Outlook for 2017: Rise of high-deductible plans has providers boosting collection efforts -AND- Doctors group warns against loss of coverage from ObamaCare repeal

Wed Jan 18 13:34:13 PST 2017

December 31, 2016

Outlook for 2017: Rise of high-deductible plans has providers boosting
collection efforts

<http://www.modernhealthcare.com/article/20161231/MAGAZINE/312319992?utm_sou
rce=modernhealthcare&utm_medium=email&utm_content=20161231-MAGAZINE-31231999
2&utm_campaign=financedaily> Modern Healthcare

By Dave Barkholz

Hospitals and health systems face the prospect of growing uncompensated care
costs following the looming repeal of the Affordable Care Act and its
Medicaid expansion. So providers will have to focus on improving collections
and helping patients cope with increasingly high out-of-pocket payments
under high-deductible health plans. One approach is requiring patients to
pay upfront for non-emergency procedures.

Some hospitals may follow the lead of St. Louis-based Ascension. The
Catholic-sponsored system waives deductibles or unpaid bills for patients
with incomes below 250% of the federal poverty level at its 141 hospitals
and other facilities in 24 states.

Hospitals are struggling to collect that increased patient share, said Brian
Sanderson, managing principal of Crowe Horwath's healthcare services group.
A recent study by Crowe Revenue Cycle Analytics, based on data from 660
hospitals, found that overall managed-care net revenue over the past year
declined 2.5% for outpatient care and 1.4% for inpatient care. The cause was
lower collection rates for the "patient responsibility" share of the bills.

"It's imperative that healthcare organizations establish effective
point-of-service collection programs by training and educating front-line
staff," Sanderson said.

The problem will only get tougher because more employers and insurers are
moving to high-deductible plans, according to a recent survey by the Kaiser
Family Foundation/Health Research & Educational Trust. In 2016, for the
first time, more than half of all workers (51%) with single coverage faced a
deductible of at least $1,000, the study found. Hospitals are relying on
their collections staff and revenue-cycle vendors to communicate clearly
with patients before services are delivered about what they will owe
out-of-pocket. They're also offering them a range of payment options,
including pre-procedure payment.

Gwinnett Medical Center in Lawrenceville, Ga., has financial advisers who
call all non-emergency hospital patients slated for high-cost surgical
procedures and advanced imaging tests at least a day before the scheduled
services. They discuss which costs will be covered by insurance and which
will have to be paid out of pocket.

The advisers use predictive, revenue-cycle software from RelayHealth. The
software evaluates credit scores to determine how much particular patients
are able and willing to pay. They also try to get patients to pay
deductibles via credit card over the phone. Or else they collect the bills
at bedside after the procedure.

The key to surviving this era of high-deductible plans is to evaluate
non-emergency patients before their treatment and communicate clearly with
them about their prospective out-of-pocket costs.

Ascension began waiving out-of-pocket costs for lower-income patients
because that's consistent with its religious and not-for-profit mission,
said Ascension CEO Anthony Tersigni. Plus, putting these patients through a
collections wringer typically produces little revenue. "We believe that
everyone deserves quality, personalized healthcare, and our new charity-care
policy relieves some of the cost pressures associated with getting the care
needed by individuals and their families," he said.

January 3, 2017

Doctors group warns against loss of coverage from ObamaCare repeal 

<http://thehill.com/policy/healthcare/312576-doctors-group-warns-against-los
s-of-coverage-from-obamacare-repeal> The Hill

By Peter Sullivan

The country's leading doctors group is urging Republicans to take steps to
ensure that people do not lose their health insurance once ObamaCare is
repealed.

The American Medical Association (AMA), wrote a letter to congressional
leaders on Tuesday calling for the gains in coverage from ObamaCare, which
has expanded insurance to 20 million people, to be preserved.  

"In considering opportunities to make coverage more affordable and
accessible to all Americans, it is essential that gains in the number of
Americans with health insurance coverage be maintained," AMA CEO Dr. James
Madara wrote leaders in both parties.  

"Consistent with this core principle, we believe that before any action is
taken through reconciliation or other means that would potentially alter
coverage, policymakers should lay out for the American people, in reasonable
detail, what will replace current policies," Madara continued. 

"Patients and other stakeholders should be able to clearly compare current
policy to new proposals so they can make informed decisions about whether it
represents a step forward in the ongoing process of health reform." 

The AMA's position is at odds with Republicans' current plan. The GOP is
moving forward this month with plans to repeal ObamaCare without a
replacement, but delay repeal going into effect for a few years to buy time
for drafting an alternative. 

The American Hospital Association, meanwhile, warned in a report last month
of an "unprecedented public health crisis" from people losing coverage under
ObamaCare repeal. 

The AMA added that ObamaCare is "imperfect" and said it would favor policies
if they increased coverage, choices and affordability.

Jeff Wells
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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