff members alike, but setting and maintaining expectations will lead to long-term success. "This [trend] is not going away and will remain the same or increase, so it is best practice to establish a good working process now," says Ms. Begy.

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