These articles from a recent addition of Medical Economics make it clear that the physician practice of 2015 will continue to change, even from that of 2014. As patients continue to move to high deductible plans physicians will face more fee pressure than has existed during their careers. Gaining full understanding of the implications of these changes will be one of the keys to who are winners and who are losers as the landscape continues to change. The financial challenges outlined also need to be met by good management techniques. Just "practicing good medicine" will no longer win the day. In today's environment accepting every insurance coverage in your area, and simply signing every standard insurance company form, will not increase profitability and may, in fact, put the practice in jeopardy of financial stability. Understanding the cost to provide services, including insurance rejections and preapproval time and effort should lead to optimizing the profitability of the practice as well as reducing emotional stress.
Rising out-of-pocket costs are changing the way patients use medical services, so physicians must evolve their billing and communication practices to keep up
Accelerated by the Affordable Care Act, high-deductible health plans have emerged as a major trend in healthcare. Placing more financial responsibility on patients for medical services has a direct impact on physician practices. Operating successfully within this framework requires greater awareness of differences among insurance policies and discussions of treatment options that are sensitive to patients’ out-of-pocket expenses.
"Doctors need to understand the landscape has changed. A doctor’s primary concern used to be whether a patient had insurance. Now, it’s the type of insurance,” says Devon M. Herrick, PhD, a senior fellow at the National Center for Policy Analysis in Dallas, a nonprofit organization that promotes private alternatives to government regulation.
“Patients are more cost-conscious now. That means patients will question their physicians about costs for procedures,” he adds. “Patients will also ask uncomfortable questions like: ‘Doctor, do I really need that MRI?’ ‘What’s that going to cost?’ ‘Can that test wait?’"
The best way to approach billing issues in a physician office is to be proactive with patients by clearly detailing costs and options. “Otherwise, a disgruntled patient who believes they were treated unfairly—and gouged by a rich physician—may be less likely to pay their bill,” Herrick says.
How costs affect patient choices
Studies have shown that consumers exercise greater caution in spending when health plans require them to share more of the costs, according to The Rand Corporation, a research organization that has conducted the largest independent study of high-deductible health plans.
High-deductible coverage “really does reduce people’s healthcare costs and use. About two-thirds of the reduction is in number of episodes of care, and about one-third of the reduction is in the cost per episode,” says Amelia M. Haviland, PhD, an adjunct senior statistician with Rand and an associate professor of statistics and health policy at Carnegie Mellon University in Pittsburgh.
“There may be some good news in terms of bending the cost curve, but there are also some concerns—that it might have a detrimental impact on patients’ health over time,” Haviland adds, citing an already apparent decline in cancer screenings, child immunizations and recommended tests for diabetics. “The concern on a physician’s side is that patients will be less compliant, or in particular, that they will not come for appointments; they’ll reduce their interactions with their doctors.”
For many patients, the decision to avoid appointments stems from not knowing that their deductible doesn’t apply to annual wellness visits, certain cancer screenings and other preventive services. Physician offices may consider countering this misunderstanding by sending explanatory postcards, e-mails or letters, Haviland says.
High-deductible health plans “certainly are continuing to gain traction in the employer-sponsored insurance world and are the dominant plan type on the individual and small group markets on the exchanges. On the employer-sponsored market, they’ve overtaken HMOs,” she adds. “It’s more and more likely that doctors will have patients who are in these plans.”