Increase in Patient Self Pay Increases Collection Risks

Posted on May 4, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There is a major trend that is happening in healthcare that is going to impact the economics of healthcare in a major way. This trend is the increase in Patient Self pay. There are a number of factors which are causing more patients to pay for their medical expense including lost jobs and employers dropping health insurance coverage. I’ve heard a number of people predicting the move to a patient focused payment model with high-deductible insurance plans. In fact, this New York Times article says “The share of employees enrolled in high-deductible plans surged to 13 percent in 2011 from 3 percent in 2006, according to Mercer Consulting.”

Personally I think this is a great thing for healthcare since I’ve long been a proponent that any healthcare reform needs to put the consumer (patient if you prefer), not the insurer or the government at the center of the healthcare financial system. However, this change also poses a risk for practices and hospitals since the risk inherent in collecting self-pay balances rises in parallel with this increase in patient self pay.

How then are EHR vendors and revenue cycle management companies dealing with this shift to patient self pay?

This certainly won’t be a comprehensive list of ways that revenue cycle management can help with patient collections, but it will show a few ways technology can help now and in the future.

EHR software can integrate a Patient Pay Estimator to provide patients a close approximation of their final bill which helps a practice collect payment before they leave. The software physicians use to estimate the patient total for an office visit are going to have to get better and more accurate. I don’t have the numbers in front of me now, but I’ve seen multiple studies that illustrate well how the key to good patient collections is to get the money while they’re present. Once the patient leaves your office your ability to collect from that patient drops dramatically.

I know I’ve been to a lot of doctors where I get to the front desk and they don’t know what to charge me. Far too often they just say, don’t worry about it, we’ll send you a bill in the mail. If they just had the right information available to them, they could collect the money on the spot and not have to worry about collecting it from me later. An EHR can really facilitate this process if it has a good patient liability estimator built into the EHR.

In the cash or check world, it was much harder to set up budget plans or recurring payment. Now there are more and more systems out there where you can store a person’s payment information and set up the recurring payment to happen automatically. This will likely be a key trend going forward.

I’ve even seen some of the larger EHR vendors who have programs that offer financial assistance. In fact, the really large EHR vendors have whole financing divisions that can assist patients who have financial issues related to their healthcare. I wonder how deeply these financing options can be integrated into EHR software, but I could see it as a big advantage to have it as an integrated part of the payment workflow. I’m always amazed at how quickly you can be approved for a credit card or financing a car. I expect this type of financing will be pushed down throughout the various layers of healthcare. Will it become a differentiating factor in a large EHR vendor versus a small EHR vendor?

Another interesting idea to stem the patient payment problem is to accept prepayments. Meaningful Use is bringing the patient portal and PHR software back to the forefront of many EHR implementations. If you have patients filling out the paperwork for their office visit, why not collect the co-pay at the same time? Pre-payment could become a really great way to avoid revenue cycle management issues on the back end.

I’d love to hear other people’s thoughts related to patient payment and revenue cycle management trends. What can be done to help avoid the patient self pay collections issues?