`Significant dollars at stake’ with surge in high-deductible plans
Members of the patient access staff need updated tools to collect
The number of patients with high-deductible plans — and therefore, the amount of uncollected revenue — is increasing sharply, according to patient access leaders.
Executive Summary
Patient access areas are increasing seeing patients with high-deductible health plans. Significant revenue is at stake if the unmet deductible is not collected.
- Departments are seeing more unpaid patient balances after insurance payment, which result in higher cost to collect.
- Price estimator software allows front-end staff to identify and request unmet deductibles.
- Staff can encourage patients with health savings accounts (HSAs) to pay within 30 days.
"Significant dollars are at stake if we do not collect the unmet deducible from these patients," says Lauren Delpino, manager of the patient service center at Crozer-Keystone Health System in Upland, PA.
The average deductible for a "bronze" plan on the Health Insurance Marketplace is $5,081 a year, according to a 2014 HealthPocket report on insurance offerings in 34 of the 36 states that rely on the federally run online marketplace.1
Kevin Coleman, head of research and data for HealthPocket, a Sunnyvale, CA-based technology company that compares and ranks available health plans, says, "My instincts tell me that the reaction to the deductibles will be affected by whether the person had been insured previously."
Individuals who couldn’t obtain insurance due to medical underwriting issues might be less concerned about deductible amounts than the previously insured who find themselves with a new high-deductible plan. "Given that current reports suggest that the Affordable Care Act is enrolling much more of the previously insured than the uninsured, that enrollee profile may translate into more frustration with deductibles, particularly for those without out-of-pocket subsidies," says Coleman.
Deductibles have doubled
Deductibles for employer-sponsored plans nearly doubled over the past seven years, to $1,135 in 2013, according to a 2014 Deloitte study.2 "It appears that this problem is only going to increase, as patients face a tax penalty for being uninsured and are forced to purchase plans with a low premium and a high deductible," Delpino says.
Crozer-Keystone’s patient access employees are seeing many more patients with high-deductible plans who are unable to pay the full unmet patient responsibility portion.
"The challenge we face is that many of our patients cannot afford to pay their entire out-of-pocket pay prior to services being rendered," Delpino explains.
Unless the services are elective, procedures are not cancelled due to lack of payment. However, the department is seeing more unpaid patient balances after insurance payment. "This results in a higher cost to collect," Delpino says.
Crozer-Keystone’s patient access areas recently implemented price estimator software (CarePricer, manufactured by Atlanta-based MedAssets). This software allows front-end staff to determine the amount of a patient’s unmet deductible and/or out-of-pocket cost.
"We will be using this tool to identify and request unmet deductibles during the pre-registration process," says Delpino.
Technology is needed
At Boston-based Massachusetts General Hospital, patient access staff members are building the infrastructure to be able to collect deductibles, reports Joseph Ianelli, associate director of admitting.
Currently, says Ianelli, "if a person registers with a certain payer and is scheduled for a procedure, we can certainly conduct an analysis and subsequently estimate the cost share," he says. "But plans have to be able to give us that information in an easy-to-access electronic way."
Currently, staff calculate unmet deductibles manually. They perform a benefits check, identify all the CPTs, and determine the contracted rate based on the patient’s coverage. "So it’s a three-step process," Ianelli explains. "It takes a lot of time, with potential for a big margin of error."
Unmet deductibles probably represent a significant amount of uncollected revenue, Ianelli says. "We are looking to be able to capture that revenue, but are working on the systems and technology to implement it," he says. "The intention is for us to move in that direction as an end goal, and I don’t see that too far away."
Paradigm shift underway
Collecting deductibles "needs to be a parallel strategy with our e-commerce strategy," says Ianelli.
"When we get an EDI [electronic data interchange] in our system, part of that information needs to be what the remaining deductible is," he explains. "We shouldn’t have to go to another system or through a manual process to find that information."
In June 2014, the department will go live with its new Epic system. "As technology changes and we can start to understand where patients are with their deductible, that’s going to make life a lot a lot easier," says Ianelli. "We are going through a real paradigm shift."
High deductibles underscore the difficulty of balancing a patient-centered culture with the need to collect revenue. "A lot of patients don’t fully realize what their cost share will be when they purchase insurance," says Ianelli. "More and more, patient access will need to work with people to help them understand their situation."
Ianelli expects to be collecting deductibles routinely once six months of data is collected in the Epic system. "A lot of great things are coming down the pike that we can leverage. It’s just a waiting game," he says.
HSA changes financial discussion
Members of the patient access staff at Intermountain Healthcare in Salt Lake City, UT, are seeing a significant increase in high deductible plans, says Teri Mark, director of patient access.
"We have a process in place to estimate our patient’s liability, using the scheduled service in conjunction with the patient’s insurance benefits," Mark says. "This process is completed on all of our scheduled services."
The department recently started asking patients if they are going to use a health savings account (HSA) to pay their responsibility. HSAs were created in 2003 so that individuals covered by high-deductible health plans could receive tax-preferred treatment of money saved for medical expenses. "We then let them know it’s important to pay their balance within 30 days after their insurance pays," says Mark. The account then is flagged, so that the hospital’s self-pay unit is aware the patient has the HSA.
"The process we developed notifies our billing department that the patient has this fund available to them," says Mark. "It changes the financial discussion they have with the patient." (For more information, see related stories on high-deductible plans and bad debt, this page, and how to help patients obtain coverage, p. 52.)
- Coleman K. Deductibles, out-of-pocket costs, and the Affordable Care Act. Dec. 12, 2013. Accessed at http://bit.ly/QyWigB.
- The Kaiser Family Foundation and Health Research & Educational Trust. Employer Health Benefits 2013 Annual Survey. Washington, DC. Aug. 20, 2013. Accessed at http://bit.ly/1dj0J5H.
- Lauren Delpino, Patient Service Center, Crozer-Keystone Health System, Upland, PA. Phone: (610) 619-7382. Email: [email protected]
- Joseph Ianelli, Associate Director of Admitting, Massachusetts General Hospital, Boston. Phone: (617) 724-2099. Email: [email protected].
- Teri Mark, Patient Access Director, Intermountain Healthcare, Salt Lake City, UT. Phone: (801) 442-1334. Fax: (801) 442-0410. Email: [email protected].
