Navigating High-Deductible Health Plans
Jason Flahive, CPA
We are in an era of high-deductible health plans. In today’s health care world governed by the Patient Protection and Affordable Care Act (ACA), the number of uninsured adults in the U.S. stayed steady in 2017 at about 13%, while the number of people with high-deductible plans has increased, according to U.S. News & World Report. The IRS defines a high-deductible plan as having an annual deductible of $1,350 or more for a single person and $2,700 or more for a family. Also, according to data pulled from the U.S. Centers for Disease Control and Prevention, the percentage of adults under the age of 65 who had high-deductible plans rose from 39.4% in 2016 to 43.2% in 2017.
What are the issues?
Low-deductible health plans tend to have extremely expensive monthly premiums. As a result, an increasing number of patients are coming into physicians’ offices with high-deductible plans. For routine care, this is unlikely to be a big problem — but for expensive procedures, many patients may be unaware of just how much of the procedure fee they will have to cover themselves.
This places a burden on physicians and their practices to alert the patient to the likelihood of a high bill. Physicians also need to put rules in place to assure that they do actually get paid for their services.
What’s the best approach?
Overall, the best solution is for your medical practice to create an appropriate financial policy. Pricing transparency should be a priority: Patients should be educated on their own insurance policies and different payment approaches should be available. Here are some pointers for handling high-deductible health plans:
Encourage Preventive Health Care
Most insurance policies completely cover annual checkups, screening and immunizations. Encourage patients to take advantage of preventive health care to minimize future health issues.
Educate Patients on their Insurance
The majority of patients probably do not know exactly what is in their health insurance policies, let alone the difference between co-pays, co-insurance, deductibles or other common terms. It might be a good idea to include a glossary of terms in your orientation paperwork.
Be Clear About Service Costs
As much as possible, be transparent about prices and be aware that patients with high-deductible coverage are likely to comparison shop. Discuss your payment policies with patients and staff. When it comes to high-priced procedures, make patients aware of how much will be their responsibility.
Collect Co-Pays or Co-Insurance at the Visit
Make it part of your policy, state it in patient communications and make sure your staff understands it as well. Many patients with high-deductible health plans will have established a health savings account (HSA). Encourage your staff to remind patients that they can use their HSA to pay for out-of-pocket costs, or even better, obtain permission to keep their HSA card on file to pay for balances due after insurance.
Offer Payment Options
Obviously, immediate payment is welcome, whether cash, check or credit card. While you may want to discount fees for immediate-paying customers, in many states it is illegal to offer these discounts — and many insurance contracts prohibit them. However, immediate payment is unlikely for high-cost procedures, so it also may make sense to offer the option of payment plans.
How can you make it easy?
High-deductible health plans are not likely to go away anytime soon. So, it is important for physicians and their staff to make it as easy as possible for patients to pay their bills and obtain high-quality health care at the same time.
A good fit: Making the right staffing decisions for your practice
Amanda Gutierrez, MBA
A medical practice’s success depends on far more than excellent physician services — though, of course, those are key. For your practice to maintain profitability and stay current with the latest value-based services and patient care trends, you need the support of a qualified and engaged staff. Rather than reacting to every new initiative by just quickly hiring another staff person, why not be proactive in your approach?
Several principles can help generate a more enlightened management of practice human resources. The first of these is to make thoughtful employment decisions. At times, management rushes to fill an open position and hires the first qualified person who applies. Later, a mismatch becomes apparent, productivity suffers, morale declines and the employee is terminated.
A better way is to establish detailed criteria for the position before beginning recruitment. Doing so requires scrutinizing potential candidates in order to find somebody who meets the requirements and fits into the practice culture.
Keep qualifications front and center
It has become a cliché that practice personnel, particularly clinicians, should work “at the top of their licenses.” This means that each licensed person should concentrate on the highest-level tasks that he or she is allowed to perform. If there are activities that both a physician and a nurse practitioner (NP) can provide, they should be handled by the NP. If there are duties within the license scope of a physician assistant (PA) and a registered nurse (RN), the RN should perform them. This often results in clinicians taking on greater patient care responsibilities — within the scope of their licenses.
In a cost-constrained world, it may make sense to employ more, rather than fewer, staff in different roles. The most effective practices often have greater staffing ratios for RNs, licensed practical nurses and advanced practice nurses. The cost of employing larger numbers of nurses recoups itself by allowing practices to see more patients and offer more attentive care.
It is an established norm in forward-looking practices to use advanced practitioners, such as PAs or NPs. The added cost of hiring more clinicians can be outweighed by the resulting improvements to practice efficiency and revenues. Furthermore, NPs also have a different approach with patients. They bring a focus on patient education and counseling, care coordination and wellness promotion that is often different from that of physicians.
Focus on patient care
Depending on individual state laws, nurse practitioners are able to provide a range of primary and specialty care services that include ordering and interpreting X-rays and lab work, diagnosing and treating acute and chronic illnesses, prescribing medications and educating patients on disease management and prevention. This usually can be completed independently or under physician supervision.
Ultimately, NPs and PAs help practices generate revenue by increasing patient volumes and allowing physicians to spend more time delivering higher-level direct, billable patient care. This new class of providers leverage their advanced medical training by focusing on more routine care and managing clinical tasks.
Provide accurate job descriptions and feedback
To develop high-performing staff, you must tell them what you want them to do and then follow up with feedback on when they are performing well or poorly. It is important to prepare accurate, comprehensive job descriptions, give them to all employees and update them whenever job content changes substantially. The description is the starting point for holding employees accountable for their work performance.
Get in the practice of routinely, and informally, commenting on employee performance. This is best done immediately after a relevant work event. Provide both positive and negative comments. Follow the rule, “Praise in public, criticize in private.” Critical feedback can easily be misconstrued, so make sure it is constructive. Additionally, look for legitimate reasons to compliment employees as well, preferably in front of co-workers. It will do wonders for everyone’s morale.
Consider tangible and intangible factors
In a medical practice, nothing is static. Making the right call on when to simplify, when to consolidate and when to expand requires ongoing planning and periodic adjustment. However, careful consideration of factors such as professional qualifications, practice culture, niche and patient type in your hiring decisions can ensure your practice will thrive.