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The Self-Pay Paradox

Screen Shot 2015-11-10 at 8.31.21 PMOne of the most important trends in healthcare today is the inexorable shift towards high-deductible health plans. Over the past few months, my colleagues and I have analyzed tens of millions of visits to practices using athenahealth’s practice management and EHR services to understand the impact that this shift is having.  We believe there are some reasons for providers and practice leaders to worry–the average patient obligation has increased by 20% over the past 4 years, and the number of patients carrying large balances is increasing as well.  We have also seen that practices’ ability to collect these obligations is highly variable.

Across our network, patient payments provide nearly one-fifth of physician income, with the median athenahealth provider failing to collect 30% of what patients owe.  And the situation is getting worse.  As the graphic below shows, patient deductible obligations are up 22% in the past two years–while commercial payments have grown only 4%.

athena networks

My colleagues and I have studied these trends, and we’ve identified a few things that top-performing practices do to ensure that they are able to collect the dollars that they are owed. In fact, at every step of the collections process–from scheduling to follow-up months after a visit–top-performing practices take a different approach than others.  Please join us on November 11th to learn what these organizations are doing to improve patient collections, and how your practice can get to similar results.

Jessica Sweeney-Platt is a lead with athenaResearch

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4 replies »

  1. Fascinating use of EHR data. I’m interested to know what impact the Affordable Care Act and narrow networks are having on bad debt and the self-pay numbers. Are people who are having trouble with their networks being pushed into the self-pay category? What is happening to people who think something is covered and find out it isn’t.? This is going to be an important inside baseball story for 2016.

  2. “I am curious regarding cancer in particular if the chemo and radiation treatments have progressed to justify the increased costs ?”

    Only if someone else is paying Don.

    Good news from Medicare in that it will also pay for palliative care, so there are more choices available to patients.

  3. I find it interesting to look at potential short term outcomes to project how this may play out over the long run
    So many times we hear of people being cancer free only to have the same disease reappear a few years thereafter
    I am curious regarding cancer in particular if the chemo and radiation treatments have progressed to justify the increased costs ?
    Don Levit

  4. “Please join us on November 11th to learn what these organizations are doing to improve patient collections, and how your practice can get to similar results.”

    Either debtor’s prison or blood from a stone?

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